团体沙盘游戏对急性闭角型青光眼患者围手术期的影响

发布时间：2018-06-07 19:30

本文选题：团体沙盘游戏 + 急性闭角型青光眼　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:急性闭角型青光眼(Acute Angle-Closure Glaucoma,AACG)是临床上一种常见、多发疾病,其本质是一种严重的不可逆性致盲眼病,也是公认的心身疾病,生物、社会以及心理因素与其发生、发展、预后恢复有着密切联系。本文旨在探讨:(1)急性闭角型青光眼患者的人格特征及心理健康状况。(2)急性闭角型青光眼患者手术前后心理状态及皮质醇水平的变化。(3)团体沙盘游戏对急性闭角型青光眼患者围手术期的影响。方法:选取2016年08月-2017年02月就诊于我院符合入选标准的急性闭角型青光眼住院手术患者,接受沙盘游戏心理干预者纳入实验组、不接受者纳入对照组。入院后均给予降眼压药物治疗及常规护理,进行皮质醇检测,填写症状自评量表(SCL-90)及艾森克个性问卷(EPQ)。实验组4名患者组成心理干预小组,由我院同一名心理咨询师于术前1d进行第1次团体沙盘游戏治疗。所有患者均符合手术指征,无手术禁忌症,由同一术者实施滤过性手术(小梁切除手术)。实验组于术后1w、2w、3w及4w各进行1次团体沙盘游戏治疗,监测眼压。术后4周再次检测皮质醇水平及填写症状自评量表(SCL-90)。结果:(1)两组患者年龄、性别、婚姻情况、文化程度、病程之间差异无统计学意义(P0.05)。(2)艾森克个性问卷(EPQ):AACG患者E值(内外向)、P值(精神质)均显著高于中国常模(P0.01),N值(神经质)高于中国常模(P0.05),L值(掩饰性)低于中国常模(P0.01)。(3)症状自评量表(SCL-90):手术后实验组躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性、总均分及总分得分均明显下降(P0.05),且均低于对照组(P0.01)。对照组除强迫症状得分较术前差异无统计学意义外(P0.05),其他方面得分均高于术前(P0.05)。(4)皮质醇:手术后实验组皮质醇水平较术前明显下降(P0.01),且较对照组明显降低(P0.01),对照组皮质醇水平较术前升高(P0.05)。(5)眼压:术后4周内,实验组眼压持续低于对照组,且波动性较对照组小(P0.05)。结论:(1)急性闭角型青光眼患者具有情感及人格不稳定、神经质倾向及精神病性等心理人格特征;(2)急性闭角型青光眼患者手术后情绪障碍加重,外周血皮质醇水平升高,内分泌系统存在紊乱现象;(3)团体沙盘游戏对改善急性闭角型青光眼患者围手术期心理状态、纠正内分泌紊乱、降低眼压并维持术后眼压稳定性起到积极作用。
[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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

【参考文献】