医护一体化护理方式联合患者自我效能训练对复治肺结核患者焦虑抑郁及生存质量的影响

目的 探讨医护一体化护理方式联合患者自我效能训练对复治肺结核患者焦虑抑郁及生存质量的影响。 方法 选择温州市中心医院2010年1月—2014年1月收治的复治肺结核患者120例，随机分为对照组和观察组，各60例。所有患者均采用标准化复治肺结核治疗方案，治疗时长为12个月。同时2组患者均给予医护一体化护理方式，观察组患者在此基础上实行自我效能训练。采用焦虑评分(SAS)量表及抑郁评分(SDS)量表对2组患者护理前后抑郁及焦虑状态进行评价，采用生存质量评估量表(WHOQOL-BREF)观察2组患者护理前后生存质量评分变化，结束治疗及护理后随访1年，观察2组患者再咳血情况、复发率。 结果 护理后，2组患者SAS及SDS评分较护理前均有所下降，且观察组患者SAS及SDS评分下降程度高于对照组，差异均具有统计学意义(P＜0.05)。护理后，2组患者各维度评分较护理前均有所上升，且观察组患者上升程度高于对照组，差异均具有统计学意义(P＜0.05)，观察组再咳血例数、再咳血量以及一年复发率等均明显低于对照组，差异有统计学意义(P＜0.05)。 结论 结合自我效能管理的患者在心理方面、生活质量方面及治疗依从性方面均较单纯给予医护一体化护理患者有显著改善，因此值得临床推广应用。 

Effect of health care integration combined with evaluation of self-efficacy on the anxiety,depression and quality of life in retreated pulmonary tuberculosis patients

Objective To investigate the effect of health integration approach combined with patient self-efficacy training on anxiety,depression and quality of life of patients with drug-resistant tuberculosis. Methods The 120 retreated pulmonary tuberculosis patients in our hospital from January,2010 to January,2014 were randomly divided into control group and observation group with 60 cases in each group.All patients were treated with a standardized drug-resistant tuberculosis treatment programs,the course was 12 months.The medical care integrated manner was performed in both groups.The observation group received additional self-efficacy training.Anxiety score(SAS) and depression scale score(SDS) Scale were used to evaluate the depression and anxiety of patients before and after the treatment;Quality of Life Assessment Scale(WHOQOL-BREF) was used to measure the QOL of patients before and after the treatment.One year follow up was carried to observe the incidence of hemoptysis again and recurrence rate. Results After the treatment,SAS and SDS scores in both groups were decreased when compared with the values before treatment,and more obviously in the observation group,the difference was statistically significant(P<0.05).After the treatment,the scores for each item increased obviously in both groups,especially in the observation group,the difference was statistically significant(P<0.05).The rate and volume of hemoptysis again and the recurrence rate in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05). Conclusion The health care integration combined with evaluation of self-efficacy can more effectively improve the psychological conditions,quality of life and treatment compliance in patients with drug-resistant tuberculosis when compared with the health care integration alone,which is worthy of clinical application.