本文選題：團體沙盤游戲 + 急性閉角型青光眼�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:急性閉角型青光眼(Acute Angle-Closure Glaucoma,AACG)是臨床上一種常見、多發(fā)疾病,其本質(zhì)是一種嚴重的不可逆性致盲眼病,也是公認的心身疾病,生物、社會以及心理因素與其發(fā)生、發(fā)展、預(yù)后恢復(fù)有著密切聯(lián)系。本文旨在探討:(1)急性閉角型青光眼患者的人格特征及心理健康狀況。(2)急性閉角型青光眼患者手術(shù)前后心理狀態(tài)及皮質(zhì)醇水平的變化。(3)團體沙盤游戲?qū)毙蚤]角型青光眼患者圍手術(shù)期的影響。方法:選取2016年08月-2017年02月就診于我院符合入選標準的急性閉角型青光眼住院手術(shù)患者,接受沙盤游戲心理干預(yù)者納入實驗組、不接受者納入對照組。入院后均給予降眼壓藥物治療及常規(guī)護理,進行皮質(zhì)醇檢測,填寫癥狀自評量表(SCL-90)及艾森克個性問卷(EPQ)。實驗組4名患者組成心理干預(yù)小組,由我院同一名心理咨詢師于術(shù)前1d進行第1次團體沙盤游戲治療。所有患者均符合手術(shù)指征,無手術(shù)禁忌癥,由同一術(shù)者實施濾過性手術(shù)(小梁切除手術(shù))。實驗組于術(shù)后1w、2w、3w及4w各進行1次團體沙盤游戲治療,監(jiān)測眼壓。術(shù)后4周再次檢測皮質(zhì)醇水平及填寫癥狀自評量表(SCL-90)。結(jié)果:(1)兩組患者年齡、性別、婚姻情況、文化程度、病程之間差異無統(tǒng)計學(xué)意義(P0.05)。(2)艾森克個性問卷(EPQ):AACG患者E值(內(nèi)外向)、P值(精神質(zhì))均顯著高于中國常模(P0.01),N值(神經(jīng)質(zhì))高于中國常模(P0.05),L值(掩飾性)低于中國常模(P0.01)。(3)癥狀自評量表(SCL-90):手術(shù)后實驗組軀體化、強迫、人際敏感、抑郁、焦慮、敵對、恐怖、偏執(zhí)、精神病性、總均分及總分得分均明顯下降(P0.05),且均低于對照組(P0.01)。對照組除強迫癥狀得分較術(shù)前差異無統(tǒng)計學(xué)意義外(P0.05),其他方面得分均高于術(shù)前(P0.05)。(4)皮質(zhì)醇:手術(shù)后實驗組皮質(zhì)醇水平較術(shù)前明顯下降(P0.01),且較對照組明顯降低(P0.01),對照組皮質(zhì)醇水平較術(shù)前升高(P0.05)。(5)眼壓:術(shù)后4周內(nèi),實驗組眼壓持續(xù)低于對照組,且波動性較對照組小(P0.05)。結(jié)論:(1)急性閉角型青光眼患者具有情感及人格不穩(wěn)定、神經(jīng)質(zhì)傾向及精神病性等心理人格特征;(2)急性閉角型青光眼患者手術(shù)后情緒障礙加重,外周血皮質(zhì)醇水平升高,內(nèi)分泌系統(tǒng)存在紊亂現(xiàn)象;(3)團體沙盤游戲?qū)Ω纳萍毙蚤]角型青光眼患者圍手術(shù)期心理狀態(tài)、糾正內(nèi)分泌紊亂、降低眼壓并維持術(shù)后眼壓穩(wěn)定性起到積極作用。
[Abstract]:Objective: acute Angle-Closure GlaucomaACG is a common and multiple disease in clinic. Its essence is a serious irreversible blinding eye disease, and it is also recognized as psychosomatic disease, biological, social and psychological factors and its occurrence and development. Prognosis is closely related to recovery. The purpose of this study was to investigate the personality and mental health status of patients with acute angle closure glaucoma (1) the changes of mental state and cortisol level before and after operation in patients with acute angle closure glaucoma. Perioperative effect of glaucoma patients. Methods: from August 2016 to February 2017, inpatients with acute angle-closure glaucoma (ACG) who were admitted to our hospital from August 2016 to February 2017 were included in the experimental group, and those who received psychological intervention in the sand game were included in the experimental group, and those who did not accept were included in the control group. After admission, all patients were given intraocular pressure relief drug therapy and routine nursing care, cortisol was detected, symptom checklist 90 (SCL-90) and Eysenck Personality questionnaire (Eysenck Personality questionnaire) were filled out. Four patients in the experimental group formed a psychological intervention group, and the same psychological counsellor in our hospital performed the first group sand game therapy 1 day before operation. All patients were in accordance with surgical indications, no contraindication, by the same person to perform filtering surgery (trabeculectomy). The patients in the experimental group were treated with group sand game at 1 week, 2 weeks, 3 weeks and 4 weeks, respectively, and intraocular pressure was monitored. Cortisol levels were measured again 4 weeks after operation and SCL-90 was filled in. Results (1) Age, sex, marital status, educational level of the two groups of patients, Eysenck Personality questionnaire (Eysenck Personality questionnaire) Eysenck Personality questionnaire (EPQQ: AACG) was significantly higher than that of Chinese norm (P0.01N) (neuroticism) and Chinese norm (P0.05L) (concealment) lower than that of Chinese norm (P 0.05 / L). Symptom Checklist (SCL-90): somatization of the experimental group after operation, Compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychosis, total mean score and total score were significantly lower than those in the control group (P 0.05), and were lower than those in the control group (P 0.01). The scores of obsessive-compulsive symptoms in the control group were significantly higher than those in the preoperation group (P 0.05), and the scores in other aspects were higher than those in the control group (P 0.05). The level of cortisol in the experimental group after operation was significantly lower than that in the pre-operation group (P 0.01), and significantly lower than that in the control group (P 0.01), while in the control group, it was significantly lower than that in the control group. Intraocular pressure (IOP): within 4 weeks after operation, the level of cortisol in the group was higher than that before operation. The intraocular pressure in the experimental group was lower than that in the control group, and the volatility was lower than that in the control group (P 0.05). Conclusion (1) Acute angle-closure glaucoma patients have emotional and personality instability, neurotic tendency and psychosis. 2) emotional disorders and cortisol level in peripheral blood of patients with acute angle-closure glaucoma after operation are aggravated and the level of cortisol in peripheral blood is higher than that in patients with acute angle-closure glaucoma. The phenomenon of endocrine system disorder is that group sand table play a positive role in improving the psychological state of patients with acute angle-closure glaucoma during perioperative period, correcting endocrine disorder, reducing intraocular pressure and maintaining the stability of intraocular pressure after operation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6

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