认知行为干预对脑卒中吞咽障碍患者负性情绪及日常生活能力的影响

Effects of intervention of cognitive behavior on negative emotions and activities of daily living in stroke patients with dysphagia

目的：评价认知行为干预对脑卒中吞咽障碍患者负性情绪及日常生活能力的影响。方法选择140例脑卒中吞咽障碍患者，按照随机数字表法分为试验组和对照组各70例。2组均给予内科常规护理干预，试验组在对照组的基础上实施认知行为干预。2组干预前和干预后2个月，采用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评估患者心理状态，用改良Barthel指数量表（MBI）评估患者日常生活能力。结果试验组完成干预69例，对照组68例，干预后2个月，试验组患者焦虑评分、抑郁评分、日常生活能力评分分别为（6.18±1.95）、（7.67±2.35）、（94.48±8.30）分，对照组分别为（17.55±4.86）、（31.46±6.78）、（63.01±5.51）分，2组比较差异有统计学意义（t＝18.02、27.52、26.11，均P＜0.01）。2组干预前后的自身对比，对照组干预前后的焦虑、抑郁及日常生活能力评分差异无统计学意义（P＞0.05），试验组干预前后的焦虑、抑郁及日常生活能力评分差异有统计学意义（P＜0.01）。结论对脑卒中吞咽障碍患者实施认知行为干预，能够降低患者负性情绪，提高生活自理能力，改善生命质量。

Objective To evaluate effects of intervention of cognitive behavior on negative emotions and activities of daily living in stroke patients with dysphagia. Methods 140 cases were selected and divided into control group and experimental group according to the random number table method with 70 in each group. The two groups were given conventional internal medicine nursing and the experimental group was applying intervention of cognitive behavior based on the control group. Two months before and after intervention, the psychological state in patients were assessed with Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), and the activities of daily living were assessed with Modified Barthel Index (MBI). Results The experimental group completed 69 cases while the control group was 68. Two months after intervention, the patients' anxiety scores in the experimental group and the control group were respectively (6.18 ± 1.95) points and (17.55 ±4.86) points (t=18.02, P<0.01), the depression scores were (7.67 ± 2.35) points and (31.46 ± 6.78) points (t=27.52, P<0.01). The activity of daily living scores were (94.48 ± 8.30) points and (63.01 ± 5.51) points (t=26.11, P<0.01). Before and after intervention of the self-comparisons of the two groups, the ability of anxiety, depression and activity of daily living scores were not statistical significant in the control group (P>0.05) while the difference between them was significant in the experimental group (P < 0.01). Conclusions The cognitive-behavioral intervention on stroke patients with dysphagia can reduce the negative emotions, enhance self-care ability and improve the quality of life.