多元化睡眠护理联合支持性-表达性团体心理干预在精神分裂症患者中的应用

陶科伟; 付康; 戴慧敏; 沈珂妍

doi:10.16766/j.cnki.issn.1674-4152.003399

多元化睡眠护理联合支持性-表达性团体心理干预在精神分裂症患者中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003399

1.
绍兴市第七人民医院心身障碍科(睡眠病区)，浙江绍兴 312000
2.
诸暨市第五人民医院精神科，浙江诸暨 311800

基金项目:

浙江省中医药科技计划项目 2022ZA176

详细信息

通讯作者:
陶科伟，E-mail：tkw19870409@163.com

中图分类号: R749.3 R473.74
计量
- 文章访问数: 45
- HTML全文浏览量: 21
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-26
- 网络出版日期: 2024-03-27

Application of diversified sleep care combined with supportive and expressive group psychological intervention in patients with schizophrenia

1.
Psychosomatic Department (Sleep Ward), the Seventh People ' s Hospital of Shaoxing, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的探讨多元化睡眠护理联合支持性-表达性团体心理干预对精神分裂症患者的影响，为进一步优化临床护理提供理论依据。方法采用随机数字表法将2020年6月—2023年6月绍兴市第七人民医院心身障碍科收治的90例精神分裂症患者分为对照组和观察组，各45例，对照组给予常规护理，观察组在此基础上给予多元化睡眠护理联合支持性-表达性团体心理干预。比较2组护理前后的睡眠质量、情绪状态[汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)]、心理弹性[心理弹性量表(CD-RISC)]及应对方式[简易应对方式问卷(SCSQ)]。结果观察组护理后睡眠效率[(83.23±5.22)%]高于对照组[(78.25±6.34)%]，总睡眠时间[(399.45±20.34)min]及快速眼球运动睡眠潜伏期时间[(129.23±15.23)min]长于对照组[(369.90±35.21)min、(108.45±13.42)min]，觉醒时间[(38.90±6.78)min]短于对照组[(45.77±5.09)min, t=4.068、5.090、6.867、6.737，P＜0.05]；HAMA和HAMD评分均明显低于对照组(P＜0.05)；CD-RISC各维度评分及总分均高于对照组(P＜0.05)；SCSQ中积极应对评分高于对照组(P＜0.05)，消极应对评分低于对照组(P＜0.05)。结论多元化睡眠护理联合支持性-表达性团体心理干预可有效提升精神分裂症患者睡眠质量，减轻负性情绪，提高心理弹性水平，改善疾病应对方式。
- 精神分裂症 /
- 多元化睡眠护理 /
- 支持性-表达性团体干预 /
- 睡眠质量 /
- 负性情绪
Abstract: Objective To explore the effects of diversified sleep care combined with supportive and expressive group psychological intervention on patients with schizophrenia, in order to provide theoretical basis for further optimization of clinical care. Methods A total of 90 patients with schizophrenia admitted to Psychosomatic Disorder Department of the Seventh People ' s Hospital of Shaoxing City from June 2020 to June 2023 were randomly divided into control group and observation group using a random number table method, 45 cases in each group. The control group was given routine nursing, and the observation group was given diversified sleep nursing combined with supportive and expressive group psychological intervention on this basis. The sleep quality, emotional state [Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD)], mental resilience [Connor-Davidson resilience scale (CD-RISC)] and coping style [simplified coping style questionnaire (SCSQ)] of the two groups were compared before and after care. Results The sleep efficiency of the observation group [(83.23±5.22)%] was higher than that of the control group [(78.25±6.34)%]; Total sleep time [(399.45±20.34) min] and rapid eye movement sleep latency time [(129.23±15.23) min] were longer than those of control group [(369.90±35.21) min and (108.45±13.42) min]; The awakening time [(38.90±6.78) min] was shorter than that of control group [(45.77±5.09) min, t=4.068, 5.090, 6.867, 6.737, P < 0.05]. The HAMA and HAMD scores were significantly lower than those of control group (P < 0.05). The score and total score of CD-RISC were higher than those of control group (P < 0.05). The positive coping score in SCSQ was higher than that in control group (P < 0.05), and the negative coping score was lower than that in control group (P < 0.05). Conclusion Diversified sleep care combined with supportive and expressive group psychological intervention can effectively improve the sleep quality and reduce negative emotions, improve the level of mental resilience and improve the coping style of schizophrenia patients.
- Schizophrenia /
- Diversified sleep care /
- Supportive and expressive group intervention /
- Sleep quality /
- Negative emotion

