叙事疗法对慢性阻塞性肺疾病终末期患者的心理干预作用

doi:10.3969/j.issn.2095-9400.2020.06.011

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摘要目的：探讨叙事疗法对改善慢性阻塞性肺疾病（COPD）终末期患者心理状态的效果及对死亡态度和生活质量的影响。方法：选择2018年1月至2019年6月温州医科大学附属第二医院育英儿童医院收治的COPD终末期患者112例，采用随机数字表法均分为2组，最终完成研究者对照组52例，观察组54例。对照组予常规心理护理，观察组予叙事疗法心理干预，2组分别接受抑郁自评量表（SDS）、焦虑自评量表（SAS）、简明心境量表（POMS）、老年人死亡恐惧量表和生活质量测定量表。结果：入院时，2组一般资料比较差异无统计学意义（P＞0.05）。相比于对照组的一般护理，叙事疗法干预后，可显著改善患者抑郁及焦虑程度（对照组 vs. 实验组，SAS评分：30.31±4.29 vs. 22.12±3.28；SDS评分：33.35±2.64 vs. 24.23±3.98；P＜0.05）。同时，干预后，患者对死亡的自然接受评分提高，死亡恐惧和逃离接受评分降低（P＜0.05）。干预后，患者总体健康状况、情绪功能和社会功能改善（P＜0.05），患者疼痛、失眠、食欲丧失和呼吸困难等症状改善（P＜0.05）。结论：叙事心理干预法可有效降低COPD终末期患者的焦虑、抑郁程度，改善患者情绪状态，缓解患者对死亡的悲观情绪，提高患者生活质量。

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	胡丹红
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	张春梅

关键词 ：肺疾病, 慢性阻塞性, 叙事疗法, 心理干预

Abstract：Objective: To explore the effect of narrative therapy on improving the mental state of patients with chronic obstructive pulmonary disease (COPD) at the end of the period and its influence on the attitude towards death. Methods: From January 2018 to June 2019, 112 patients with COPD in the Second Affiliated Hospital of Wenzhou Medical University were selected. Due to 6 patients lost to follow-up, there were 52 patients in the control group and 54 patients in the experimental group. The control group was given routine psychological care, while the patients in the experimental group was treated by narrative therapy to give psychological intervention. SDS, SAS, POMS and EORTC QLQ-C30 were conducted on patients and their death fear was assessed by the death fear scale. Results: There was no significant difference between the two groups (P>0.05). Compared with the general nursing of the control group, narrative therapy can significantly improve depression and anxiety degree (control group vs. experimental group, SAS score: 30.31±4.29 vs. 22.12±3.28; SDS score: 33.35±2.64 vs. 24.23±3.98). The difference between the two groups was statistically significant (P<0.05). Narrative therapy can significantly improve patients’ mood (P<0.05). The intervention of therapy could significantly improve the natural acceptance score and reduced fear of death and acceptance of escape (P<0.05), thus significantly improving the life quality of patients (P<0.05). Conclusion: Narrative psychological intervention can effectively reduce the level of anxiety and depression in patients with COPD at the end of the period, alleviate the pessimistic mood of patients and fear of death, and therefore improve the life quality of patients.

Key words： pulmonary disease, chronic obstructive narrative therapy psychological intervention

收稿日期: 2020-01-24

基金资助:温州市科技局科研基金资助项目（Y20180463）；浙江省自然科学基金资助项目（LY18H160046）。

通讯作者: 张春梅，主任护师，Email：sallyzcm@126.com。

作者简介: 胡丹红（1982-），女，浙江台州人，主管护师。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.06.011 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I6/485

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