健康宣教对脑血管病患者心理健康的影响

目的 探讨综合健康宣教模式对脑血管病患者焦虑-抑郁障碍的影响。方法 采用汉密尔顿抑郁量表（Hamilton Rating Scale for Depression，HRSD）、汉密尔顿焦虑量表（Hamilton Anxiety Scale，HAMA）进行焦虑-抑郁程度的评价，将门诊患有焦虑-抑郁的脑血管病患者60例按照连续入组前后对照的方式分为试验组和对照组各30例；对照组仅采用常规模式宣教，口服选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors，SSRIs）类抗焦虑-抑郁药，而试验组实行口服SSRIs类抗焦虑-抑郁药的同时给予面对面的口头宣教、书面宣教、肢体宣教、随机宣教等模式的健康宣教，3个月后对试验组和对照组重新进行HRSD和HAMA评价。结果 经过3个月的治疗，试验组没有焦虑11例（36.7％），可能有焦虑15例（50％），肯定有焦虑4例（13.3％），对照组没有焦虑2例（6.6％），可能有焦虑14例（46.7％），肯定有焦虑14例（46.7％），两组复诊时焦虑障碍程度试验组明显比对照组缓解焦虑效果好，两组之间差异有显著性（P<0.05）。3个月后试验组没有抑郁12例（40％），可能有抑郁15例（50％），肯定有抑郁3例（10％），对照组没有抑郁1例（3.3％），可能有抑郁18例（60％），肯定有抑郁11例（36.7％），两组复诊时抑郁障碍程度试验组明显比对照组缓解抑郁效果好，两组之间差异有显著性（P <0.05）。经过3个月的治疗，对照组患者的焦虑和抑郁虽有一定的改善，但经秩和检验，差异无显著性（P >0.05）。而给患者口服抗焦虑-抑郁药治疗的同时配以健康宣教护理，对预防和缓解患者的焦虑和抑郁效果比仅采用常规模式护理的对照组有显著的提高，经秩和检验，差异有显著性（P<0.05）。结论 采用健康宣教护理对预防和缓解患者的焦虑和抑郁，并配以药物治疗，其效果优于单纯药物治疗，可以增强脑血管病患者自我保健意识，减少焦虑-抑郁的发生。

Effects of Health Education for Mental Health in Patients with CerebrovascularDiseases

Objective To discuss the effects of comprehensive health education model on the anxiety and depressive disorders of patients with cerebrovascular diseases.
Methods The Hamilton Rating Scale for Depression（HRSD） and Hamilton Anxiety Scale（HAMA） were applied to evaluate the severity of anxiety-depression. Sixty outpatients with cerebrovascular diseases suffering from anxiety-depression were divided into experimental group and control group with 30 cases in each group. The control group received only conventional mode of education, and took anti anxiety-depression medicines of selective serotonin reuptake inhibitors（SSRls）; while the experimental group received health education together with taking SSRIs anti anxiety-depression medicines. Three months later, the experimental group and the control group were re-evaluated by HRSD and HAMA.
Results After 3 months treatment, in the experimental group, there are 11 cases（36.7%） which don＇t have anxiety, 15 cases（50%） may have anxiety, and 4 cases（13.3%） have anxiety certainly. In the control group, there are 2 cases（6.6%） which don＇t have anxiety, 14 cases（46.7%） may haveanxiety, and 14 cases（46.7%） have anxiety certainly. It shows that the alleviate anxiety effect of 3 months treatment to anxiety disorder of experimental group is significantly better than that of the control group（P〈0.05）. After 3 months treatment, in the experimental group, there are 12 cases（40%） which don＇t have depression, 15 cases（50%） may have depression, and 3 cases（10%） have depression certainly. In the control group, there is 1 case （3.3%） which doesn＇t have depression, 18 cases（60%） may have depression, and 11 cases（36.7%） have depression certainly. The alleviate depression effect of 3 months treatment to depression disorder of experimental group is significantly better than that of the control group（P〈0.05）. After 3 months treatment, the conditions of all 60 patients with anxiety and depression in both the experimental group and control group were improved. Comparing the two groups, the effect of prevention and mitigation of anxiety and depression of patients receiving health education care coupled with taking anti- anxiety-depression drugs treatment is significantly greater than that of the control group with conventional mode care. The result of Rank sum test showed（P〈0.05）.
Conclusion The effect of health education care together with drug therapy to prevent and alleviate the patient＇s anxiety and depression is better than medication alone. Effective health education can enhance the self health care consciousness of patients with cerebrovascular diseases, and reduce the anxiety depression.