HTML全文

表 1 2组精神分裂症患者一般资料比较

Table 1. 2 Comparison of general data for schizophrenia patients

组别	例数	性别 (男性/女性，例)	年龄 (x±s，岁)	BMI(x±s)	文化程度(高中/中专/大专/ 本科及以上, 例)	病程 (x±s，年)
观察组	45	21/24	41.14±8.10	22.50±3.17	7/3/19/16	1.33±0.29
对照组	45	25/20	40.23±5.67	22.34±3.40	6/5/15/19	1.42±0.37
统计量		0.712^a	0.617^b	0.231^b	1.305^a	1.284^b
P值		0.400	0.539	0.818	0.728	0.202
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组精神分裂症患者护理前后睡眠情况比较(x±s)

Table 2. Comparison of sleep status between two groups of patients with schizophrenia before and after nursing (x±s)

组别	例数	睡眠效率(%)		总睡眠时间(min)		觉醒时间(min)		REM潜伏期时间(min)
组别	例数	护理前	护理后	护理前	护理后	护理前	护理后	护理前	护理后
观察组	45	66.47±6.10	83.23±5.22^a	298.24±35.67	399.45±20.34^a	70.23±4.57	38.90±6.78^a	85.67±9.09	129.23±15.23^a
对照组	45	67.09±7.98	78.25±6.34^a	302.78±20.44	369.90±35.21^a	68.34±7.29	45.77±5.09^a	87.45±8.22	108.45±13.42^a
t值		0.414	4.068	0.741	5.090	1.474	6.737	0.974	6.867
P值		0.680	＜0.001	0.461	＜0.001	0.144	＜0.001	0.333	＜0.001
注：与同组护理前比较，^aP＜0.05。

下载: 导出CSV

表 3 2组精神分裂症患者护理前后HAMA和HAMD评分比较(x±s，分)

Table 3. Comparison of HAMA and HAMD scores between two groups of patients with schizophrenia before and after nursing care (x±s, points)

组别	例数	HAMA评分		HAMD评分
组别	例数	护理前	护理后	护理前	护理后
观察组	45	16.45±2.67	10.16±2.70^a	23.56±4.11	15.02±3.75^a
对照组	45	17.23±3.08	14.42±3.28^a	22.23±4.20	19.83±4.19^a
t值		1.284	6.727	1.518	5.738
P值		0.204	＜0.001	0.133	＜0.001
注：与同组护理前比较，^aP＜0.05。

下载: 导出CSV

表 4 2组精神分裂症患者护理前后CD-RISC比较(x±s，分)

Table 4. Comparison of CD-RISC between the two groups of schizophrenia patients before and after nursing care (x±s, points)

组别	例数	坚韧		自强		乐观		总分
组别	例数	护理前	护理后	护理前	护理后	护理前	护理后	护理前	护理后
观察组	45	26.67±5.90	34.56±6.70^a	18.24±4.78	28.23±5.78^a	13.24±3.11	19.45±4.09^a	58.15±6.09	82.24±5.10^a
对照组	45	25.70±7.09	30.90±5.44^a	19.08±5.32	25.23±6.10^a	12.67±3.20	15.12±3.22^a	57.45±6.12	71.25±5.99^a
t值		0.705	2.845	0.778	2.395	0.857	5.580	0.544	9.371
P值		0.482	0.006	0.438	0.019	0.394	＜0.001	0.588	＜0.001
注：与同组护理前比较，^aP＜0.05。

