认知行为疗法结合生物反馈训...者术后认知、应激反应的影响_陈思帆.pdf

黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2认知行为疗法结合生物反馈训练对冠状动脉搭桥患者术后认知、应激反应的影响陈思帆驻马店市中心医院心血管内一科，河南驻马店463000摘要目的：探讨认知行为疗法（cognitive and behavior therapy，CBT）结合生物反馈训练对冠状动脉搭桥患者术后认知、应激反应的影响。方法：选取2017年5月2021年4月驻马店市中心医院收治的126例进行冠状动脉搭桥术的患者作为研究对象，根据围术期应用的护理方案将患者分为对照组（n=63，常规护理干预）及试验组（n=63，CBT结合生物反馈训练护理干预）。术后随访6个月，监测并比较两组患者术后心率变异性指标、情绪、认知、应激反应相关指标。结果：对各项心率变异性检测指标比较可见，术后3个月两组患者全部窦性心搏RR间期（简称NN间期）的标准差（standarddiviation of NN intervals，SDNN）、相邻正常心动周期差值的均方根（root mean square of the successive differences rMSSD）均较术前升高，且术后3个月试验组心率变异性指标改善情况均优于对照组，差异有统计学意义（t=6.805、8.064，P0.05）；干预后焦虑自评量表（Self-Rating Anxiety Scale，SAS）与抑郁自评量表（Self-rating depression scale，SDS）评分比较可见，两组患者均较干预前降低，且试验组较对照组降低，差异有统计学意义（t=19.400、10.214，P0.05）；术后简易智力状态检查量表（mini-mental state examination，MMSE）评分比较可见，术后3 d、7 d、14 d试验组均显著高于对照组，差异有统计学意义（t=2.378、3.190、6.610，P0.05）；两组患者术后心率、舒张压比较，试验组低于对照组，差异有统计学意义（t=15.913、10.734，P0.05）。结论：与常规护理干预相比，进行冠状动脉旁路移植术的患者应用CBT结合生物反馈训练干预可更有效地改善心率变异性，改善患者抑郁情绪，提升患者的术后认知能力，降低其生理应激反应。关键词冠状动脉搭桥；认知行为干预；生物反馈训练；冠心病；认知；应激反应doi10.3969/j.issn.1004-5775.2023.02.002学科分类代码320.2410中图分类号R541.4文献标识码BEffects of Cognitive Behavioral Therapy Combined with Biofeedback Training on Postoperative Cognitive and StressResponses in Patients Undergoing Coronary Artery Bypass Grafting/CHEN Si-fan/Department of Cardiovascular Medicine,Zhumadian Central Hospital,Zhumadian,Henan,463000,ChinaAbstract Objective:To investigate the effects of cognitive and behavior therapy(CBT)combined with biofeedback training onthe cognitive and stress responses of postoperative coronary artery bypass graft patients.Methods:126 patients admitted to thehospital for coronary artery bypass grafting from May 2017 to April 2021 were selected as study subjects,and the patients weredivided into a control group(63 cases,conventional nursing intervention)and a pilot group(63 cases,CBT combined withbiofeedback training nursing intervention)according to the perioperative applied nursing protocol.Patients were followed up for 6months after surgery,and postoperative heart rate variability indexes,mood,cognition,and stress response-related indexes weremonitored and compared between the two groups.Results:At 3 months after surgery,the standard diviation of NN intervals(SDNN),root mean square of the successive differences rMSSD,and the standard diviation of NN intervals(SDNN)of all sinusbeats in both groups were higher than those before surgery,and the improvement of heart rate variability indexes in the test groupwas better than that in the control group at 3 months after surgery,and the difference was statistically significant(t=6.805,8.064,P0.05).After the intervention,the scores of Self-Rating Anxiety Scale(SAS)and Self-rating depression scale(SDS)decreased inboth groups compared with those before the intervention,and the test group was lower than the control group,and the differencewas statistically significant(t=19.400,10.214,P0.05).At 3 d,7 d,and 14 d postoperatively,the postoperative simple mentalstate examination scale(MMSE)scores were higher in the test group than in the control group,with statistically significantdifferences(t=2.378,3.190,6.610,P0.05).The postoperative heart rate and diastolic blood pressure in the test group were lowerthan those in the control group,the differences were statistically significant(t=15.913,10.734,P0.05).Conclusion:Comparedwith conventional nursing interventions,CBT combined with biofeedback training intervention in patients undergoing coronaryartery bypass grafting was more effective in improving heart rate variability,improving patients depression,enhancing theirpostoperative cognitive abilities,and reducing physiological stress responses.Keywords Coronary artery bypass graft;Cognitive behavioral intervention;Biofeedback training;Coronary heart disease;Cognition;Stress response137黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2冠心病是由冠状动脉粥样硬化引发的一种在世界范围内常见的心血管疾病，据WHO调查预测，到2030年因冠心病死亡的人数将达世界总死亡人数的13.1%1-2。冠脉搭桥术是目前临床冠心病患者的有效治疗术式，在临床也称为冠状动脉旁路移植术，通过在患者主动脉与梗阻冠状动脉远端建立一条血管通路，从而增加心脏搏出血流量，改善心脏功能，并缓解患者心绞痛症状。临床应用中发现，进行冠脉搭桥术的患者常因手术创伤、麻醉药物等因素伴有不同程度的焦虑、抑郁等负性情绪，影响患者康复治疗的行为方式3。认知行为疗法（cognitive and behaviortherapy，CBT）是一种短程心理治疗方法，通过改变患者的思维方式和行为，纠正其对疾病的不良认知，达到消除不良情绪和行为的目的4。而生物反馈训练通过进行有意识的“意念”控制与心理训练，达到调节患者身心健康的目的5。因此，本研究旨在探讨CBT结合生物反馈训练对冠状动脉搭桥患者术后认知、应激反应的影响，现将结果报告如下。1资料与方法1.1一般资料选取2017年5月2021年4月收治126例的进行冠状动脉搭桥术的患者作为研究对象，根据围术期应用的护理方案将患者分为对照组（n=63，常规护理干预）及试验组（n=63，CBT结合生物反馈训练护理干预）。对照组男40例，女 23 例；年龄 3570 岁，平均年龄（62.835.74）岁；病程110年，平均病程（3.150.56）年；术前左室射血分数（left ventricular ejection fraction，LVEF）24%62%，平均LVEF（52.324.21）%。实验组男38例，女25例；年龄3270岁，平均年龄（63.626.43）岁；病程112年，平均病程（3.420.73）年；术前LVEF 26%66%，平均LVEF（53.644.53）%。两组患者一般资料具有可比性（P0.05）。本研究经医院医学伦理委员会审批。纳入标准：经冠脉造影确诊，年龄3080岁，首次进行冠状动脉搭桥术，年龄70岁，美国纽约心脏病协会6心功能分级-级，既往无精神病史。排除标准：有手术禁忌证，合并急性心肌梗死、活动性心肌炎及全身感染性疾病，血压、血糖控制不佳者，长期服用镇静、抗抑郁药物等。1.2方法两组患者采用冠状动脉搭桥术进行治疗，对照组患者围术期接受院内科室的常规治疗和护理措施，密切观察患者的术后恢复情况，同时为患者提供心理干预和饮食指导，指导患者早期下床活动及出院后适度进行运动锻炼，以及运动过程中需要留意的问题。试验组患者在常规护理的基础上联合CBT结合生物反馈训练的干预，建成护理干预小组，小组成员讨