计算机化认知行为疗法在慢性阻塞性肺疾病患者症状群管理中的影响:一项随机对照试验  

Effect of computerized cognitive behavioral therapy in the management of symptom cluster in patients with chronic obstructive pulmonary disease: a randomized controlled trial

作　　者：袁丽荣[1] 杨青龙 李育玲[2] 李琳[3] 邓莎莎 李淑花[1] Yuan Lirong;Yang Qinglong;Li Yuling;Li Lin;Deng Shasha;Li Shuhua(Pulmonary and Critical Care Medicine,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Nursing Department,First Hospital of Shanxi Medical University,Taiyuan 030001,China;School of Nursing,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院呼吸与危重症医学科,太原030001 [2]山西医科大学第一医院护理部,太原030001 [3]山西医科大学护理学院,太原030001

出　　处：《结核与肺部疾病杂志》2024年第5期476-483,共8页Journal of Tuberculosis and Lung Disease

摘　　要：目的:针对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者存在的症状多样性、自我管理能力不足及心理健康复杂性等特点,探讨计算机化认知行为疗法(computerized cognitive behavioral therapy,CCBT)的干预效果。方法:采用单中心、双盲、随机对照试验,将2023年3—10月于山西医科大学第一医院就诊的72例急性加重期COPD患者纳入研究对象,采用随机数字表法将患者随机分配至观察组(37例)和对照组(35例)。对照组治疗包括常规护理及电话随访,观察组在对照组的基础上接受为期6周的CCBT。采用主要指标(焦虑和抑郁程度)和次要指标[呼吸困难、6分钟步行距离(6-minute walk distance,6MWD)、失眠和疲乏状况]作为评价指标,并于治疗前、中、后进行比较。结果:观察组在CCBT干预6周后的焦虑评分[(53.64±1.46)分]、抑郁评分[(56.59±3.52)分]、呼吸困难评分[(2.14±0.67)分]、失眠评分[(6.19±1.65)分]和疲乏评分[(40.65±0.33)分],均低于干预3周后的焦虑评分[(55.14±2.37)分]、抑郁评分[(58.55±2.33)分]、呼吸困难评分[(2.72±0.45)分]、失眠评分[(7.97±1.57)分]和疲乏评分[(46.09±0.26)分],干预6周后的6MWD[(280.00±8.33)m]高于干预3周后的6MWD[(268.59±7.86)m],差异均有统计学意义(F值分别为16.141、76.745、14.976、46.250、42.337、11.700,P值分别为<0.001、<0.001、<0.001、<0.001、<0.001、0.001);且在干预3周后对照组焦虑评分[(57.43±2.33)分]、抑郁评分[(62.46±2.39)分]、呼吸困难评分[(3.06±0.42)分]、失眠评分[(9.83±1.65)分]及疲乏评分[(47.49±0.33)分]均低于观察组,6MWD[(262.14±9.11)m]高于观察组,差异均有统计学意义(t值分别为―4.564、―7.673、―3.200、―4.881、―3.334、2.992,P值分别为<0.001、<0.001、0.002、<0.001、<0.001、0.004)。干预6周后对照组焦虑评分[(55.04±2.36)分]、抑郁评分[(59.89±2.42)分]、呼吸困难评分[(2.74±0.56)分]、失眠评分[(9.00±1.77)分]�Objective:To explore the intervention effects of computerized cognitive behavioral therapy(CCBT)for patients with chronic obstructive pulmonary disease(COPD)in terms of the diversity of symptoms,the lack of self-management ability and the complexity of mental health.Methods:A single-center,double-blind,randomized controlled trial was conducted in this study.Seventy-two patients with acute exacerbation COPD who were admitted to the First Hospital of Shanxi Medical University from March to October 2023 were included in the study,and 72 patients were randomly assigned to the experimental group(n=37)and the control group(n=35)by using random number table method.The control group received conventional care and telephone follow-up,and the experimental group received CCBT for 6 weeks.Major indicators(anxiety and depression)and secondary indicators(dyspnea,6-minute walking distance(6MWD),insomnia and fatigue)were used as evaluation indicators and were compared before,during and after treatment.Results:The anxiety score(55.14±2.37),depression score(58.55±2.33),dyspnea score(2.72±0.45),insomnia score(7.97±1.57)and fatigue score(46.09±0.26)after 3 weeks of CCBT intervention in the experimental group were higher than that of the anxiety score(53.64±1.46),depression score(56.59±3.52),dyspnea score(2.14±0.67),insomnia score(6.19±1.65),fatigue score(40.65±0.33)after 6 weeks of intervention.The 6MWD((280.00±8.33)m)after 6 weeks of intervention was higher than the 6MWD(268.59±7.86)after 3 weeks of intervention,and the differences were statistically significant.The F values of experimental groups were 16.141,76.745,14.976,46.250,42.337,11.700,respectively,and the P values were<0.001,<0.001,<0.001,<0.001,<0.001,0.001.After 3 weeks of intervention,the anxiety score(57.43±2.33),depression score(62.46±2.39),dyspnea score(3.06±0.42),insomnia score(9.83±1.65)and fatigue score(47.49±0.33)of the control group were all higher than those of the experimental group,and 6MWD((262.14±9.11)m)was lower than that of the experimen

关 键 词：认知疗法 治疗 计算机辅助 肺疾病 慢性阻塞性 情感症状 随机对照试验 

分 类 号：R563[医药卫生—呼吸系统]