發(fā)布時間：2018-12-09 19:18

【摘要】：目的調(diào)查類風(fēng)濕關(guān)節(jié)炎患者的生命質(zhì)量、焦慮抑郁、疼痛、疾病不確定感、睡眠質(zhì)量狀況,探究影響生命質(zhì)量的心理社會因素。運(yùn)用認(rèn)知行為和正念為理論基礎(chǔ)對患者進(jìn)行心理干預(yù),分析干預(yù)對影響類風(fēng)濕關(guān)節(jié)炎患者生命質(zhì)量各因素的效果。方法1.調(diào)查研究:采取方便抽樣,對230例類風(fēng)濕關(guān)節(jié)炎患者進(jìn)行調(diào)查研究,采用類風(fēng)濕關(guān)節(jié)炎患者生命質(zhì)量測定量表QLICD-RA(V2.0)、疼痛VAS評分、焦慮自評量表(SAS)、抑郁自評量表(SDS)、疾病不確定感量表(MUIS)、匹茲堡睡眠指數(shù)量表(PSQI)對患者進(jìn)行調(diào)查,剔除無效問卷后,共收集210例類風(fēng)濕關(guān)節(jié)炎患者。2.干預(yù)研究:選取符合入組條件的80例患者,由于研究中途脫落,最后完成干預(yù)組和對照組各35人。干預(yù)組患者在常規(guī)藥物治療的基礎(chǔ)上給予心理干預(yù),對照組只進(jìn)行常規(guī)藥物治療。結(jié)果1.調(diào)查研究結(jié)果:(1)類風(fēng)濕關(guān)節(jié)炎患者生命質(zhì)量水平低于平均值。(2)類風(fēng)濕關(guān)節(jié)炎患者生命質(zhì)量的各維度及總分在性別、年齡、文化程度、婚姻狀況等社會人口學(xué)特征及疾病的DAS28評分上有差異(p0.01)。(3)疾病不確定感各維度及總分均與生命質(zhì)量各維度及總分呈負(fù)相關(guān),除特異模塊與復(fù)雜性不相關(guān)外(p0.01);焦慮抑郁與生命質(zhì)量的各維度及總分均呈負(fù)相關(guān)(p0.01);匹茲堡睡眠指數(shù)量表得分與生命質(zhì)量得分間呈負(fù)相關(guān)(p0.05),除社會功能、特異模塊與催眠藥物不相關(guān)外;疼痛與生理功能、社會功能、特異模塊和生命質(zhì)量總分呈負(fù)相關(guān)(p0.01)。(4)回歸分析結(jié)果顯示,影響RA患者生命質(zhì)量的主要因素依次為:SDS、睡眠障礙、SAS、疼痛VAS評分、不確定性、婚姻狀況。2.干預(yù)研究結(jié)果:(1)心理干預(yù)后,干預(yù)組和對照組患者在生命質(zhì)量上得分差異具有統(tǒng)計學(xué)意義(p0.01),干預(yù)組患者的生命質(zhì)量改善程度高于對照組;(2)心理干預(yù)后,干預(yù)組患者的焦慮、抑郁、疾病不確定感改善程度高于對照組,睡眠質(zhì)量顯著提高,疼痛感和生理指標(biāo)也顯著降低(p0.01)。結(jié)論類風(fēng)濕關(guān)節(jié)炎患者生命質(zhì)量總體水平低�；颊呱|(zhì)量受人口學(xué)變量及疾病相關(guān)因素的影響,而抑郁、睡眠障礙、焦慮、疼痛VAS評分、疾病不確定性、婚姻狀況在一定程度上能預(yù)測患者生命質(zhì)量的高低。心理干預(yù)可以有效地降低患者疾病不確定感和疼痛感,緩解其焦慮抑郁情緒狀態(tài),提升患者睡眠狀況和生命質(zhì)量。
[Abstract]:Objective to investigate the quality of life, anxiety, depression, pain, uncertainty and sleep quality of patients with rheumatoid arthritis. Using cognitive behavior and mindfulness as the theoretical basis, psychological intervention was conducted to analyze the effects of intervention on the factors affecting the quality of life of patients with rheumatoid arthritis. Method 1. Investigation and study: using convenience sampling, 230 patients with rheumatoid arthritis were investigated. QLICD-RA (V2.0), VAS score of pain, (SAS), of anxiety scale were used to measure the quality of life of patients with rheumatoid arthritis. Self-rating Depression scale (SDS),) (MUIS), Pittsburgh Sleep Index scale (PSQI) was used to investigate the patients. After eliminating invalid questionnaires 210 patients with rheumatoid arthritis (RA) were collected. 2. 2. Intervention study: 80 patients who fit into the group were selected, 35 patients in the intervention group and 35 patients in the control group were finished because of falling off in the middle of the study. The patients in the intervention group were given psychological intervention on the basis of routine drug therapy, while the patients in the control group were only given routine drug therapy. Result 1. The results were as follows: (1) the quality of life of patients with rheumatoid arthritis was lower than the average. (2) the dimensions and total scores of quality of life of patients with rheumatoid arthritis were gender, age, education level. There were significant differences in social demographic characteristics such as marital status and DAS28 score of disease (p0.01). (3). Each dimension and total score of disease uncertainty were negatively correlated with each dimension and total score of quality of life. The specific modules were not related to complexity (p0.01). There was a negative correlation between anxiety and depression and all dimensions and total scores of quality of life (p0.01), and there was a negative correlation between the scores of Pittsburgh Sleep Index and quality of Life (p0.05), except social function, specific modules and hypnotic drugs. There was a negative correlation between pain and physiological function, social function, specific module and total score of quality of life (p0.01). (4). The results showed that the main factors influencing the quality of life of RA patients were SDS, sleep disorder, SAS,. Pain VAS score, uncertainty, marital status. 2. The results of intervention study: (1) after psychological intervention, the scores of quality of life in the intervention group and the control group were significantly different (p0.01), and the improvement degree of the quality of life in the intervention group was higher than that in the control group; (2) after psychological intervention, the degree of anxiety, depression, disease uncertainty in the intervention group was higher than that in the control group, the sleep quality was significantly improved, and the pain and physiological indexes were also significantly decreased (p0.01). Conclusion the overall quality of life in patients with rheumatoid arthritis is low. The quality of life of patients was affected by demographic variables and disease-related factors, while depression, sleep disorder, anxiety, pain VAS score, disease uncertainty and marital status could predict the quality of life of patients to a certain extent. Psychological intervention can effectively reduce patients' feeling of uncertainty and pain, relieve their anxiety and depression, and improve their sleep status and quality of life.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R593.22

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