Snyder希望理论指导下行为干预对NTM肺病患者负性情绪和应对方式的影响

doi:10.19983/j.issn.2096-8493.20220059

摘要/Abstract

摘要：

目的: 探讨Snyder希望理论指导下的行为干预对非结核分枝杆菌(non-tuberculous mycobacterial,NTM)肺病患者负性情绪和应对方式的影响。方法:选取武汉市肺科医院2021年1—6月收治的符合入组标准的75例NTM肺病患者作为对照组,7—12月的75例NTM肺病患者作为观察组;对照组予以常规护理,观察组在常规护理的基础上予以Snyder希望理论指导下的行为干预。通过心理弹性量表简化版(CD-RISC10)、Herth希望量表(HHI)、医学应对方式问卷(MCMQ)、Morisky服药依从性量表,以及肺总量(TCL)、用力肺活量(FVC)、一氧化碳弥散量(DLCO)评价两组患者护理后负性情绪、应对方式(包括面对、回避、屈服3个维度)、治疗依从性,以及肺功能变化情况。结果:观察组护理后的CD-RISC10评分[(32.22±3.23)分]、HHI评分[(38.36±3.33)分]、MCMQ面对维度评分[(28.84±2.23)分]、肺总量[(5.32±0.73)L]、用力肺活量[(4.24±0.75)L]、一氧化碳弥散量水平[(18.68±3.22)ml·min^-1·mmHg^-1]均高于对照组[分别为(26.28±3.37)分、(30.68±3.35)分、(21.23±2.25)分、(4.83±0.58)L、(3.28±0.53)L、(15.95±2.21)ml·min^-1·mmHg^-1](t=11.020、14.081、20.804、4.551、9.053、6.054,P值均<0.001);治疗依从性[97.33%(73/75)]也高于对照组[88.00%(66/75)](χ²=4.807,P=0.028);但回避维度评分[(15.24±1.25)分]和屈服维度评分[(7.68±1.22)分]均低于对照组[分别为(18.98±2.23)分、(10.95±2.21)分](t=12.680、11.218,P值均<0.001)。结论:Snyder希望理论指导下的行为干预可有效改善NTM肺病患者的负性情绪、应对方式,有助于进一步提升患者治疗依从性及肺功能。

关键词: 分枝杆菌,非典型性, 行为疗法, 干预性研究, 对比研究, Snyder希望理论

Abstract:

Objective: To explore the effects of behavioral intervention under the guidance of Snyder’s Hope theory on negative emotions and coping styles of patients with non-tuberculous mycobacterial (NTM) pulmonary disease. Methods: Seventy-five patients with NTM pulmonary disease admitted to Wuhan Pulmonary Hospital from January to June 2021 were selected as the control group,75 patients with NTM pulmonary disease from July to December 2021 were selected as the observation group. The former were given routine nursing, while the latter were given behavioral intervention under the guidance of Snyder’s Hope theory on the basis of routine nursing. Through the Resilience Scale Simplified (CD-RISC10), Herth Hope Inventory (HHI), Medical Coping Style Questionnaire (MCMQ), Morisky Medication Adherence Scale, as well as total lung capacity (TCL), forced vital capacity (FVC), the diffusing capacity of carbon monoxide (DLCO) were used to evaluate the negative emotions, coping styles (including three dimensions of face, avoidance, and yield), treatment compliance and pulmonary function changes in the two groups of patients after nursing. Results: In the observation group,the scores of Psychological Resilience Scale Simplified (CD-RISC10)(32.22±3.23), Herth Hope Inventory (HHI)(38.36±3.33), the post-nursing medical coping style questionnaire (MCMQ) in the face dimension score (28.84±2.23),the total lung capacity (TCL), force vital capacity (FVC), diffusing capacity of carbon monoxide (DLCO)((5.32±0.73) L, (4.24±0.75) L, (18.68±3.22) ml·min^-1·mmHg^-1) after nursing,were higher than the control group (26.28±3.37), (30.68±3.35), (21.23±2.25) points, (4.83±0.58) L, (3.28±0.53) L, (15.95±2.21) ml·min^-1·mmHg^-1 points (t=11.020, 14.081,20.804, 4.551, 9.053, 6.054, all P<0.001). The treatment compliance of the observation group (97.33% (73/75)) was higher than of the control group (88.00% (66/75)) (χ²=4.807, P=0.028).But the scores of avoidance dimension (15.24±1.25) and yield dimension (7.68±1.22) were lower than the control group (18.98±2.23) and (10.95±2.21) (t=12.680, 11.218, all P<0.001). Conclusion: Behavioral intervention guided by Snyder’s Hope theory can effectively improve the negative emotions and coping styles of NTM patients, and further improve their treatment compliance and lung function.