下载: 导出CSV

表 5 2组精神分裂症患者护理前后SCSQ比较(x±s，分)

Table 5. Comparison of SCSQ before and after care in patients with schizophrenia between the two groups (x±s, points)

组别	例数	积极应对		消极应对
组别	例数	护理前	护理后	护理前	护理后
观察组	45	21.34±4.09	26.67±5.43^a	19.11±3.98	12.98±2.34^a
对照组	45	20.78±4.11	23.98±4.20^a	18.57±4.09	16.90±3.10^a
t值		0.648	2.629	0.635	6.770
P值		0.519	0.010	0.527	＜0.001
注：与同组护理前比较，^aP＜0.05。

下载: 导出CSV

参考文献(22)

[1]	王颖怡, 吕钦谕, 陆燕华, 等. 谷氨酸受体与精神分裂症治疗的研究进展[J]. 中国医药导报, 2019, 16(22): 42-45, 65. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201922010.htm WANG Y Y, LYU Q Y, LU Y H, et al. Reserch progress of glutamate receptor and schizophrenia treatment[J]. China Medical Herald, 2019, 16(22): 42-45, 65. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201922010.htm
[2]	李旋, 卓恺明, 刘登堂. 精神分裂症的睡眠结构研究进展[J]. 精神医学杂志, 2019, 32(5): 397-400. https://www.cnki.com.cn/Article/CJFDTOTAL-SDJB201905020.htm LI X, ZHUO K M, LIU D T. Progress in sleep structure research in schizophrenia[J]. Journal of Psychiatry, 2019, 32(5): 397-400. https://www.cnki.com.cn/Article/CJFDTOTAL-SDJB201905020.htm
[3]	王伟梁, 周郁秋, 王正君. 精神分裂症患者睡眠紊乱发生率的meta分析[J]. 中国心理卫生杂志, 2019, 33(2): 93-95. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201902004.htm WANG W L, ZHOU Y Q, WANG Z J. A meta-analysis of prevalence of sleep disturbances in patients with schizophrenia[J]. Chinese Mental Health Journal, 2019, 33(2): 93-95. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201902004.htm
[4]	常一心, 李珺, 王莉. 个案管理模式配合多元化睡眠护理对脑肿瘤患者术后心理状况和睡眠质量的影响[J]. 中国肿瘤临床与康复, 2019, 26(11): 1233-1236. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201911032.htm CHANG Y X, LI J, WANG L. Effect of case management mode combined with diversified sleep nursing on postoperative psychological status and sleep quality in patients with brain tumors[J]. Chinese Journal of Clinical Oncology and Rehabilitation, 2019, 26(11): 1233-1236. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201911032.htm
[5]	黄玉夏, 李丽, 黄晓蔚, 等. 支持-表达性团体心理干预对中晚期非小细胞肺癌患者创伤后成长的影响[J]. 系统医学, 2023, 8(5): 154-156, 161. https://www.cnki.com.cn/Article/CJFDTOTAL-XTYX202305036.htm HUANG Y X, LI L, HUANG X W, et al. Effect of Support-expressive group psychological intervention on posttraumatic growth of patients with advanced non-small cell lung cancer[J]. Systems Medicine, 2023, 8(5): 154-156, 161. https://www.cnki.com.cn/Article/CJFDTOTAL-XTYX202305036.htm
[6]	美国精神医学学会. 精神疾病诊断与统计手册[J]. 北京: 北京大学医学出版社, 2014: 30. The American Academy of Psychiatrists. The Diagnostic and Statistical Manual of Mental Disorders[J]. Beijing: Peking University Medical Press, 2014: 30.
[7]	刘东玮, 任兴华, 周郁秋, 等. 中文版心理弹性量表在精神分裂症患者中的信效度测量[J]. 中国实用护理杂志, 2020, 36(18): 1366-1371. doi: 10.3760/cma.j.cn211501-20190906-02540 LIU D W, REN X H, ZHOU Y Q, et al. The validity and reliability of the Chinese version of Connor Davidson Resilience Scale in schizophrenia[J]. Chinese Journal of Practical Nursing, 2020, 36(18): 1366-1371. doi: 10.3760/cma.j.cn211501-20190906-02540
