目的: 探讨心理干预和团体活动对耐多药结核病患者心理状态及治疗依从性的影响。方法: 将200例患者随机分为常规组和干预组各100例,常规组采用常规健康教育及一般常规护理,干预组采用心理干预、团体活动等多形式干预,采用症状自评量表(symptom checklist-90,SCL-90)进行心理状况调查测评,采用服药依从性量表进行服药依从性测评。结果: SCL-90中躯体化、强迫症状、人际关系敏感、抑郁、偏执、精神病性、睡眠及饮食几个维度,干预组得分均低于常规组(P＜0.05),干预组SCL-90情况总均分低于常规组(P＜0.05);干预组患者治疗依从性总均分高于常规组(t=-2.740,P=0.007);其中“结核病治疗周期长,您是否觉得长期服药有困难？”“您多久会有一次忘记服药？”“在过去的2周内,是否曾经忘记服用结核药？”这3个条目的分值干预组均高于常规组(P＜0.05)。结论: 心理干预及团体活动可改善耐多药结核病患者的不良心理状态,提高治疗依从性,促进患者康复。
Objective: To explore the effects of psychological intervention and group activities on the psychological state and treatment compliance of patients with multi-drug resistant tuberculosis. Methods: A total of 200 patients were randomly divided into the control group and intervention group with 100 cases in each group. The control group received routine health education and general routine nursing. Psychological intervention, group activities and other forms of intervention were used in the intervention group. The self-rating Symptom Scale (SCL-90) was used to evaluate the psychological status of patients, and the medication compliance scale was used to evaluate the medication compliance. Results: The total mean score of SCL-90 in the intervention group was lower than that in the control group (t=2.877, P=0.004). Items of SCL-90 including somatization, obsessive symptoms, interpersonal sensitivity, depression, paranoia, psychosis, sleep and diet, the scores of the above items were lower in the intervention group than those in the conventional group (P＜0.05). The total mean score of treatment compliance in the intervention group was higher than that in the control group (t=-2.740, P=0.007). "Is it difficult for you to take anti-tuberculosis medicine for a long time?", "How often have you forgot taking your medication? ", Have you ever forgot taking your TB medicine in the past two weeks? ", the scores of the above 3 items in the intervention group were all higher than those in the control group (P＜ 0.05). Conclusion: Psychological intervention and group activities can alleviate the adverse psychological state of MDR-TB patients, improve the treatment compliance, and enhance the recovery of patients.
[1] 周琳, 王晓萌, 柴程良, 等. 耐多药肺结核患者心理健康状况及其影响因素调查研究[J]. 中国预防医学杂志, 2017, 18(12): 894-897.
[2] 全国第5次结核病流行病学抽样调查技术指导组, 全国第5次结核流行病抽查抽样办公室. 2010年全国第五次结核病流行病学抽样调查报告[J]. 中国防痨杂志, 2012, 34(8): 485-508.
[3] 周永彪. 耐多药肺结核患者心理健康状况及其影响因素的调查研究[J]. 临床合理用药, 2019, 12(3): 117-118.
[4] 郝俊玲. 实施心理护理干预在耐多药结核病患者中的效果观察[J]. 疾病监测与控制, 2017, 11(4): 339-340.
[5] 张培元. 肺结核诊断和治疗指南[J]. 中华结核和呼吸杂志, 2001, 24(2): 70-74.
[6] 那崇坤, 陈萍, 沈梅. 症状自评量表各因子稳定性评估[J]. 中国临床康复, 2006, 10(2): 156.
[7] 司在霞, 郭灵霞, 周敏, 等. 修订版Morisky服药依从性量表用于抗凝治疗患者的信效度检测[J]. 护理学杂志, 2012, 27(22): 23-26.
[8] 马雪雪. 耐多药结核病患者服药依从性现状调查[J]. 黑龙江科学, 2021, 12(18): 61-63.
[9] 李媛媛, 苏东栋, 阿尔泰. 全球基金标准化疗方案治疗耐多药肺结核临床疗效研究进展[J]. 新疆医学, 2018, 48(12): 1346-1348.
[10] 喻忠慧, 陈金瓯, 郭亚男, 等. 团体干预对耐多药肺结核患者治疗效果的影响[J]. 实用临床护理学杂志, 2017, 2(3): 3-6.
[11] 周永彪. 肺结核患者心理状况与服药依从性的相关性研究[J]. 吉林医学, 2018, 39(9): 1761-1762.
[12] 臧珊珊, 崔敬华, 朱惠英, 等. 肺结核患者心理状况及影响因素分析[J]. 解放军医药杂志, 2019, 31(11): 47-49.
[13] 乔琳娜. 心理护理干预对耐多药肺结核患者用药依从性及负性情绪的影响[J]. 山西职工医学院学报, 2018, 28(3): 100-101.
[14] 钟艳华, 吕露, 曾慧频. 自我效能理论对耐多药肺结核患者服药依从性的影响[J]. 齐鲁护理杂志, 2017, 23(9): 78-80.
[15] 黄静静. 陈亚玲, 熊昌富, 等. 海南省92例肺结核耐药的危险因素分析[J]. 2018, 18(2): 125-127.
