發(fā)布時間：2018-05-24 11:21

  本文選題：先天性小耳畸形 + 心理彈性��； 參考：《北京協(xié)和醫(yī)學院》2011年博士論文

【摘要】：研究背景 先天性小耳畸形是整形外科最為常見的顱面先天缺陷之一,以往的研究大都關(guān)注患者的臨床外科治療,手術(shù)方式的改進、軟骨組織工程基礎(chǔ)研究等層面,或僅對小耳畸形患者的社會心理缺陷進行研究,但是部分小耳畸形患者適應良好,這與近年來心理學研究熱點“心理彈性”密切相關(guān),這一現(xiàn)象目前尚缺乏關(guān)注。對于先天缺陷帶來的一系列心理影響,小耳畸形患者能否積極應對和調(diào)整,心態(tài)如何,這關(guān)系到小耳畸形患者手術(shù)能否順利進行,也關(guān)系到小耳畸形患者長期的生理心理健康穩(wěn)定發(fā)展。因此,針對小耳畸形患者心理彈性問題開展系統(tǒng)研究,對于預防和改善小耳畸形患者身心健康問題,促進小耳畸形患者身心健康具有重要意義。 研究目的 掌握來院就診的先天性小耳畸形患者的適應現(xiàn)狀及心理彈性存在問題；分析影響小耳畸形患者心理彈性的相關(guān)危險因素；利用定量研究構(gòu)建先天性小耳畸形患者的心理彈性結(jié)構(gòu)模型,并結(jié)合國內(nèi)外非自愿手術(shù)小耳畸形患者心理健康的干預措施,為有針對性地制定適合于小耳畸形患者心理彈性危險因素的干預對策及改善其心理彈性提供科學依據(jù)。 研究方法 1.通過對隨機抽取250例小耳畸形患者對其訪談并進行適應結(jié)果四類量表問卷調(diào)查,初步了解小耳畸形患者心理彈性適應結(jié)果的現(xiàn)狀,對各個量表測量學特征進行檢驗,了解小耳畸形心理彈性適應結(jié)果的基本情況,為確立本研究的基本假設提供現(xiàn)實依據(jù)。 2.采用胡月琴和甘怡群等人編制的《青少年心理彈性量表》心理彈性問卷,通過對161名小耳畸形患者的調(diào)查,運用探索性因素分析和驗證性因素分析等手段探索小耳畸形患者心理彈性的結(jié)構(gòu),并初步構(gòu)建小耳畸形患者的心理彈性模型。 3.本研究在獲得心理彈性以及相關(guān)因素的數(shù)據(jù)之后,通過分析它們之間的因果關(guān)系,確定三類指標：一是能夠有效預測心理彈性的前因變量,二是能夠代表心理彈性狀況的五個維度變量,三是表示心理彈性降低后果的結(jié)果變量。將這三類變量的測查問卷進行計算機化,從而建立起小耳畸形患者心理彈性降低的預警系統(tǒng)。結(jié)合國內(nèi)外對小耳畸形患者的心理健康問題的干預策略,制定適合于小耳畸形患者心理彈性危險因素的干預對策以改善其心理彈性,促進其以后的身心健康發(fā)展。 主要結(jié)果 1.小耳畸形患者適應結(jié)果問卷調(diào)查結(jié)果： (1)先天性小耳畸形患者心理健康狀況及適應狀況 總體上未手術(shù)組小耳畸形患者的心理健康狀況及適應結(jié)果較手術(shù)組差,表現(xiàn)在心理幸福感量表、身體自尊量表、生活滿意量表等因子得分均顯著低于手術(shù)組,且出現(xiàn)陽性癥狀的比例較高。小耳畸形患者普遍存在著身體吸引力評價較低、主觀幸福感得分低、求助傾向弱、壓力調(diào)節(jié)較差等心理。不同出生地來源下,小耳畸形患者的心理彈性狀況有差異,其中,農(nóng)村小耳畸形患者適應結(jié)果低于城市小耳畸形患者。 (2)先天性小耳畸形患者心理彈性調(diào)查結(jié)果及影響因素 影響小耳畸形患者心理健康的因素主要包括以下幾個方面：①社會環(huán)境因素：如生活事件和心理社會應激、社會支持、社會文化適應、老師同學支持、人際協(xié)助、小耳畸形外耳再造手術(shù)事件應激等；②家庭因素：如父母及親屬的支持；③個體因素：性別、情緒控制、積極認知、目標專注應對方式等。其中,心理社會應激、家庭支持、外耳再造事件等社會因素是影響小耳畸形患者心理健康的重要因素。 2.小耳畸形患者心理彈性模型構(gòu)建及預警機制初探： 將患者的心理彈性各因素進行回歸分析,結(jié)合結(jié)構(gòu)方程模型,得出初步公式。同時總結(jié)分析文獻報道已有的干預措施。以往干預對象主要是戰(zhàn)爭、創(chuàng)傷、家庭暴力、地震、虐待、慢性病等引起的兒童心理問題。所有心理干預分為預防和治療干預兩類,主要干預措施有：心理綜合干預、團體療法、認知行為療法、證言療法、敘事暴露療法、支持性咨詢服務、家庭支持及療法等等,其中,綜合干預是最常用的干預方法。評價心理干預效果的研究大部分為觀察性研究,且存在很多方法學上的局限性。絕大多數(shù)研究均肯定了已開展的心理干預對非自愿手術(shù)小耳畸形患者心理健康有積極的促進作用。 研究結(jié)論 先天性小耳畸形患者的適應狀況總體上未手術(shù)組較手術(shù)組差,且不同出生地下小耳畸形患者的心理彈性各有其特點,小耳畸形患者的心理健康受到社會因素、家庭因素、個體因素及手術(shù)因素的綜合影響,因此采用綜合性的心理干預措施有助于達到更好的干預效果。 結(jié)合先天性小耳畸形患者心理健康問題的總體特點及現(xiàn)有的關(guān)于非自愿手術(shù)小耳畸形患者心理干預的證據(jù),提出一套針對先天性小耳畸形患者心理問題的綜合干預模式,即采取綜合性的以預防為主的干預措施,從社會、學校家庭醫(yī)院及小耳畸形患者個體三個層面,重點針對影響小耳畸形患者心理彈性的主要因素,通過多種干預方式減少小耳畸形患者的社會心理應激、改善其社會支持、提高小耳畸形患者心理彈性等,從而改善小耳畸形患者心理健康水平。此外,家長老師醫(yī)生還應結(jié)合拒絕手術(shù)的小耳畸形患者心理問題的特殊性,開展一些有針對性的心理干預。
[Abstract]:Research background
Congenital microtia is one of the most common congenital craniofacial defects in plastic surgery. Most of the previous studies have paid attention to the clinical surgical treatment, the improvement of the mode of operation, the basic research of cartilage tissue engineering, or the social psychological defects of the patients with small ear deformities, but some patients with small ear deformities are well adapted. This is closely related to psychological elasticity in recent years. This phenomenon is still lack of attention. For a series of psychological effects of congenital defects, whether the patients with small ear deformities can actively respond and adjust their mental attitude is related to the smooth operation of the small ear deformities and the length of the patients with small ear deformities. The physiological and psychological health of the period is stable and stable. Therefore, systematic research on the psychological elasticity of the patients with microtia is of great significance in preventing and improving the physical and mental health of the patients with small ear deformities and promoting the physical and mental health of the patients with small ear deformities.