[8]	李琰, 白春杰, 陈丽霞. 临床失眠患者应对方式与焦虑、抑郁的相关性[J]. 中国临床研究, 2020, 33(1): 102-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202001025.htm LI Y, BAI C J, CHEN L X. Clinical associations of coping style with anxiety and depression in patients with insomnia[J]. Chinese Journal of Clinical Research, 2020, 33(1): 102-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202001025.htm
[9]	李荣华, 王秀艳, 汪腾龙, 等. 伴与不伴睡眠障碍的精神分裂症高危人群的认知功能差异[J]. 国际精神病学杂志, 2021, 48(1): 26-28. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202101009.htm LI R H, WANG X Y, WANG T L, et al. Differences in cognitive function in individuals at ultra-high-risk for psychosis with and without sleep disturbances[J]. Journal Of International Psychiatry, 2021, 48(1): 26-28. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202101009.htm
[10]	王伟伟. 个案管理模式配合多元化睡眠护理对脑肿瘤患者术后心理状况和睡眠质量的影响[J]. 世界睡眠医学杂志, 2022, 9(3): 488-490. https://www.cnki.com.cn/Article/CJFDTOTAL-SMZZ202203038.htm WANG W W. Effect of Case Management mode combined with diversified sleep nursing on postoperative psychological status and sleep quality of patients with brain tumor[J]. World Journal of Sleep Medicine, 2022, 9(3): 488-490. https://www.cnki.com.cn/Article/CJFDTOTAL-SMZZ202203038.htm
[11]	赵文青. 支持性-表达性团体心理干预联合棕榈酸帕利哌酮治疗急性期首发精神分裂症患者的临床疗效[J]. 医学临床研究, 2022, 39(5): 690-692, 696. ZHAO W Q. Clinical Efficacy of supportive expressive group psychological intervention combined with paliperidone palmitate in the treatment of acute first-episode schizophrenia[J]. Journal of Clinical Research, 2022, 39(5): 690-692, 696.
[12]	李素勤, 徐丽琳, 祁彬. 多元化睡眠干预对重症急性脑梗死患者睡眠质量的影响[J]. 河北医药, 2023, 45(18): 2874-2876, 2880. doi: 10.3969/j.issn.1002-7386.2023.18.037 LI S Q, XU L B, QI B. Effects of pluralistic sleep interventions on sleep quality in patients with severe acute cerebral infarction[J]. Hebei Medical Journal, 2023, 45(18): 2874-2876, 2880. doi: 10.3969/j.issn.1002-7386.2023.18.037
[13]	马孔永, 王月霞, 杜超, 等. 支持-表达性团体干预联合健康教育护理对肺癌化疗患者负性情绪、疾病认知和睡眠质量的影响[J]. 肿瘤基础与临床, 2023, 36(1): 71-75. https://www.cnki.com.cn/Article/CJFDTOTAL-HLZL202301016.htm MA K Y, WANG Y X, DU C, et al. Impact of supportive-expressive group intervention combined with health education care on negative mood, disease cognition and sleep quality in lung cancer chemotherapy patients[J]. Journal Of Basic And Clinical Oncology, 2023, 36(1): 71-75. https://www.cnki.com.cn/Article/CJFDTOTAL-HLZL202301016.htm
[14]	肖凡, 李莹, 赵芳, 等. 渐进性肌肉放松训练干预联合睡眠卫生知识教育对焦虑性失眠患者多导睡眠监测结果的影响[J]. 贵州医药, 2022, 46(6): 1000-1002. https://www.cnki.com.cn/Article/CJFDTOTAL-GZYI202206092.htm XIAO F, LI Y, ZHAO F, et al. Effect of progressive muscle relaxation training intervention combined with sleep health knowledge education on polysomnographic monitoring results in patients with anxious insomnia[J]. Guizhou Medical Journal, 2022, 46(6): 1000-1002. https://www.cnki.com.cn/Article/CJFDTOTAL-GZYI202206092.htm
