认知行为疗法在合并焦虑的慢性难愈合创面患者中的临床研究

目的探讨认知行为疗法对合并焦虑的慢性难愈合创面患者创面治疗效果的影响。 方法选取2018年2月至9月于临沂市中心医院烧伤整形科住院治疗的符合入选标准的40例合并焦虑的慢性难愈合创面患者，将所有患者随机编号，编号为奇数的设为干预组，编号为偶数的设为对照组，每组各20例。2组患者均接受常规慢性难愈合创面的治疗和护理，干预组患者在此基础上给予认知行为疗法干预，包括会谈治疗、音乐治疗及腹式呼吸放松治疗，共4周，对照组未予任何心理干预治疗。分别于入院时、治疗2周、治疗4周采用焦虑自评量表(SAS)、汉密尔顿焦虑量表(HAMA)对2组患者进行焦虑程度评分；应用毫米网格纸法测量患者入院时、治疗2周、治疗4周创面面积并计算创面愈合率。数据比较采用t检验。 结果入院时，干预组患者SAS评分(67.1±2.4) 分，对照组(65.9±2.2) 分，2组比较差异无统计学意义(t＝0.49, P＝0.65)；认知行为疗法干预治疗2、4周后，干预组患者SAS评分分别为(55.6±1.9)、(49.3±2.6) 分，低于同期对照组(59.8±2.1)、(53.5±2.7) 分，差异均有统计学意义(t＝2.17、2.54，P＝0.04、0.02)；入院时，干预组患者HAMA评分(23.8±3.3) 分，对照组(24.1±3.6) 分，2组比较差异无统计学意义(t＝0.96, P＝0.34)；干预2、4周后，干预组患者HAMA评分分别为(17.2±2.7)、(11.9±2.1) 分，低于同期对照组(20.8±3.4)、(15.3±3.0) 分，差异均有统计学意义(t＝2.23、2.86，P＝0.03、0.01)。治疗2、4周后，干预组患者创面愈合率分别为(26.2±2.4)%、(80.5±4.2)%，均高于同期对照组(22.3±2.1)%、(59.2±3.9)%，2组比较差异均有统计学意义(t＝2.54、2.86，P＝0.02、0.01)。 结论认知行为疗法干预有助于缓解慢性难愈合创面患者的焦虑情绪，提高慢性难愈合创面的愈合速度。

Clinical study of cognitive behavioral therapy on patients with chronic refractory wounds complicated with anxiety

ObjectiveTo investigate the effect of cognitive behavioral therapy on wound healing in patients with chronic refractory wounds with anxiety. MethodsFrom February 2018 to September 2018, 40 cases of patients with chronic refractory wounds combined with anxiety who were hospitalized in Department of Burns and Plastic Surgery, Linyi Central Hospital and meeted the inclusion criteria were selected. All patients were randomly numbered, the odd number was set as the intervention group, and the even number was set as the control group, 20 cases in each group. Patients in both groups received conventional treatment and nursing care of chronic refractory wounds. On this basis, patients in the intervention group were given cognitive behavioral therapy intervention, including talk therapy, music therapy and abdominal breathing relaxation therapy, for a total of 4 weeks. The control group received no psychological intervention. Self-rating anxiety scale (SAS) and Hamilton anxiety scale (HAMA) were used to score the 2 groups at admission, 2 weeks of treatment and 4 weeks of treatment respectively. The wound area at admission, 2 weeks of treatment and 4 weeks of treatment were measured by using mm mesh paper method, and wound healing rate was calculated. Data were compared with t test. ResultsAt admission, the SAS score of patients in the intervention group was (67.1±2.4) points and those in the control group was (65.9±2.2) points, there was no statistically significant difference between the two groups (t=0.49, P=0.65). After 2 and 4 weeks of cognitive behavioral therapy, the SAS scores of the intervention group were (55.6±1.9) and (49.3±2.6) points, respectively, which were lower than those of the control group [(59.8±2.1) and (53.5±2.7) points], the differences were statistically significant (t=2.17, 2.54; P=0.04, 0.02). At admission, the intervention group had a HAMA score of (23.8±3.3) points, and the control group was (24.1±3.6) points, there was no significant difference between the two groups (t=0.96, P=0.34). After 2 and 4 weeks of intervention, HAMA scores of patients in the intervention group were (17.2±2.7) and (11.9±2.1) points, respectively, lower than those of the control group [(20.8±3.4) and (15.3±3.0) points], the differences were statistically significant (t=2.23, 2.86; P=0.03, 0.01). After 2 and 4 weeks of treatment, the wound healing rates of the intervention group were (26.2±2.4)% and (80.5±4.2)%, which were higher than those of the control group (22.3±2.1)% and (59.2±3.9)%, the differences between the two groups were statistically significant (t=2.54, 2.86; P=0.02, 0.01). ConclusionCognitive behavioral therapy intervention can relieve anxiety in patients with chronic refractory wounds and improve the healing rate of chronic refractory wounds.