Key words: Behavior therapy, Intervention studies, Mycobacteria,atypical, Comparative study, Snyder’s theory of hope

中图分类号:

林晶, 李岚, 刘颖. Snyder希望理论指导下行为干预对NTM肺病患者负性情绪和应对方式的影响[J]. 结核与肺部疾病杂志, 2022, 3(4): 287-291. doi: 10.19983/j.issn.2096-8493.20220059

Lin Jing, Li Lan, Liu Ying. Effects of behavioral intervention on negative emotions and coping styles of NTM patients with pulmonary disease under the guidance of Snyder’s Hope theory[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(4): 287-291. doi: 10.19983/j.issn.2096-8493.20220059

图/表 5

表1

两组患者一般资料情况

组别	男性[例 (构成比,%)]	女性[例 (构成比,%)]	年龄(岁, $x ¯$ ±s)	初治[例 (构成比,%)]	复治[例 (构成比,%)]	病程(年, $x ¯$ ±s)	住院时间 (d, $x ¯$ ±s)
组(75例)	40(53.3)	35(46.7)	44.50±8.78	53(70.7)	22(29.3)	6.27±1.54	7.00±1.32
对照组(75例)	39(52.0)	36(48.0)	44.12±8.76	52(69.3)	23(30.7)	6.25±1.56	6.80±1.34
统计检验值	χ²=0.027		t=0.265	χ²=0.032		t=0.079	t=0.921
P值	0.870		0.791	0.859		0.937	0.359

表1

表2

两组患者负性情绪评分情况

组别	CD-RISC10(分, $x ¯$ ±s)		t值	P值	HHI(分, $x ¯$ ±s)		t值	P值
	CD-RISC10(分, $x ¯$ ±s)				护理前	护理后
	护理前	护理后			护理前	护理后
观察组(75例)	19.57±2.47	32.22±3.23	26.942	<0.001	23.23±3.32	38.36±3.33	27.865	<0.001
对照组(75例)	19.56±2.45	26.28±3.37	13.968	<0.001	23.21±3.31	30.68±3.35	13.737	<0.001
t值	0.025	11.020	-	-	0.037	14.081	-	-
P值	0.980	<0.001	-	-	0.971	<0.001	-	-

表2

表3

两组患者MCMQ中应对方式各维度评分情况

组别	面对(分, $x ¯$ ±s)		t值	P值	回避(分, $x ¯$ ±s)		t值	P值	屈服(分, $x ¯$ ±s)		t值	P值
组别	护理前	护理后	t值	P值	护理前	护理后	t值	P值	护理前	护理后	t值	P值
观察组 (75例)	16.84± 2.33	28.84± 2.23	32.222	<0.001	23.87± 2.33	15.24± 1.25	28.266	<0.001	16.43± 2.35	7.68± 1.22	28.619	<0.001
对照组 (75例)	16.86± 2.32	21.23± 2.25	11.710	<0.001	23.86± 2.35	18.98± 2.23	13.045	<0.001	16.45± 2.33	10.95± 2.21	14.832	<0.001
t值	0.053	20.804	-	-	0.026	12.680	-	-	0.052	11.218	-	-
P值	0.958	<0.001	-	-	0.979	<0.001	-	-	0.958	<0.001	-	-

表3

表4

表5

两组患者肺功能护理前后评分情况

组别	TCL(L, $x ¯$ ±s)		t值	P值	FVC(L, $x ¯$ ±s)		t值	P值	DLCO(ml·min^-1· mmHg^-1, $x ¯$ ±s)		t值	P值
组别	护理前	护理后	t值	P值	护理前	护理后	t值	P值	护理前	护理后	t值	P值
观察组 (75例)	3.84± 0.63	5.32± 0.73	13.292	<0.001	2.97± 0.43	4.24± 0.75	12.722	<0.001	14.43± 2.35	18.68± 3.22	9.233	<0.001
对照组 (75例)	3.86± 0.62	4.83± 0.58	9.895	<0.001	2.96± 0.45	3.28± 0.53	3.985	<0.001	14.45± 2.33	15.95± 2.21	4.045	<0.001
t值	0.196	4.551	-	-	0.139	9.053	-	-	0.052	6.054	-	-
P值	0.845	<0.001	-	-	0.890	<0.001	-	-	0.958	<0.001	-	-

表5

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组别	完全依从	部分依从	不依从	依从性
观察组(75例)	29(38.67)	44(58.67)	2(2.67)	73(97.33)
对照组(75例)	46(61.33)	20(26.67)	9(12.00)	66(88.00)
χ²值	7.707	15.698	4.807	4.807
P值	0.006	0.000	0.028	0.028