research objective
To master the adaptation status and psychological elasticity of the patients with congenital microtia in the hospital, analyze the related risk factors of the psychological elasticity of the patients with small ear malformation, construct the mental elastic structure model of the patients with congenital microtia, and combine the mental health of the patients with the involuntary operation of the small ear malformation at home and abroad. The intervention measures of Kang provide a scientific basis for formulating the intervention strategies suitable for the psychological elastic risk factors of the patients with small ear malformation and improving their mental resilience.
research method
1. in order to establish the basic situation of the results of the psychological resilience of the microtia, the basic situation of the psychological resilience of the small ear deformities was examined and the basic situation of the psychosoelastic adaptation of the small ear deformities. The hypothesis provides a realistic basis.
2. the psychological resilience questionnaire of Hu Yueqin and Gan Yiqun was used to explore the psychological elasticity of the patients with small ear malformation by means of exploratory factor analysis and confirmatory factor analysis, and the psychological elastic model of the patients with small ear deformities was constructed by means of exploratory factor analysis and confirmatory factor analysis.
3. after analyzing the data of psychological resilience and related factors, by analyzing the causal relationship between them, three kinds of indicators are determined: one is the antecedent variable that can effectively predict the psychological elasticity, the two is the five dimension variables that can represent the mental resilience, and the three is the result variable that shows the consequences of the psychological resilience. This is the three In order to improve the psychological resilience of the patients with microtia, the psychological resilience of the patients with microtia and the psychological resilience of small ear deformities can be improved. Physical and mental health development.
Main results
1. the results of questionnaire survey of patients with microtia.
(1) mental health status and adaptation of patients with congenital microtia
In general, the mental health status and adaptation results of the patients with small ear malformation were lower than those in the operation group. The scores of factors such as mental well-being scale, body self-esteem scale and life satisfaction scale were significantly lower than those in the operation group, and the proportion of positive symptoms was higher. The score of subjective well-being was low, the tendency of help seeking was weak, and the pressure regulation was poor. The psychological elasticity of the patients with small ear malformation was different from the sources of different birthplaces, and the results of the rural small ear malformation were lower than those of the urban small ear deformity.
(2) investigation results and influencing factors of resilience in patients with congenital microtia
