心理疏导在神经性失眠患者治疗中的作用.pdf

心理疏导在神经性失眠患者治疗中的作用邹春莉 钟代曲【摘要】目的 了解心理疏导法在神经性失眠患者治疗中所起的作用。方法 将神经性失眠患者随机分成疏导组与对照组各98例,2组均采用医生既定的治疗方案,对照组除按时完成治疗外,按常规进行入院介绍、疾病相关知识指导等护理;疏导组在完成治疗的同时,根据住院患者不同时期的心理需求,及时进行正确的心理疏导。观察2组治疗、护理效果。结果 治疗前2组PSQI、SAS分数间比较无显著性差异,经过联合治疗及适时施护,2组PSQI各因子评分及总评分、SAS评分显著减低(P 0.01),说明治疗护理的有效性,护理后疏导组与对照组PSQI各因子评分及总评分比较均有显著性差异(P 0.05),SAS评分比较有显著性差异(P 0.01),可认为疏导组的护理方法优于对照组。结论 心理疏导法纠正了患者对疾病不正确的认识,帮助患者找到并消除了造成神经性失眠的心理应激源,教会患者正确的睡眠卫生知识和配合治疗的方法,对患者康复后如何维持健康做了深入指导,使患者得到全面康复。【关键词】神经性失眠;心理护理;心理疏导Role of psychological direction therapy in the treatment for patients with psychophysiologic insomniaZOU Chun2li,ZHON G Dai2qu.Third Department of B rain,Research Institute of Field Surgery,Daping Hospital,Third Military Medical University,Chongqing400042,China【Abstract】ObjectiveTo determine the effect of psychological direction therapy in the treatmentof patients with psychophysiologic insomnia.MethodsThe psychophysiologic insomnia patients wererandomly divided into two groups,with 98 cases for each,respectively.One was the psychological direc2tion therapy group,and the other was the control group.Patients of the two groups were treated usingthe therapy project selected by the doctor.Besides completing the therapy on time,the patients in thecontrol group were provided with the introduction of admission to hospital and the direction of the knowl2edge correlated with the diseases.At the same time of completing the therapy,the patients of the psy2chological direction group were treated using the psychological direction therapy according to the patients mentality requirement in different phases.The therapy and nursing effects of the two groups were ob2served.ResultsThere was no significant difference on the PSQI and SAS between the two groups be2fore the therapy.After the treatment,the SAS score,as well as the scores of every factor in PSQI andthe total PSQI score,was decreased significantly(P 0.01)through the combination therapy and timelynursing.PSQI and SAS of the psychological direction therapy group ameliorated more than those of thecontrol group.This indicated that the nursing was effective,the scores of every factor and the total scorein PSQI between the psychological direction group and the control group had significant differences(P 0.05),and the SAS score had a significant difference(P 40分者有焦虑情绪存在。1.5 统计学方法 采用SPSS/PC软件包进行t检验。2 结果2.1 治疗前2组PSQI分数比较无显著性差异(P 0.05),经过联合治疗及适时施护,2组PSQI各因子评分及总评分显著减低(P 0.01),说明治疗护理的有效性;护理后疏导组与对照组PSQI各因子评分及总评分比较均有显著性差异(P 0.05),疏导组的护理方法优于对照组。表1 治疗前后2组患者PSQI评分比较(xs)组别睡眠质量入睡时间睡眠时间睡眠效率睡眠紊乱安眠药物日间功能总分疏导组 护理前2.110.732.650.782.321.062.161.241.970.881.631.762.181.2615.74.54 护理后0.820.521.080.890.680.820.620.580.660.610.410.450.680.444.632.15对照组 护理前2.130.782.570.712.281.122.221.361.910.831.681.212.061.1215.44.78 护理后1.130.841.520.761.041.270.910.670.980.720.720.540.960.586.762.36t值P值3.3263.5272.4032.9372.9473.0154.3173.581 0.01 0.01 0.05 0.01 0.05 0.01 0.010.05),经过联合治疗及适时施护,2组SAS评分显著减低(P 0.01),说明治疗护理的有效性;护理后疏导组与对照组SAS评分有显著性差异(P 0.01),说明心理疏导法对焦虑情绪有控制作用。表2 治疗前后2组患者SAS评分计划(xs)组别例数护理前护理后疏导组9867.47.2238.84.25对照组9864.96.3847.74.48 注:2组治疗护理前后SAS评分比较,P 0.01;护理后疏导组与对照组SAS评分比较,P 0.013 讨论神经性失眠绝大多数是由于长期的紧张、焦虑情绪引起植物神经功能紊乱所致,而失眠又可加重紧张、焦虑症状,如此往复形成恶性循环,长期失眠常导致患者白天心境紊乱、疲劳、社会交往不适和认知行为受损5。因此患者的负性心理严重,给临床治疗带来麻烦。以往我们对失眠的治疗多以药物为主,但由于药物副作用大、有的患者不能坚持、不能解决致病因素等原因,疗效往往不佳,随着整体化护理的开展,患者也对疾病有所认识,按护士所提供的睡眠卫生知识去帮助睡眠,有一定的成效,但对一些紧张、焦虑情绪重的患者,常因配合不好而使疗效欠佳。我们采用心理疏导法,通过讲解疾病及治疗相关知识,纠正了患者对疾病及药物不正确的认识;帮助患者找到应激源,与其一起制定应对措施,解决了患者的心理问题,消除了造成神经性失眠的心理应激源;适时教会其正确的睡眠卫生知识和配合治疗的方法,充分调动其主观能动性配合治疗等,取得了满意疗效;对患者康复后如何维持健康做了深入指导,使其有信心开始新的生活,意义深远。由此还看出,我们为患者提供整体护理,不但要把健康知识教给患者,还要做到根据不同疾病特点,掌握好传授时机及方法,才能取得良好效果,这就要求我们护士要掌握更全面的知识,才能把护理工作做得更好。参 考 文 献1 潘集阳.睡眠障碍临床诊疗 M.广州:华南理工大学出版社,2001:33.2American Psychiatric Association.Diagnostic and statistical manu2al of mental disordersM.4th ed.Washington DC:American Psy2chiatric Association,1994:11.3Buysse DJ,Reynolds CF,Monk TH,et al.the Pittsburgh sleepquality index:A new instyument for psychiatric practice and re2searchJ .Psychiatric Research,1989,28(2):193.4 吴杲,瞿发林,吴汉斌.失眠症的药物治疗进展J.现代中西医结合杂志,2004,13(6):835.5 张玲.失眠症的心理治疗J.中国临床康复杂志,2003,15(3):820.(收稿日期:2006203201)2572论 著 MODERN NURSING2006,Vol.12,No.29