發(fā)布時間：2018-05-07 08:15

  本文選題：老年期癡呆 + 非藥物干預(yù)治療�。� 參考：《寧波大學(xué)》2017年碩士論文

【摘要】：目的:本研究擬通過對寧波市康寧醫(yī)院老年病區(qū)老年期癡呆患者的“豐富環(huán)境”干預(yù),探索以豐富環(huán)境干預(yù)措施為主體的非藥物治療的有效性。如果能通過非藥物干預(yù)治療手段改善癡呆預(yù)后,減少住院時間,提高患者的生活質(zhì)量,這不僅能解決醫(yī)療資源緊張的問題,也能減少疾病負擔(dān)。同時也為今后在社區(qū)開展進行非藥物干預(yù)治療提供一定的理論及技術(shù)支持依據(jù)。方法:2015年11月~12月,我們對寧波市康寧醫(yī)院三個老年病區(qū)的所有患者進行了篩查。共選擇60名年齡在65歲以上的且診斷為“老年期癡呆”的患者,同時需滿足簡易智力狀態(tài)檢查量表(Mini-mental State Examination,MMSE)評分大于等于10分。對照組為藥物治療組;實驗組為藥物治療+豐富環(huán)境干預(yù)組。根據(jù)實驗設(shè)計需要,又將實驗組分為兩組,實驗組1:藥物治療+3條目豐富環(huán)境組;實驗組2:藥物治療+5條目豐富環(huán)境組。實驗組每周需接受5次豐富環(huán)境干預(yù)治療,時間為半小時,累計12周�；颊呷虢M后,將分別在干預(yù)前(基線期)和干預(yù)后第4周末、8周末及12周末,進行相應(yīng)量表評定。對評定人員進行培訓(xùn),并作為一致性檢驗,采用一對一的方式對患者進行認(rèn)知功能評定、日常生活能力及抑郁情緒評定,并由精神科主治醫(yī)師參與質(zhì)控。建立數(shù)據(jù)庫Epidata3.1的數(shù)據(jù)庫,采用雙人錄入的方法,最終收集的數(shù)據(jù)導(dǎo)入SPSS15.0,采用卡方檢驗來檢驗計算資料,采用T檢驗或者方差對計量資料進行分析,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:整個研究共脫落患者5例,實驗組共有19名男性老年期癡呆患者和18名女性老年期癡呆患者完成研究,年齡為66~76歲,平均72.9±2.3歲;對照組共有9名男性老年期癡呆患者和9名女性老年期癡呆患者完成研究,年齡67~78歲,平均年齡71.3±3.5歲。干預(yù)前,各組之間無顯著性差異。加入豐富環(huán)境干預(yù)后,三組認(rèn)知功能改善情況在4周末、8周末以及12周末,對照組患者的MMSE量表評分都小于實驗組,差異顯著。實驗組中5條目豐富環(huán)境干預(yù)組的MMSE總分均高于3條目豐富環(huán)境干預(yù)組。三組在豐富環(huán)境干預(yù)前后情緒改善(HAMD)情況評定顯示:在豐富環(huán)境干預(yù)治療4周末、8周末以及12周末,實驗組患者的HAMD總均分均低于對照組(P0.05),但5條目豐富環(huán)境干預(yù)組對比3條目豐富環(huán)境干預(yù)組。在豐富環(huán)境干預(yù)后,三組BADL(Basic activities of daily living,基礎(chǔ)性日常生活能力量表)的BI(Barthel Index)比較顯示:相對于入組前,入組后均表現(xiàn)出BI均數(shù)的提高,入組前后的BI差異對比有統(tǒng)計學(xué)意義(P0.05)。在BI均數(shù)提高方面,實驗組表現(xiàn)更佳,不管是在4周末、8周末還是12周末,豐富環(huán)境干預(yù)組BI均數(shù)與對照組相比均明顯升高,有統(tǒng)計學(xué)意義(P0.05);但需要指出的是,實驗組2增加了豐富環(huán)境干預(yù)條目數(shù),但對比實驗組1,其BI差異無統(tǒng)計學(xué)意義。在豐富環(huán)境干預(yù)后,三組老年期癡呆患者的主動活動量,均未表現(xiàn)出明顯的變化,且三組間對比無明顯差異(P0.05)。結(jié)論:非藥物干預(yù)中,利用豐富環(huán)境治療老年期癡呆是有效的。通過豐富環(huán)境對老年期癡呆患者的干預(yù),能顯著改善他們的認(rèn)知功能、空間記憶能力并對情緒的改善等一系列的問題得到明顯的改善,進而降低老年期癡呆患者的殘疾水平,使其社會功能得到改善,生活質(zhì)量得到提高。以此也能減輕家庭及社會的疾病負擔(dān),對促進患者回歸社會、提升家庭幸福指數(shù),有著重要的意義。簡單、方便、安全、經(jīng)濟的“豐富環(huán)境”的非藥物干預(yù)模式,值得在家庭及社區(qū)中應(yīng)用推廣。
[Abstract]:Objective: the purpose of this study is to explore the effectiveness of non drug treatment in the elderly patients with dementia in the geriatric area of Ningbo, Ningbo, and to improve the prognosis of dementia, reduce the time of hospitalization and improve the quality of life of the patients by non drug intervention. Only to solve the problem of medical resources tension can also reduce the burden of disease. At the same time, it also provides the basis for theoretical and technical support for non drug intervention treatment in the community. Method: in ~12 month of November 2015, we screened the patients in three geriatric areas of Corelle hospital in Ningbo. A total of 60 were selected for the age of 65. The patients above and above the age of "senile dementia" were diagnosed as "senile dementia", and the score of Mini-mental State Examination (MMSE) was equal to 10 points. The control group was the drug treatment group; the experimental group was treated with drug therapy + rich environment intervention group. The experimental group was divided into two groups according to the actual design needs, and the experimental group was 1: The +3 items were rich in the environment group, and the experimental group was treated with 2: for the rich environment group. The experimental group was required to receive 5 times a week for the rich environment intervention treatment, the time was half an hour and a total of 12 weeks. After the patients entered the group, the corresponding scale was evaluated before the intervention (the baseline) and the fourth weekend of the fourth weeks, the 8 weekend and the 12 weekend. A one to