非药物干预中丰富环境治疗老年期痴呆有效性的临床研究

发布时间：2018-05-07 08:15

本文选题：老年期痴呆 + 非药物干预治疗　；参考：《宁波大学》2017年硕士论文

【摘要】：目的:本研究拟通过对宁波市康宁医院老年病区老年期痴呆患者的“丰富环境”干预,探索以丰富环境干预措施为主体的非药物治疗的有效性。如果能通过非药物干预治疗手段改善痴呆预后,减少住院时间,提高患者的生活质量,这不仅能解决医疗资源紧张的问题,也能减少疾病负担。同时也为今后在社区开展进行非药物干预治疗提供一定的理论及技术支持依据。方法:2015年11月~12月,我们对宁波市康宁医院三个老年病区的所有患者进行了筛查。共选择60名年龄在65岁以上的且诊断为“老年期痴呆”的患者,同时需满足简易智力状态检查量表(Mini-mental State Examination,MMSE)评分大于等于10分。对照组为药物治疗组;实验组为药物治疗+丰富环境干预组。根据实验设计需要,又将实验组分为两组,实验组1:药物治疗+3条目丰富环境组;实验组2:药物治疗+5条目丰富环境组。实验组每周需接受5次丰富环境干预治疗,时间为半小时,累计12周。患者入组后,将分别在干预前(基线期)和干预后第4周末、8周末及12周末,进行相应量表评定。对评定人员进行培训,并作为一致性检验,采用一对一的方式对患者进行认知功能评定、日常生活能力及抑郁情绪评定,并由精神科主治医师参与质控。建立数据库Epidata3.1的数据库,采用双人录入的方法,最终收集的数据导入SPSS15.0,采用卡方检验来检验计算资料,采用T检验或者方差对计量资料进行分析,P0.05为差异有统计学意义。结果:整个研究共脱落患者5例,实验组共有19名男性老年期痴呆患者和18名女性老年期痴呆患者完成研究,年龄为66~76岁,平均72.9±2.3岁;对照组共有9名男性老年期痴呆患者和9名女性老年期痴呆患者完成研究,年龄67~78岁,平均年龄71.3±3.5岁。干预前,各组之间无显著性差异。加入丰富环境干预后,三组认知功能改善情况在4周末、8周末以及12周末,对照组患者的MMSE量表评分都小于实验组,差异显著。实验组中5条目丰富环境干预组的MMSE总分均高于3条目丰富环境干预组。三组在丰富环境干预前后情绪改善(HAMD)情况评定显示:在丰富环境干预治疗4周末、8周末以及12周末,实验组患者的HAMD总均分均低于对照组(P0.05),但5条目丰富环境干预组对比3条目丰富环境干预组。在丰富环境干预后,三组BADL(Basic activities of daily living,基础性日常生活能力量表)的BI(Barthel Index)比较显示:相对于入组前,入组后均表现出BI均数的提高,入组前后的BI差异对比有统计学意义(P0.05)。在BI均数提高方面,实验组表现更佳,不管是在4周末、8周末还是12周末,丰富环境干预组BI均数与对照组相比均明显升高,有统计学意义(P0.05);但需要指出的是,实验组2增加了丰富环境干预条目数,但对比实验组1,其BI差异无统计学意义。在丰富环境干预后,三组老年期痴呆患者的主动活动量,均未表现出明显的变化,且三组间对比无明显差异(P0.05)。结论:非药物干预中,利用丰富环境治疗老年期痴呆是有效的。通过丰富环境对老年期痴呆患者的干预,能显著改善他们的认知功能、空间记忆能力并对情绪的改善等一系列的问题得到明显的改善,进而降低老年期痴呆患者的残疾水平,使其社会功能得到改善,生活质量得到提高。以此也能减轻家庭及社会的疾病负担,对促进患者回归社会、提升家庭幸福指数,有着重要的意义。简单、方便、安全、经济的“丰富环境”的非药物干预模式,值得在家庭及社区中应用推广。
[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.

【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.16

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