The factors that affect the mental health of the patients with microtia mainly include the following aspects: (1) social environmental factors, such as life events and psychosocial stress, social support, social and cultural adaptation, teachers and students' support, interpersonal assistance, small ear deformity and external ear reconstruction, etc.; and family factors such as support from parents and relatives; 3. Individual factors: gender, emotional control, positive cognition, and target focused coping style. Among them, social factors such as psychosocial stress, family support and external ear reconstruction are important factors affecting the mental health of patients with small ear malformation.
Construction of mental resilience model and early warning mechanism for 2. patients with microtia:
The psychological resilience of the patients was analyzed by regression analysis, combined with the structural equation model, and a preliminary formula was obtained. At the same time, the existing intervention measures were summarized and analyzed. The previous subjects were mainly the psychological problems of children, such as war, trauma, domestic violence, earthquake, maltreatment, chronic disease and so on. All psychological interventions were divided into prevention and treatment. The main intervention measures include psychological comprehensive intervention, group therapy, cognitive behavioral therapy, testimony therapy, narrative exposure therapy, supportive counseling service, family support and therapy, etc., in which comprehensive intervention is the most commonly used intervention. Most of the studies on psychological intervention results are observational, and there are many methodological studies. Most of the studies affirmed that psychological intervention has a positive effect on mental health of patients with involuntary microtia.
research conclusion
The conditions of the patients with congenital microtia were generally worse than those in the operation group, and the mental resilience of the patients with different subterranean microtia had their own characteristics. The psychological health of the patients with small ear malformation was influenced by social factors, family factors, individual factors and surgical factors, so the comprehensive psychological intervention measures were adopted. It helps to achieve better intervention.
Combined with the general characteristics of the mental health problems of the patients with congenital microtia and the existing evidence about the psychological intervention of the patients with involuntary microtia, a set of comprehensive intervention models for the psychological problems of the patients with congenital microtia are put forward, that is to adopt a comprehensive preventive intervention, from the society and the school family hospital. And the individual three levels of the patients with small ear malformation, focusing on the main factors affecting the mental resilience of the patients with microtia, reducing the social psychological stress of the patients with small ear deformities through various intervention methods, improving their social support and improving the mental resilience of the patients with small ear deformities, so as to improve the mental health level of the patients with microtia. In addition, parents Teachers and doctors should also carry out some specific psychological interventions in combination with the particularity of psychological problems of patients with microtia who refuse to operate.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2011
【分類號】：R764

【引證文獻】

相關(guān)博士學位論文 前1條

1 張愛華;意外創(chuàng)傷者的心理彈性及其發(fā)展模型的研究[D];第二軍醫(yī)大學;2012年

相關(guān)碩士學位論文 前1條

1 黃維肖;杭州市空巢老人心理韌性橫斷面研究及其影響因素分析[D];杭州師范大學;2013年

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本文編號：1928862