臂叢神經損傷患者傷殘接受度和相關因素及其干預的研究

1、臂叢神經損傷患者傷殘接受度和相關因素及其干預的研究        【中文摘要】背景傷殘接受度是個體對自己傷殘狀態(tài)的接受程度,并對患者的心理和生理健康產生重要作用。目前國內外尚未見臂叢神經損傷患者傷殘接受度的有關研究,本研究描述臂叢神經損傷患者傷殘接受度的現(xiàn)況,探討傷殘接受度的影響因素和相關因素,引進和發(fā)展評估傷殘接受度的量表,制定并實施有效進步患者傷殘接受度,幫助患者適應傷殘的短期心理護理干預模式,使他們建立理性的信念,采用積極的應對,減少消極的應對,從而減輕患者的心理應激,終極促進患者的整體康復。目的描述臂叢神經

2、損傷患者的傷殘接受度及其相關因素;評價以艾理斯的理情行為治療理論為指導的認知干預對臂叢神經損傷患者傷殘接受度、創(chuàng)傷后應激反應及應對方式的效果。方法本研究分為兩個階段進行:第一階段,以臂叢神經損傷患者一般資料及損傷特征調查表、傷殘接受度量表(ADS)、事件影響量表修訂版(IESR)、醫(yī)學應對問卷(MCMQ)和視覺模擬評分法(VAS)作為主要研究工具,對復旦大學附屬西岳醫(yī)院305例臂叢神經損傷患者進行傷殘接受度及其相關因素的基線調查。第二階段,對符合進選標準的68例在復旦大學附屬西岳醫(yī)院手外科住院的臂叢神經損傷患者,按時間段分為干預組(34例)和對照組(34例),兩組研究對象在年齡、性別、文化程度

3、、婚姻狀況、損傷側別、損傷類型等方面的差異無統(tǒng)計學意義(p0.05)。對照組接受常規(guī)的手外科一般護理,干預組在接受常規(guī)手外科護理的同時,給予認知干預,為期1個月,包括集體心理健康教育3次,個體支持性認知干預7次,全程心理咨詢熱線和參觀手外科康復部1次。以傷殘接受度量表(ADS)、事件影響量表(IES-R)和醫(yī)學應對問卷(MCMQ)為主要評價工具,分別于干預前、干預后和干預后3個月評價干預效果,并采用重復丈量方差分析對各丈量指標在4個月內的變化及趨勢進行統(tǒng)計分析。結果臂叢神經損傷患者的傷殘接受度處于中低程度,臂叢神經損傷患者傷殘接受度(ADS)總均分為79.00±12.29(44分11

4、6分),一般情況和損傷特征資料中,患者的損傷側別、性別、經濟困難、疼痛和傷后時間是傷殘接受度的影響因素。臂叢神經損傷患者的傷殘接受度與其手術自信心成正相關,并有統(tǒng)計學意義(r=0.126,p0.05);臂叢神經損傷患者的傷殘接受度與創(chuàng)傷后應激反應和屈服應對方式之間存在負相關,并有統(tǒng)計學意義(r=0.455,p0.001;r=0.353,p0.001);臂叢神經損傷患者傷殘接受度的包容維度與回避成負相關,并有統(tǒng)計學意義(r=0.148,p0.05)。兩組患者干預前的一般資料、傷殘接受度總分及其各維度得分、創(chuàng)傷后應激反應得分及其各維度得分、應對方式各維度得分沒有統(tǒng)計學差異。干預后和干預后3個月,重

5、復丈量方差分析顯示:干預組的傷殘接受度總分及其各維度(擴大維度除外)得分高于對照組得分,有統(tǒng)計學差異(p0.01;p0.05)。傷殘接受度擴大維度得分高于對照組得分,但尚無統(tǒng)計學差異,(p0.05);干預組的創(chuàng)傷后應激反應(IES-R)總分及高警覺和回避維度得分低于對照組得分,但未出現(xiàn)統(tǒng)計學差異,(p0.05),其侵擾維度得分低于對照組,有統(tǒng)計學差異(p0.05);干預組面對應對方式得分高于對照組,回避應對方式得分低于對照組,但未出現(xiàn)統(tǒng)計學差異,(p0.05),干預組的屈服應對方式得分低于對照組得分,具有統(tǒng)計學差異,(p0.05)。結論臂叢神經損傷患者的傷殘接受度處于中低水平,并與手術自信心、

