认知-行为疗法提高糖尿病肾病患者活动量和生活质量的研究

目的探讨认知—行为疗法对糖尿病肾病(diabetic nephropathy,DN)患者活动量和生活质量的影响。方法纳入陆军军医大学大坪医院肾内科108名DN患者,根据随机数字表分成试验组(认知—行为干预组)和对照组(标准护理组)。两组患者均接受相同的标准治疗方案、饮食指导和常规活动指导建议。在此基础上,试验组采用认知-行为干预疗法:(1)建立信任;(2)检验负性思维;(3)重塑认知;(4)巩固意识。入组后0、3、6、12月进行随访,采用体育活动等级量表(PARS-3)评价运动量。记录心血管危险因素、肾小球滤过率,白蛋白,体质量指数等。采用SF-36量表评价两组生活质量评分。结果入组3个月时,认知干预组的运动量(39.6±6.4)分大于对照组(22.4±7.1)分,差异有统计学意义(t=-3.983,P<0.01);试验组每月运动累计时间(79.6±11.2)h大于对照组(32.1±11.6)h,差异有统计学意义(t=-2.015,P=0.021)。入组6个月后实验组糖化血红蛋白、空腹血糖、舒张压和收缩压低于对照组(P<0.05)、实验组肾小球滤过率高于对照组(P<0.05),躯体功能(PF)、由躯体问题所造成的角色限制(RP)分值显著高于对照组(P<0.05)。入组12个月后实验组的PF、RP、躯体不适(BP)分值均高于对照组(P<0.05)。结论认知行为干预可加强DN患者的运动意识,增加其活动量,改善血糖控制水平,提高患者生存质量。

Cognitive-behavioral therapy improves the activity and quality of life of patients with diabetic nephropathy

Objective To investigate the effects of cognitive-behavioral therapy on activity and quality of life in patients with diabetic nephropathy(DN).Methods A total of 108 patients with diabetic nephropathy in Army Medical University were enrolled,and randomly divided into experimental group(cognitive-behavioral intervention group)and control group(standard nursing group)according to a random number table.The patients in both the groups received the same standard treatment plan,dietary guidance,and general activity guidance recommendations.On this basis,the experimental group adopted cognitive-behavioral intervention therapy:(1)building trust;(2)testing negative thinking;(3)reshaping cognition;(4)consolidating consciousness.At 0,3,6 and 12 months after enrollment,A follow-up was performed,and the physical activity rating scale(PARS-3)was adopted to evaluate activity strength.Cardiovascular risk factors,glomerular filtration rate,albumin,and body mass index were recorded.The SF-36 scale was used to evaluate quality of life scores of the two groups.Results At 3 months of enrollment,the exercise volume of the cognitive intervention group(39.61±6.43 points)was greater than that of the control group(22.42±7.12 points)significantly(t=-3.983,P<0.01).The cumulative exercise time(79.56±11.21 hours)of the cognitive intervention group was greater than that of the control group(32.13±11.64 hours)significantly(t=-2.015,P=0.021).After 6 months of enrollment,the glycated hemoglobin,fasting blood glucose,diastolic blood pressure and systolic blood pressure in the experimental group were lower than those in the control group(P<0.05),and the glomerular filtration rate in the experimental group was higher than that in the control group(P<0.05).Physical function(PF)and role physical(RP)values were significantly higher than the control group(P<0.05).The scores of PF,RP and bodily pain(BP)in the experimental group were higher than those in the control group after 12 months(P<0.05).Conclusions Cognitive behavioral intervention can enhance the exercise consciousness of patients with diabetic nephropathy,increase their activity,improve blood sugar control and improve the quality of life of patients.