one method was used to evaluate the patients' cognitive function, daily life ability and depression, and the psychiatrist of the Department of psychiatry participated in quality control. The database of database Epidata3.1 was set up, the method of double entry was adopted, and the final data was introduced into SPSS15.0, and the chi square test was used. The test data were analyzed with T test or variance. The difference was statistically significant. Results: there were 5 cases of P0.05 in the whole study. In the experimental group, there were 19 male senile dementia patients and 18 female senile dementia patients. The average age was 66~76 years, the average was 72.9 + 2.3 years old, and the control group had 9 men. The patients with Alzheimer's disease and 9 female senile dementia patients completed the study, age 67~78 years old, the average age was 71.3 + 3.5 years old. Before intervention, there was no significant difference between each group. The three groups of cognitive functions were improved at the end of 4 weekend, 8 weekend and 12 weekend, and the MMSE scale score of the control group was less than the experimental group, and the difference between the two groups was less than the experimental group. The total score of MMSE in the 5 items of the experimental group was higher than that of the 3 items in the environment intervention group. The evaluation of the emotional improvement (HAMD) of the three groups before and after the rich environmental intervention (HAMD) showed that the total HAMD score of the patients in the experimental group was lower than that of the control group (P0.05) at the weekend of the rich environmental intervention treatment, the 8 weekend and the 12 weekend, but the 5 entries were abundant. The rich environment intervention group compared the 3 items of the rich environmental intervention group. The comparison of the BI (Barthel Index) of the three groups of BADL (Basic activities of daily living, basic daily living capacity scale) showed that the average number of BI increased after the entry group, and the BI difference before and after the entry group was statistically significant (P0.0). 5). In the improvement of the average number of BI, the experimental group had better performance, whether in the 4 weekend, the 8 weekend or the 12 weekend, the average number of BI in the rich environment intervention group was significantly higher than the control group (P0.05). However, it should be pointed out that the experimental group 2 increased the number of environmental intervention items, but compared with the experimental group, the difference in BI was not statistically significant. There was no obvious change in the active activity of the three groups of Alzheimer's patients in the rich environment, and there was no significant difference between the three groups (P0.05). Conclusion: the use of the rich environment in the treatment of senile dementia is effective in non drug intervention. A series of problems such as cognitive function, spatial memory ability and improvement of emotion have been obviously improved, and then the disability level of the patients with senile dementia is reduced, the social function is improved, the quality of life is improved, and the burden of family and society can also be reduced, and the patient's return to society and the happiness of the family can be promoted. The number is of great significance. Simple, convenient, safe and economical non drug intervention mode of "rich environment" is worthy of application and promotion in family and community.

【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.16

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