6、創(chuàng)傷后應激反應和應對方式之間存在相關的關系。通過對臂從神經損傷患者的傷殘接受度進行短期的認知干預,能進步臂叢神經損傷患者的傷殘接受度,并減少創(chuàng)傷后應激反應和屈服的應對方式,但對創(chuàng)傷后應激反應和應對方式的影響力度還需要進一步的探討。');【Abstract】 Background The acceptance of disability,which is defined the extent to which individuals demonstrates an accepting attitude toward their disability,has an important ef

7、fect on their physical and mental wellbeing.Unfortunately,there has been no study on acceptance of disability of Patients with Brachial Plexus Injuries(BPI) in china and abroad.This study was conduct to describe the level of acceptance of disability,explore the influenced and related factors,introdu

8、ce and develop the Acceptance of Disability Scale,develop and implement the short term psychological nursing intervention for BPI patients to effectively strengthen the level of acceptance of disability,encourage rational beliefs and enhance active coping strategies with the hope of decreasing postt

9、raumatic stress and finnally hastening holistic rehabilitation.Objective The objective of this study was to investigate the level of acceptance of disability and psychological factors related of BPI patients and to evaluate the effectiveness of the cognitive intervention programe on acceptance of di

10、sability,posttraumatic stress response and coping of BPI patients.Methods This research was conducted in two consecutive phases. Phase 1:A descriptive and correlative design was employed.The ADS (Acceptance of disability scale),IES-R(Impact of Event Scale Revised),MCMQ(Medical Coping Modes Questionn

11、aire),VAS(Visual Analogue Scale)and general information questionnaire were used to survey 305 BPI patients in Huashan hospital of Shanghai to assess the level of acceptance of disability and its influenced factors,posttraumatic stress response,and coping style.Phase 2:A quasi-experimental design was

12、 conducted.Sixty-eight BPI patients were recruited from those who met the inclusion criteria and divided in to an intervention group(n=34) and a control group(n=34) respectively according to the time segment.There were no statistical difference in age,gender,education level,marital status,side of pl

13、exus injury,the types of brachial plexus injury and so on between the two groups (p0.05 ).Patients in the intervention group attended a one-month cognitive intervention program guided by the Rational Emotion Behavior Therapy Theory and the routine nursing care of hand surgery,while the control group

14、 received the routine care only.The intervention program consisted of three-time group psychological health education,seven-time individual supportive-and-cognitive intervention,whole-course hotline for mental assistance and one visiting tour to post hand surgery rehabilitation department.The ADS,IE

15、S-R,MCMQ and general information questionnaire were administered to evaluate effects of the intervention program at the end of the intervention and 3 months after the intervention respectively.The change of them were compared and analyzed by the repeated-measure ANOVA.Results Phase 1 The level of ac

16、ceptance of disability was below the average with the mean of total score at 79.00,standard deviation was 12.29 (44116).The influenced factors of acceptance of disability in BPT patients were gender,side of plexus injury,pain,financial condition and post-injury period.The level of confidence in surg

17、ery was positively correlated with acceptance of disability(r=0.126,p0.05 ) Posttraumatic stress response and resignation were significantly and negatively correlated with acceptance of disability(r=-0.455,p0.001; r=-0.353,p0.001).Negative correlations were also found between avoidance coping and th

18、e containment of disability domain(r=-0.148,p0.05).Phase 2 There were no statistically significant differences in baseline between the intervention and control groups.The results of repeated-measures ANOVA showed that scores of acceptance of disability and its subscores except for enlargement domain

19、 were statistically significant higher in the intervention group patients than in the control group(p0.01;p0.05).The intervention group patients showed lower scores of the IES-R total score and its subscores compared with the control group patients.The intrusion domain was statistical differences(p0

20、.05),but there was no statistical difference in the IES-R total score and avoidance as well as hyperarousal domain between the two groups, (p0.05).The intervention group showed higher scores of confrontation and lower scores of avoidance than the control group,however there was no statistical difference between the two groups,(p