首页|焦点解决短期治疗改善慢性骨感染患者预后质量及心理状态的效果

焦点解决短期治疗改善慢性骨感染患者预后质量及心理状态的效果

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目的 比较焦点解决短期治疗(SFBT)与常规护理改善慢性骨感染患者预后质量及心理状态的效果.方法 采用回顾性队列研究分析2018年1月至2019年2月陆军军医大学第一附属医院收治的219例慢性骨感染患者的临床资料,其中男172例,女47例;年龄15~65岁[(42.1±3.8)岁].感染部位:胫骨144例,股骨75例.按Cierny-Mader骨感染分类:Ⅰ型(髓内骨感染)44例,Ⅱ型(表层骨感染)57例,Ⅲ型(局部骨感染)79例,Ⅳ型(弥漫性骨感染)39例.根据入院时间将患者分为常规护理组(2018年1月至2018年7月入院,106例)和SFBT组(2018年8月至2019年2月入院,113例).常规护理组采用常规护理方法,SFBT组在常规护理的基础上从入院开始实施SFBT,干预周期为6个月.比较两组术前、出院时及术后6个月美国特种外科医院(HSS)膝关节功能评分,健康调查问卷(SF-36)躯体功能、情绪功能、角色功能、社会功能评分,焦虑自评量表(SAS),抑郁自评量表(SDS);末次随访时护理满意度和骨愈合率.结果 患者均获随访12~36个月[(24.5±6.3)个月].术前两组HSS膝关节功能评分,SF-36躯体功能、情绪功能、角色功能、社会功能评分,SAS,SDS差异均无统计学意义(P>0.05).出院时,SFBT组HSS膝关节功能评分及SF-36躯体功能、情绪功能、角色功能、社会功能评分分别为(68.6±6.9)分、(23.0±1.8)分、(23.2±1.6)分、(23.4±1.5)分和(23.1±1.8)分,均较常规护理组明显提高[(66.3±7.2)分、(19.7±3.3)分、(20.0±2.7)分、(19.8±3.2)分、(20.5±2.7)分](P<0.05);SFBT组SAS、SDS分别为(40.9±6.2)分和(41.1±6.2)分,均较常规护理组明显降低[(46.4±6.3)分、(47.3±6.4)分](P<0.05).术后6个月,SFBT组HSS膝关节功能评分及SF-36躯体功能、情绪功能、角色功能、社会功能评分分别为(81.6±6.7)分、(26.3±1.6)分、(27.9±1.4)分、(26.6±1.4)分和(27.9± 1.6)分,均较常规护理组明显提高[(78.5±7.2)分、(17.4±2.9)分、(18.7±2.5)分、(18.3±3.0)分、(20.0±2.5)分](P<0.05或0.01);SFBT组 SAS、SDS分别为(32.8±4.8)分和(30.8±5.5)分,均较常规护理组明显降低[(44.2±5.5)分、(42.5±6.2)分](P<0.05).末次随访时,常规护理组和SFBT组护理满意度分别为66.0%(70/106)和88.5%(100/113)(P<0.01);常规护理组和SFBT组骨愈合率分别为96.2%(102/106)和94.7%(107/113)(P>0.05).结论 与常规护理方法比较,采用SFBT对慢性骨感染患者进行干预,可促进功能恢复、改善生活质量、减轻焦虑及抑郁情绪、提高患者满意度,是一种安全有效的心理护理模式.
Efficacy of solution-focused brief therapy in the improvement of prognosis and mental state of patients with chronic bone infection
Objective To compare the efficacy of Solution-focused brief therapy(SFBT)and the conventional care in the improvement of the prognosis and mental state of patients with chronic bone infection.Methods A retrospective cohort study was conducted to analyze the clinical data of 219 patients with chronic bone infection who were admitted to the First Affiliated Hospital of the Army Medical University from January 2018 to February 2019,including 172 males and 47 females,aged 15-65 years[(42.1±3.8)years].Infection sites were the tibia in 144 patients and the femur in 75 patients.According to the classification of Cierny-Mader bone infection,there were 44 patients with type Ⅰ(intramedullary bone infection),57 with type Ⅱ(superficial bone infection),79 with type Ⅲ(local bone infection),and 39 with type Ⅳ(diffuse bone infection).The patients were divided into conventional care group(admitted from January to July 2018,n=106)and SFBT group(admitted from August 2018 to February 2019,n=1 13)according to their admission time.The conventional care group received the conventional care,while the SFBT group underwent SFBT on the basis of the conventional care,with an intervention period of 6 months.The Hospital for Special Surgery(HSS)knee score,36-item Short Form Health Survey(SF-36)for somatic,emotional,role and social function,Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were compared between the two groups before surgery,at discharge and at 6 months after surgery.The rates of satisfaction with the nursing care and bone healing were collected at the last follow-up.Results All the patients were followed up for 12-36 months[(24.5±6.3)months].The differences in HSS knee score,SF-36 for somatic,emotional,role,and social function scores,SAS score,and SDS score between the two groups were not statistically significant before surgery(P>0.05).At discharge,the HSS knee score and SF-36 for somatic,emotional,role,and social function scores of the SFBT group were(68.6±6.9)points,(23.0±1.8)points,(23.2±1.6)points,(23.4±1.5)points,and(23.1±1.8)points respectively,which were all significantly higher than those of the conventional care group[(66.3±7.2)points,(19.7±3.3)points,(20.0±2.7)points,(19.8± 3.2)points,and(20.5±2.7)points respectively](P<0.05);The SAS and SDS scores in the SFBT group were(40.9±6.2)points and(41.1±6.2)points respectively,which were both significantly lower than those in the conventional care group[(46.4±6.3)points and(47.3±6.4)points](P<0.05).At 6 months after surgery,the HSS knee score and SF-36 for somatic,emotional,role,and social function scores in the SFBT group were(81.6±6.7)points,(26.3±1.6)points,(27.9±1.4)points,(26.6±1.4)points,and(27.9±1.6)points respectively,which were all significantly higher than those in the conventional care group[(78.5±7.2)points,(17.4± 2.9)points,(18.7±2.5)points,(18.3±3.0)points,and(20.0±2.5)points respectively](P<0.05 or 0.01);the SAS and SDS scores in the SFBT group were(32.8±4.8)points and(30.8±5.5)points respectively,which were significantly lower than those in the conventional care group[(44.2±5.5)points and(42.5±6.2)points](P<0.05).At the last follow-up in the conventional care group and the SFBT group,the rates of satisfaction with the nursing care were 66.0%(70/106)and 88.5%(100/113)respectively(P<0.01),and the bone healing rates were 96.2%(102/106)and 94.7%(107/113)respectively(P>0.05).Conclusion Compared with the conventional care,SFBT for intervention to patients with chronic bone infection is a safe and effective mental nursing model which can improve the recovery of the function and the quality of the patients'life,reduce their anxiety and depression,and enhance their satisfaction rate.

Bone diseases,infectiousQuality of lifeDepressionAnxietySolution-focused brief therapy

徐瑶芯、王舒琳、任晓勤、谢肇、郑婷婷

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陆军军医大学第一附属医院骨科,重庆 400038

骨疾病,感染性 生活质量 抑郁 焦虑 焦点解决短期治疗

国家自然科学基金西南医院护理科技创新基金

81672160SWHLKJ-A03

2024

中华创伤杂志
中华医学会

中华创伤杂志

CSTPCD北大核心
影响因子:1.425
ISSN:1001-8050
年,卷(期):2024.40(3)
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