急性胰腺炎患者心理应激情况与医学应对方式的关系以及基于IMB模型干预方案的效果研究

目的 探讨急性胰腺炎（AP）患者心理应激情况与医学应对方式的关系，研究基于信息-动机-行为技巧（information-motivation-behavioral skill，IMB）模型的综合干预对患者心理应激情况及医学应对方式的作用。方法 前瞻性选取西安交通大学第二附属医院2016年3月至2019年1月期间收治的AP患者100例，随机分为两组，对照组（50例）实施常规临床干预+常规护理干预，干预组（50例）实施基于IMB模型的综合干预。根据焦虑自评量表（SAS）和抑郁自评量表（SDS），对比两组干预前及干预后7 d的焦虑、抑郁等不良心理状态；根据Herth希望量表（HHI）评估患者干预前后的差异；根据医学应对方式问卷（MCMQ）评价患者干预前后的医学应对方式。随后，采用线性回归法，分析患者心理应激情况与医学应对方式的关系。结果 干预前两组SAS评分、SDS评分、HHI量表各维度评分及HHI总分均无统计学差异（P＞0.05）；干预后两组SAS、SDS评分均低于干预前，且干预组评分下降程度高于对照组，差异均有统计学意义（P＜0.05）；两组HHI量表各维度评分及总分均高于干预前，且干预组评分上升程度高于对照组，差异均有统计学意义（P＜0.05）。干预前两组患者MCMQ问卷各分量表评分均无统计学差异（P＞0.05）；干预后的面对分量表评分高于干预前，回避、屈服分量表评分均低于干预前，差异均有统计学意义（P＜0.05）；经协方差分析，调整干预前的各分量表评分后，干预组干预后的面对分量表评分高于对照组，回避和屈服分量表评分均低于对照组，差异均有统计学意义（P＜0.05）。线性回归分析，SAS评分对患者医学应对方式“面对”情况有显著负向影响，对患者“回避”“屈服”情况均有显著正向影响；SDS评分对患者“面对”情况有显著负向影响，对患者“回避”情况无影响，但对患者“屈服”情况有显著正向影响；HHI总分对患者“面对”情况有显著正向影响，但对患者“回避”“屈服”情况均有显著负向影响。结论 急性胰腺炎患者可发生焦虑、抑郁且希望水平下降，会影响其医学应对方式；基于IMB模型的综合干预方案不仅可改善患者的心理应激情况，而且可进一步改善其医学应对方式。

Relationship between psychological stress and medical coping style in patients with acute pancreatitis and the effect of intervention based on IMB model

Objective To investigate the relationship between psychological stress and medical coping style in patients with acute pancreatitis (AP), and to study the effect of comprehensive intervention based on the information-motivation-behavioral skill (IMB) model on patients’ psychological stress and medical coping style.Methods A total of 100 AP patients were prospectively selected and randomly divided into two groups. Patients in the control group (n=50) received routine clinical intervention+nursing intervention, patients in the intervention group (n=50) received comprehensive intervention based on the IMB model. According to Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS), the bad psychological state before and 7 d after intervention were compared between the two groups, the hope level of patients before and after intervention were evaluated by Herth Hope Index (HHI), and the medical coping style of patients before and after intervention were evaluated by Medical Coping Modes Questionnaire (MCMQ). Then, linear regression analysis was employed to analyze the relationship between psychological stress and medical coping style. Results Before the intervention, there was no significant difference in SAS score, SDS score, HHI score or HHI total score between the two groups (P>0.05); after the intervention, both SAS score and SDS score of the two groups were lower than those before the intervention, and the decrease degree of the intervention group was higher than that of the control group (P<0.05); both the HHI score and total score of the two groups were higher than those before the intervention, and the increase degree of the intervention group was higher than that of the control group (P<0.05). Before the intervention, there was no statistical difference between the two groups in the MCMQ subscales (P>0.05); after the intervention, the score of the face subscale was statistically higher than that before the intervention, and the scores of avoidance subscale and yield subscale were statistically lower than those before the intervention (P<0.05). According to covariance analysis, after adjusting the scores of each subscale before intervention, the score of face subscale in intervention group was higher than that of the control group, and the scores of avoidance subscale and yield subscale were lower than those of the control group (P<0.05). Linear regression analysis showed that SAS score had a significant negative impact on the “face” state of patients’ medical coping style, and had a significant positive impact on the “avoidance” state and “yield” state of patients; SDS score had a significant negative impact on the “face” state of patients, had no impact on the “avoidance” state of patients, but had a significant positive impact on the “yield” state of patients; HHI total score had a significant positive impact on the “face” state of patients, but had significant negative effects on the “avoidance” state and “yield” state of patients. ConclusionAnxiety and depression may occur in patients with AP, and the level of hope may decrease, which would affect their medical coping style. The comprehensive intervention based on IMB model could not only improve the psychological stress of AP patients, but also further improve their medical coping style.