心理干预对慢性下肢动脉硬化闭塞症介入治疗患者心理困扰和抗凝药物服用依从性的影响

Effect of psychological intervention on psychological distress and compliance of anticoagulant medication in patients with chronic lower extremity arteriosclerosis obliterans treated by interventional therapy

目的:分析心理干预对慢性下肢动脉硬化闭塞症(ASO)介入治疗患者心理困扰及抗凝药物服用依从性的影响。方法:选择2013年7月-2018年4月我院收治的88例慢性ASO患者作为研究对象,按随机数字表法分为对照组与观察组各44例,两组均接受介入+抗凝治疗,观察组加用心理干预,比较两组入院后、出院前抑郁自评量表(SDS)、焦虑自评量表(SAS)、症状自评量表(SCL-90)评分的变化,评定出院不同时间患者Morisky服药依从性量表评分的变化,统计两组患肢无复流、急性动脉血栓形成、穿刺部位出血等并发症发生率。结果:出院前,两组SDS、SAS评分均降低,观察组评分低于对照组,比较差异有统计学意义(t=3.944,5.894;P<0.05);出院前,两组SCL-90躯体化,强迫,人际关系,抑郁,焦虑,敌对,恐怖,偏执,精神病性维度评分均降低,观察组各维度评分均低于对照组(t=3.354,6.532,6.973,6.135,5.958,9.711,8.316,10.618,11.530;P<0.05);出院不同时间两组服药依从性评分组内及组间比较差异均有统计学意义(F=132.000,48.811,142.845;P<0.05),观察组出院后1周、出院后1个月、出院后3个月服药依从性评分均低于对照组(t=9.832,13.848,12.423;P<0.05);观察组治疗总并发症发生率低于对照组(χ~2=5.143,P<0.05)。结论:心理干预可明显纠正慢性下肢ASO介入治疗患者心理负面情绪,提高患者抗凝药物服用依从性,减少治疗相关并发症发生率。

Objective:To analyze the effect of psychological intervention on psychological distress and compliance of anticoagulant medication in patients with chronic lower extremity arteriosclerosis obliterans(ASO)treated by interventional therapy.Methods:A total of 88 patients with chronic ASO treated in our hospital from July 2013 to April2018were selected as the subjects,and they were divided into the control group and the observation group with 44 cases in each group by the random number table method.The two groups were given intervention and anticoagulant therapy,and the observation group were additionally given psychological intervention.Changes in scores of Self-rating Depression Scale(SDS),Self-rating Anxiety Scale(SAS)and symptom checklist 90(SCL-90)after admission and before discharge were compared between the two groups.Changes in scores of Morisky Compliance Scale were evaluated at different time after discharge.The incidence rates of complications such as no reflow,acute arterial thrombosis and puncture site bleeding in the two groups were statistically analyzed.Results:After discharge,scores of SDS and SAS were decreased in the two groups,and the scores in the observation group were lower than those in the control group(t=3.944,5.894;P<0.05).After discharge,scores of somatization,compulsion,interpersonal relationship,depression,anxiety,hostility,phobia,paranoia and psychosis in SCL-90 were decreased,and scores of different dimensions of observation group were lower than those of the control group(t=3.354,6.532,6.973,6.135,5.958,9.711,8.316,10.618,11.530;P<0.05).There were significant differences of medication compliance scores within and between groups at different time after discharge(F=132.000,48.811,142.845;P<0.05).Medication compliance scores of the observation group at 1week,1month and 3months after discharge were lower than those of the control group(t=9.832,13.848,12.423;P<0.05).The total incidence of complications in the observation group was lower than that in the control group(χ~2=5.143,P<0.05).Conclusion:Psychological intervention can significantly correct the negative emotions,improve the compliance of anticoagulant medication,and reduce the incidence of treatment related complications in patients with chronic lower extremity ASO.