认知行为干预在尿毒症血液透析患者护理中的临床意义

目的研究认知行为干预对尿毒症血液透析患者的焦虑抑郁情绪及营养指标的影响。方法将2010年10月—2012年12月在西安市第九医院血液净化中心行血液透析的慢性肾功能衰患者398例。随机分为试验组和对照组，试验组199例，对照组199例，对照组采用血液透析患者常规护理方式，试验组在血液透析患者常规护理方式上加用认知行为干预心理护理方法，记录两组患者采用一般情况调查表，焦虑自评量表（SAS）、抑郁自评量表（SDS）进行问卷调查的结果，并对患者进行主观综合营养评估、体重指数、前白蛋白等进行检测。结果经过12周干预后，试验组患者SAS与SDS总分较对照组有明显的下降，差异具有统计学意义（P〈0．05）；干预后试验组焦虑抑郁发生率均低于对照组，其差异具有统计学意义（P〈0．05）；干预后试验组正常营养状态、轻中度营养不良、重度营养不良例数较对照组有一定的好转，其差异具有统计学意义（P〈0．05）；干预后试验组患者体重指数、前白蛋白较对照组具有不同程度的升高，其差异具有统计学意义（P〈0．05）。结论认知行为干预可以明显缓解焦虑抑郁不良情绪；认知行为干预可在一定程度上改善患者的营养状态。

Clinical significance of cognitive behavioral intervention on nursing care of uremia patients undergoing hemodialysis

Objective] To study the effect of cognitive behavioral intervention on anxiety, depression and nutrition indexes in uremia patients undergoing hemodialysis. Methods] 398 patients with chronic renal failure, who were treated with the hemodialysis in the Blood Purification Center of the Ninth Hospital of Xi＇an City from October 2010 to December 2012, were randomly divided into the experimental group （ 199 cases） and the control group （ 199 cases ）. The control group was given the routine nursing care of hemodialysis, while the experimental group received the psychological nursing care of cognitive behavioral intervention on the basis of routine nursing care. The results of the general situation questionnaire, Self-rating anxiety scale （SAS） and Self-rating depression scale （SDS） in two groups were recorded. The subjective global assessment of nutrition was conducted, while BMI and prealbumin level were tested. Results] After 12 weeks of intervention, the total scores of SAS and SDS in the experimental groups were signifi- cantly lower than those in the control group （ P 〈 0.05 ）. After intervention, the incidence rates of anxiety and depression in the ex- perimental groups were significantly lower than those in the control group （ P 〈 0.05 ）. After intervention, the case proportion of normal nutritional status, mild-moderate malnutrition, and severe malnutrition in the experimental groups was significantly better than that in the control group （ P 〈 0.05 ）. After intervention, BMI and prealbumin level of the experimental group were significant- ly higher than those in the control group （ P 〈 0.05 ）. Conclusion ] The cognitive behavioral intervention can obviously alleviate the unhealthy emotion of anxiety and depression, and improve the nutritional status of patients in a certain degree.