类风湿关节炎患者生命质量的影响因素及心理干预研究

发布时间：2018-12-09 19:18

【摘要】：目的调查类风湿关节炎患者的生命质量、焦虑抑郁、疼痛、疾病不确定感、睡眠质量状况,探究影响生命质量的心理社会因素。运用认知行为和正念为理论基础对患者进行心理干预,分析干预对影响类风湿关节炎患者生命质量各因素的效果。方法1.调查研究:采取方便抽样,对230例类风湿关节炎患者进行调查研究,采用类风湿关节炎患者生命质量测定量表QLICD-RA(V2.0)、疼痛VAS评分、焦虑自评量表(SAS)、抑郁自评量表(SDS)、疾病不确定感量表(MUIS)、匹兹堡睡眠指数量表(PSQI)对患者进行调查,剔除无效问卷后,共收集210例类风湿关节炎患者。2.干预研究:选取符合入组条件的80例患者,由于研究中途脱落,最后完成干预组和对照组各35人。干预组患者在常规药物治疗的基础上给予心理干预,对照组只进行常规药物治疗。结果1.调查研究结果:(1)类风湿关节炎患者生命质量水平低于平均值。(2)类风湿关节炎患者生命质量的各维度及总分在性别、年龄、文化程度、婚姻状况等社会人口学特征及疾病的DAS28评分上有差异(p0.01)。(3)疾病不确定感各维度及总分均与生命质量各维度及总分呈负相关,除特异模块与复杂性不相关外(p0.01);焦虑抑郁与生命质量的各维度及总分均呈负相关(p0.01);匹兹堡睡眠指数量表得分与生命质量得分间呈负相关(p0.05),除社会功能、特异模块与催眠药物不相关外;疼痛与生理功能、社会功能、特异模块和生命质量总分呈负相关(p0.01)。(4)回归分析结果显示,影响RA患者生命质量的主要因素依次为:SDS、睡眠障碍、SAS、疼痛VAS评分、不确定性、婚姻状况。2.干预研究结果:(1)心理干预后,干预组和对照组患者在生命质量上得分差异具有统计学意义(p0.01),干预组患者的生命质量改善程度高于对照组;(2)心理干预后,干预组患者的焦虑、抑郁、疾病不确定感改善程度高于对照组,睡眠质量显著提高,疼痛感和生理指标也显著降低(p0.01)。结论类风湿关节炎患者生命质量总体水平低。患者生命质量受人口学变量及疾病相关因素的影响,而抑郁、睡眠障碍、焦虑、疼痛VAS评分、疾病不确定性、婚姻状况在一定程度上能预测患者生命质量的高低。心理干预可以有效地降低患者疾病不确定感和疼痛感,缓解其焦虑抑郁情绪状态,提升患者睡眠状况和生命质量。
[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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.22

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