[15]	王子含, 蔺华利, 宋春杨, 等. 过度觉醒条件下音乐干预诱导睡眠的研究[J]. 重庆医学, 2023, 52(8): 1151-1154. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX202308007.htm WANG Z H, LIN H L, SONG C Y, et al. Study on the effect of music intervention induce sleep under the condition of hyperarousal[J]. Chongqing Medicine, 2023, 52(8): 1151-1154. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX202308007.htm
[16]	祝利红, 林娟, 陈上仲. 以音乐治疗为核心的系统化护理在重症肺炎患者中的应用及临床价值[J]. 中华全科医学, 2018, 16(6): 1029-1031. doi: 10.16766/j.cnki.issn.1674-4152.000282 ZHU L H, LIN J, CHEN S C. Application and clinical value of systematic nursing based on music therapy in patients with severe pneumonia[J]. Chinese Journal of General Practice, 2018, 16(6): 1029-1031. doi: 10.16766/j.cnki.issn.1674-4152.000282
[17]	杜琴, 郭青山, 杜晖, 等. 音乐治疗对非器质性失眠症患者维持期睡眠质量的影响[J]. 国际精神病学杂志, 2022, 49(6): 1015-1017. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202206008.htm DU Q, GUO Q S, DU H, et al. Effects of music therapy on sleep quality in patients with nonorganic insomnia maintenance period[J]. Journal Of International Psychiatry, 2022, 49(6): 1015-1017. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202206008.htm
[18]	李懿, 曾莉, 何丽雯, 等. 不同风格音乐对CUMS抑郁大鼠行为的影响及机制研究[J]. 中国实验动物学报, 2022, 30(3): 384-391. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSD202203011.htm LI Y, ZENG L, HE L W, et al. Effects of different style music on behavior in CUMS depression rats[J]. Acta Laboratorium Animalis Scientia Sinica, 2022, 30(3): 384-391. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSD202203011.htm
[19]	刘位真, 李光辉, 刘艳玲. 支持-表达性团体辅助对肺癌病人心理弹性、死亡态度及述情障碍的影响[J]. 全科护理, 2022, 20(6): 786-789. https://www.cnki.com.cn/Article/CJFDTOTAL-JTHS202206018.htm LIU W Z, LI G H, LIU Y L. Support-Effect of expressive group assistance on psychological resilience, death attitude and alexithymia in lung cancer patients[J]. Chinese General Practice Nursing, 2022, 20(6): 786-789. https://www.cnki.com.cn/Article/CJFDTOTAL-JTHS202206018.htm
[20]	陈宁, 马志杰, 王娇娇, 等. 支持-表达性团体干预对行内镜黏膜下剥离术早期胃癌患者术前心理状态和治疗配合度的影响[J]. 癌症进展, 2023, 21(1): 97-100, 104, 107. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202301016.htm CHEN N, MA Z J, WANG J J, et al. Effect of support-expressive group intervention on preoperative psychological state and treatment compliance in patients with early gastric cancer under going endoscopic submucosal dissection[J]. Oncology Progress, 2023, 21(1): 97-100, 104, 107. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202301016.htm
[21]	杨宇珍, 谢银燕, 栾秋月. 支持-表达性团体干预配合化疗日记对淋巴瘤化疗患者心理状态及自护能力的影响[J]. 齐鲁护理杂志, 2022, 28(17): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL202217001.htm YANG Y Z, XIE Y Y, LUAN Q Y. Effect of supportive-expressive group therapy combined with chemotherapy diary on psychological status and self-care ability in patients undergoing chemotherapy for lymphoma[J]. Journal of Qilu Nursing, 2022, 28(17): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL202217001.htm
[22]	ELIAS R, LOH K P, TARGIA V, et al. Behavioral, psychological, and supportive care interventions in geriatric oncology: the Cancer and Aging Research Group infrastructure core[J]. J Geriatr Oncol, 2020, 11(2): 347-349.