认知行为干预对冠状动脉支架植入术后病人焦虑、抑郁的作用分析
Analysis of the influence of the cognitive behavior intervention on anxiety and depression in patients treated with percutaneous coronary intervention
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摘要: 目的：探讨认知行为干预对冠状动脉支架植入术（PCI）后病人焦虑、抑郁和治疗依从性及自我效能的影响。方法：选取行PCI术的冠心病病人84例，随机分为观察组和对照组，各42例。对照组给予常规护理，观察组在常规护理基础上给予认知行为干预。比较2组病人手术前后的焦虑自评量表（SAS）和抑郁自评量表（SDS）评分，以及术后治疗依从性、心血管事件发生率和自我效能水平。结果：2组病人术前1 d的SAS和SDS评分差异均无统计学意义（P>0.05）；术后1、3、5 d，观察组病人SAS和SDS评分均明显低于对照组（P<0.01），且观察组病人SAS和SDS评分均明显高于术前1 d（P<0.01），随时间延长SAS和SDS评分均逐渐降低（P<0.05~P<0.01）。PCI术后，观察组病人的服药依从率、健康行为依从率、定期复查依从率、运动治疗依从率及饮食治疗依从率均优于对照组（P<0.05）。观察组病人心血管事件发生率为7.1%，亦低于对照组的23.8%（P<0.05）。除情绪控制外，干预后观察组病人自我效能总分和症状管理、角色功能、沟通能力评分均明显优于对照组（P<0.01）。病人的冠心病认知水平与自我效能总分及因子症状管理、角色功能、沟通能力均呈正相关关系（P<0.05~P<0.01），而与因子情绪控制无明显相关关系（P>0.05）。结论：认知行为干预能改善冠心病病人的焦虑抑郁水平，提高其冠心病认知水平，加强自我效能，具有重要临床价值。Abstract: Objective:To discuss the influence of the cognitive behavior intervention on the anxiety,depression,treatment compliance and self-efficacy in patients treated with percutaneous coronary intervention(PCI).Methods:Eighty-four patients treated with PCI were randomly divided into the observation group and control group(42 cases each group).The control group was treated with routine nursing,and the observation group was treated with cognitive behavior intervention based on routine nursing.The scores of SAS and SDS before and after operation,and treatment compliance,incidence rate of cardiovascular events and self-efficacy after operation between two groups were compared.Results:The differences of the scores of SAS and SDS before 1 day of operation between two groups were not statistically significant(P>0.05).The scores of SAS and SDS in observation group after 1,3 and 5 days of operation were significantly lower than those in control group(P<0.01),higher than those in observation group before 1 day of operation(P<0.01),and gradually decreased with the time prolonging(P<0.05 to P<0.01).After PCI,the compliance rates of medication,health behavior,regular review,exercise treatment and diet treatment in observation group were better than those in control group(P<0.05).The incidence rate of cardiovascular event in observation group(7.1%) was lower than that in control group(23.8%)(P<0.05).After the intervention,except for the emotion control,the self-efficacy score,and the scores of symptom management,role function and communication ability in observation group were better than those in control group(P<0.01).The cognition of coronary heart disease knowledge was positively correlated with the scores of symptom management,role function and communication ability(P<0.05 to P<0.01),and not obviously correlated with emotion control(P>0.05).Conclusions:Cognitive behavior intervention can improve the levels of anxiety and depression,improve the cognitive level of coronary heart disease knowledge,strengthen the self-efficacy in patients with coronary heart disease,which has important clinical values.
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