【作者】 王彩霞；

【导师】 卢爱工；

【作者基本信息】 吉林大学 ， 临床医学， 2007， 硕士

【摘要】 目的:探讨心理干预对增殖型糖尿病性视网膜病变患者视功能相关生存质量的影响。资料与方法:采集2006年1月至2006年12月在吉林大学第二医院眼底病二科诊断为增殖型糖尿病性视网膜病变的住院患者,共40例进行研究。随机分为对照组和实验组(患者按入院时间顺序编号,奇数号为对照组,偶数号为实验组),每组各20例。两组患者一般状况(年龄、性别、文化程度、糖尿病病程、平均住院日)无明显差异。在住院期间,对照组实施眼科手术的常规护理和分期健康教育,实验组实施眼科手术的常规护理和分期健康教育,在此基础上联合心理干预。两组患者分别在入院后第2日、出院前1日采用视功能损害眼病患者生存质量量表、汉密顿(HAMA)焦虑量表进行调查,比较两组间生存质量得分、焦虑得分。入院后第2日、术后第1日应用自行设计的焦虑相关因素调查问卷进行调查,得出问卷中每一焦虑相关因素患者所占比例。结果:1出院前与入院时生存质量总分差值:实验组与对照组相比有显著性差异(P<0.01)。2生存质量量表中出院前与入院时症状与视功能方面得分差值、身体机能方面得分差值、社会活动方面得分差值,实验组与对照组相比无显著性差异(P >0.05),精神心理方面得分差值有明显差异(P<0.01)。3出院前与入院时焦虑评分差值:实验组与对照组相比有显著性差异(P<0.01)。4通过自行设计的焦虑相关因素调查问卷得出结果:术前87.5%患者焦虑相关因素是惧怕术后俯卧位带来躯体不适;术后90%患者焦虑相关因素是俯卧位带来生理上的不适。结论:心理干预可以明显缓解增殖型糖尿病性视网膜病变患者住院期间的焦虑情绪,改善心理功能,提高住院期间视功能相关生存质量,对患者出院后的恢复和生存应对起到积极的正性作用。更多还原

【Abstract】 The incidence of proliferative diabetic retinopathy(PDR) increases with the rise of people’s living standard and life prolongation of diabetes.PDR is a disease of having serious ocular fundus changes,morbility with both eyes and multiplicity for treatment,most patients need to be operated by vitrectomy combined with silicon oil or gas filling which is one of the most complicate operations of ophthalmogy.Its therapeutic efficacy is affected by many factors including blood sugar,the condition of ocular fundus and course of diabetes.Thus,it is difficult for patients with PDR to estimate the efficacy of operation.Because the patients, visual function is seriously damaged by PDR,their means of communication have decreased. Meanwhile,PDR brings the patients unconvenience of living and influence their normal activities,patients with PDR always emerge psychological changes and emotional reaction as anxiety,depress and despair,et.The psychological reactions result in patients, descending of quality of life.To raise quality of life of patients with PDR,besidestherapentic tool should be impoved constantly,psychological support should be thought highly of.Till now, studies on quality of life for patients with PDR only include some overviews and general surveys on influence actors.It is meaningful to research the psychological charactors of patients with PDR in order to raise quality of life.Investigations on influence of mental interventions on quality of life of patients with PDR is have not been reported.The purpose of present study is to explore the effect of mental interventions on quality of life in patients with PDR in hospital receiving vitrectomy combined with silicon oil or gas filling ,eventually to find out effective measures to raise quality of life. Methods:40 patients with PDR who receiving vitrectomy combined with silicon oil or gas filling were divided into two groups according to admission order(odd number patients was added to the control group, even number patients was added to treatment group). Routine nursing care and health education were performed in control group while routine nursing care , health education and mental intervention measures were performed in treatment group. The Hamilton anxiety scale(HAMA) ,quality oflife scale of eye diseases with visual functional lesion and self-designed related factors of anxiety questionnaire were used to assess the patients on the second day after admission,on the first day after operation and before discharge.The results showed that:(1)Anxiety and descending of quality of life existed in both groups when they were recruited. (2)Compared with the two groups, there were no significant differences in the scores of the Hamilton(HAMA) anxiety scale and the quality of life scale (P>0.05) when they were recruited.There were significant differences in the scores of the Hamilton(HAMA) anxiety scale, the quality of life scale, aspect of mind and psychological in the quality of life scale(P<0.01) after mental intervention; there were no differences in the scores of aspects of symptom and vision function,body function and social activities in the quality of life scale (P>0.05). (3)The main related factor of anxiety of patients before operation was fearing forced decumbent position during post-operation; the main related factor of anxiety of patients after operation was phisiological discomforts caused by prone position.The results demonstrated that mental intervention could not only relieve anxiety of patients with PDR in hospital,but promote the patients, vision-related quality of life. Mental interventions of pre-operation and post-operation raised quality of life by improving mental state, but did not influence patients, symptom and vision function,body function and social activity function. Concrete measures of mental interventions in this study were as following:(1)establish satisfactory nurse-patient relationship. (2) give patients supportive psychological nursing:apply explaination,encouragement, comforting, suggestion, changing environments to solve psychological problems existing in patiens.(3)psychological behavior interventions:muscle slacken train,deep breathing to relieve anxiety.(4) family intervention.The measures in this study improved patients, psychological condition with PDR.The measures have certain clinic practical value to raise quality of life of patients with PDR in hospital .更多还原