【作者】 吴雪；

【导师】 冯美丽； 娄凤兰；

【作者基本信息】 山东大学 ， 护理学， 2005， 硕士

【摘要】 研究目的 探讨认知行为干预 (cognitive-behavioral therapy, CBT)对改善维持性血液透析(maintenance hemodialysis, MHD)患者生活质量(qualityoflife,QOL)和主观生活满意度(subiective life satisfaction)的作用。 方法 采用心理干预试验方法。将60例维持性血液透析患者随机分为两组:试验组和对照组,每组30例。研究对象均满足以下条件:年龄18周岁以上;规律血透治疗3个月以上,每周血透2-3次,透析充分;病情相对稳定,无恶性肿瘤、严重病残、新近(3个月)无大手术等严重影响生活质量的因素;已有严重心理障碍、精神失常、严重视听力障碍者除外。试验组在日常血液透析护理常规的基础上应用认知行为干预,认知行为干预包括理性情绪疗法和放松训练,由同一研究者面对面指导进行,每周一次,每次40分钟,对照组同期仅应用日常血液透析护理常规。第一轮干预8周,暂停4周后进行第二轮干预,第二轮干预4周。干预前、第一轮干预后、第二轮干预后均采用一般情况调查表(自制)、自评抑郁量表(SDS)、自评焦虑量表(SAS)、生活质量综合评定问卷(GQOLI-74)测评,同期调查对照组。全部原始数据输入计算机,采用SPSS10.0统计软件包进行方差分析和t检验。 结果 1.干预后试验组SDS,SAS评分显著降低,QOL评分显著升高,差异更多还原

【Abstract】 OBJECTIVE To evaluate the effects of cognitive-behavioral therapy ( CBT ) on the quality of life(QOL) in the maintenance hemodialysis(MHD) patients, especially on the psychological function and the subjective life satisfaction.METHODS In the experiment, psychological intervention was performed.Sixty maintenance hemodialysis patients were divided into two groups:the intervention group and the control group,30 patients respectively.All the participants were older than 18 years, who were undergoing MHD, 2-3 times a week, and the duration of MHD was more than 3 months, with the exception of carcinoma, severe body disability, severe psychological problem, eyes or ears disfunction and operation in the last 3 months. Based on the conventional MHD nursing,we performed cognitive-behavioral therapy on the intervention group,including rational emotional therapy (RET) and relaxtion therapy. All the CBT were performed by one researcher,to one patient each time. The intervention was performed once a week to each participant, 40min each time. Meanwhile we just performed conventional MHD nursing on the control group. Thefirst, round of intervention went on for 8 weeks. After a break of 4 weeks, another round of intervention went on for 4 weeks, that was the second one.All the participants were administered the General Information Questionair(self-designed),Self-Rating Depression Scale(SDS), Self-Rating Anxiety Scale(SAS) and the Generic Quality of Life lnventory-74(GQ0LI-74)before the intervention, after the first round of intervention and after the second round. The questionairs are all well-known standardized and have high viability and validity. The original data were put into the computer and the statistical tool was SPSSJO. 0. ANOVA and t-test was used.RESULT 1.After the intervention,the score of SDS,SAS decreased while the score of QOL increased significantly in the intervention group.We evaluted the score of this group before the intervention, after the first round and after the second round. ANOVA indicated severe significant statistic difference(K0. 000) existed among the score of SDS, SAS, QOL-physical function, psychological function,the total score,as well as social function (/K0. 01). But no difference existed in the substantial wealth(P>0. 05). Compare the score after both rounds of intervention, statistic difference existed in SDS, SAS, QOL-physical function and psychological function (/K0. 05, K0. 01, K. 000). Meanwhile ANOVA indicated no difference existed among the score of the control group. For the intervention group, LSD-t test was performed to the twenty factors of QOL before the intervention and after the first round, after the first round and after the second round. Statistic difference(K0. 05, /K0. 01,/*. 000) existed in the factor of sleep and energy, nervous, negative emotion, positive emotion, work or study, entertainment and family life. No statistic difference(/^>0. 05) existed in the factor of sexal activity, movement and awareness, self-esteem, social support. Severe significant difference(KQ. 01,K. UO0)exsited in the factor of the overall evaluation of QOL before and after the intervention.2.No difference existed in the demographic characters between the intervention group and the control group. Meanwhile, before the intervention,there was no difference(P>0. 05) in the score of SDS, SAS, QOL between this two groups. However, after the first round of intervention,statistic difference(PCO. 01, K. 000) came into being in SDS, SAS, QOL-physical function, social function and the total score of QOL. between the two groups, but no difference (f=-0. 787, P=. 435, i=l. 290, /^0.202) existed in the substantial wealth and the psychological function.After the second round of intervention, severe significant difference(fK. 000) emerged in SDS,SAS and the four aspects, with the exception of the substantial wealth, of QOL.3. For the intervention group, after the first and second round of intervention,the objective life status and the subjective life satisfaction was improved greatly. Statistic difference(j°CO. 05) existed in the score of the the objective life status of physical function before and after the first round of intervention, while no statistic difference(P>0. 05) existed in that after the first round of intervention and after the second.Severe significant statistic difference(K0. 01) existed in the score of the objective status of psychological function after the both round of intervention. After the first round of intervention, severe significant difference(/<0.01) existed in the score of the subjective life satisfaction of physical function, psychological function in the contrast of that before the intervention.After the second round of the intervention, statistic difference(￡=2. 433, P=0. 044) existed in the score of the subjective life satisfaction of physical function and severe significant difference(f=-3.567, P=0. 002) existed in that of psychologicalfunction. No statistic difference(P>0. 05) existed in the objective life status and subjective life satisfaction the the substantial wealth and the social function after the both round of intervention.CONCLUSION l.The cognitive-behaviral therapy is a very effective way to improve the quality of life and subjective life satisfaction of the maintenance hemodialysis patients. After the intervention,the score of SDS,SAS decreased and the score of physical function, psychological function,social function and the total score of the quality of life increased significantly.2. Cognitive-behavioral therapy is a very effective way to improve the objective life status and the subjective life satisfaction of the physical function and psychological function of the maintenance hemodialysis patients.3. After the second round of intervention,the score of SDS, SAS decreased and the score of quality of life increased more. So the effect of long term of intervention is better.A long term of intervention should be established to the maintenance hemodialysis patients in the clinical settings.更多还原