家庭心理治疗对初期尿毒症患者抑郁和治疗依从性的应用研究  

The application of psychological family therapy in depression and treatment adherence of maintenance hemodialysis patients in initial period

作　　者：石艳[1] 高小玲[1] 

机构地区：[1]重庆市第九人民医院肾内科,重庆市北碚区400700

出　　处：《中国血液净化》2015年第5期311-314,共4页Chinese Journal of Blood Purification

摘　　要：目的调查透析初期尿毒症患者抑郁、治疗依从性现状,并进一步探讨家庭治疗对其抑郁和治疗依从性的影响。方法使用抑郁自评量表、终末期肾脏病维持性血液透析患者治疗依从性量表和透析间期体质量增加值对53位透析初期患者的抑郁和治疗依从性现状进行评估,然后在4～6次的家庭治疗后再次对其进行后测。使用单样本t检验和带控制变量的回归分析分析患者抑郁和治疗依从性现状,探讨抑郁对治疗依从性的预测度;使用配对样本t检验比较家庭治疗对患者抑郁和治疗依从性改善的有效性。结果接受调查的患者中有86.79%存在抑郁症状;接受家庭治疗前后,患者的SDS得分都可作为预测患者治疗依从性的独立因素（R治疗前2==0.134、P=0.009,R治疗后2=0.379、P=0.000）。患者在接受家庭治疗前后抑郁自评得分（SD治疗前=57.45±6.33、SD治疗后=47.29±4.97、t=12.825,P=0.000）、治疗依从性得分（SD治疗前=68.70±7.23、SD治疗后=76.74±5.52、t=-14.423,P=0.000）和透析间期体质量增加值（SD治疗前=2.75±1.28、SD治疗后=2.53±1.20、t=6.383,P=0.000）都有显著的变化。结论透析初期尿毒症患者存在较广泛的抑郁症状,其治疗依从性也不容乐观,患者的抑郁程度可作为预测患者治疗依从性的独立因素。家庭治疗对患者治疗抑郁症状和治疗依从性都有显著的改善作用。Objective To investigate the depression,treatment adherence condition of maintenance hemodialysis patient（MHD） in initial period,and to explore the effect of family therapy on their depression and treatment adherence.Method 53 MHD in initial period were assessed with self-rating depression scale,the specific medical treatment adherence scale for ESRD clients with maintenance hemodialysis,alone with their interdialysis weight gain（IDWG）,we evaluate their depression and treatment adherence condition,then we gave the patents family therapy of 4-6 times,and the aftertests.The one-sample T test and the regression analysis with control variables were manipulated to patents＇ depression,treatment adherence,and the relationship of the two;paired-sample T test were manipulated to explore the effect of family therapy on patients＇ depression and adherence.Result 86.79% of the patients were checked out with depression symptom;the SDS of the patients could be an independent factor to predict their treatment adherence both before and after the family therapy（Rbefore2=0.134,P=0.009,Rafter2=0.379,P=0.000）.The patients＇ SDS（SDbefore=57.45 ± 6.33,SDafter=47.29±4.97,t=12.825,P=0.000）,treatment adherence（SDbefore=68.70±7.23,SDafter=76.74±5.52,t=-14.423,P=0.000） and IDWG（SDbefore=2.75 ± 1.28,SDafter=2.53 ± 1.20,t=6.383,P=0.000）were significantly improved after family therapy.Conclusion Depression could be as prevalent among MHD in initial period,their treatment adherence are not ideal too,and depression could be an independent factor to predict their adherence.However,family therapy could be a useful way to improve their depression symptom and treatment adherence.

关 键 词：透析初期 抑郁 治疗依从性 家庭治疗 

分 类 号：R473[医药卫生—护理学]