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1、 I摘 要 目的目的：研究团体认知行为干预对维持性血液透析患者的焦虑抑郁情绪、生活质量及营养指标的影响。 方法：方法： 研究对象来源于某三甲医院血液净化中心， 自 2010 年 7 月至 2010 年 10 月期间，选取符合入选标准的患者 60 例，采用随机化分组，分为对照组和实验组，两组在性别、年龄、婚姻状况、透析时间、文化程度、职业、原发病等差异没有统计学意义（P0.05） 。对照组采用血液透析患者常规护理方式，实验组在血液透析患者常规护理方式上加用团体认知行为干预心理护理方法。团体认知行为干预方法包括：团体干预措施即通过团体创始阶段、过渡阶段、成熟阶段、结束阶段四个过程来完成团体的建立；
2、认知行为干预措施包括认知重建、知识讲解、行为示范、健康教育等方式。团体认知行为干预分为 4 组，每组7-8 人，每周 1 次，每次 60 分钟，共 12 次。干预前后分别对两组患者运用一般情况调查表，焦虑自评量表、抑郁自评量表、SF-36 简明健康调查问卷进行问卷调查，并对患者进行主观综合营养评估、体重指数、前白蛋白等进行检测。采用 SPSS 13.0 软件包进行统计学处理，组间比较采用X2或t检验，以P 0.05） ，而经过 12 周干预后，实验组患者 SAS 与 SDS 总分较对照组有明显的下降，差异具有统计学意义（P0.05） ，而实验组干预后 SAS 和 SDS 得分较干预前有明显的下
3、降，其差异具有统计学意义（P0.05） ，干预后实验组焦虑抑郁程度的百分比构成均优于对照组，其差异具有统计学意义（P0.05） ，实验组在干预后较干预前焦虑抑郁程度有所减轻，差异具有统计学意义（P0.05） ，而干预后实验组各项积分均高于对照组，其差异具有统计学意义（P0.05） ，实验组在干预后生存质量各维度积分较干预前有所增加，差异具有统计学意义（P0.05） ，干预后实验组正常营养状态、轻中度营养不良、重度营养不良例数较对照组有一定的好转，其差异具有统计学意义（P0.05） ；MHD 患者体重指数、前白蛋白在干预前两组差异没有统计学意义（P0.05） ，而在干预后实验组较对照组具有不同程
4、度的升高，其差异具有统计学意义（P0.05） 。 结论：结论：团体认知行为干预可以明显缓解 MHD 患者焦虑抑郁不良情绪；团体认知行为干预可以明显改善患者的生活质量；团体认知行为干预可在一定程度上改善患者的营养状态。 关键词：团体认知行为干预，维持性血液透析，焦虑,抑郁，生活质量，营养状态 IIIABSTRACT Objective:To study the effect of group cognitive-behavioral therapy on anxiety ,depression ,the quality of life and nutritional status . Metho
5、ds: The patients come from blood purification center of one Class 3-A hospital, 60 patients with end-stage renal disease were randomly selected for this study from July to October in 2010. They were randomly divided into control group or experimental group. It is no significant different in gender,
6、age, marital status, dialysis time, education level, occupation, primary disease (P0.05). The control group was received routine nursing care of hemodialysis; the experimental group was received routine care plus group cognitive-behavioral intervention. The methods of group cognitive-behavioral inte
7、rvention include that: group establishing, cognition rebuilding, explaining knowledge, preaching example, enjoying music, relaxation training and health education. Group was divided into 4 groups and each group 7-8 patients , once a week, 60min, for 12 times. The patients were investigated by the ge
8、neral conditions questionnaire, SAS, SDS and SF-36, and were detected the SGA, BMI, PA. SPSS 13.0 software package was used for statistical description and analysis. Chi square test or independent sample were used to analysis the date，value of P 0.05),but After 12 weeks of intervention, SAS and SDS
9、score of experimental groups decreased more significantly than the control group, The difference was significant (P 0.05). (2) Before the intervention, there is no significant difference in the percentage pose of anxiety and depression degree between groups, but after the intervention ,the percentag
10、e of degree of anxiety and depression were better than the control group,the difference was statistically significant (P 0.05).(3) Before intervention, There were no significant differences in various dimensions scores of quality of life between two groups patients. But a various points after the in
11、tervention were higher, the difference was statistically significant (P0.05).(4) Using SGA method to assess nutritional status of patients, before the intervention,the difference of control group was not statistically significant(P0.05);But after the intervention the normal nutritional status, mild-
12、moderate malnutrition, severe malnutrition cases in the treatment group improved more significantly than in the control group,and the difference was statistically significant (P 0.05). (5) After mental intervention, by human studies measurements on MHD patients, BMI of the experimental group has sig
13、nificantly improved more than the control group, the difference was statistically significant (P0.05). Conclusions:(1) Group cognitive-behavioral psychological intervention can significantly ease negative feelings of anxiety and depression with the MHD patients;(2) Group cognitive-behavioral psychol
14、ogical interventions can improve the life quality of MHD patients;(3) Group cognitive behavioral psychology interventions can significantly improve the nutritional status of patients and reduce the incidence of malnutrition. KEY WORDS： Group cognitive-behavioral intervention, Maintenance hemodialysi
15、s, anxiety, depression, nutritional status V英文缩略语中文对照 中文 英文 缩略语 慢性肾功能衰竭 chronic renal failure CRF 血液透析 hemodialysis HD 维持性血液透析 maintenance hemodialysis MHD 终末期肾脏病 end-stage renal diseases ESRD 蛋白质能量营养不良 protein-energy malnutrition PEM 主观综合营养评价 subjective global assessment of nutritional status SGA 体
16、重指数 body mass index BMI 前白蛋白 pre-albumin PA 理性情绪疗法 rational emotional therapy RET 生理机能 physical functioning PF 生理职能 role-physical RP 躯体疼痛 bodily pain BP 一般健康状况 general health GH 精力 vitality VT 社会功能 social functioning SF 情感职能 role-emotional RE 精神健康 mental health MH 健康变化 reported health transition RHT 1 引 言 11 引引 言言 1.1 研究背景 终末期肾脏疾病（End-stage Renal Disease，ESRD）是一种不可逆转的慢性渐进性疾病，由于各种原因造成肾单位的严重破坏、肾小球滤过率显著下降，以及肾脏慢性实质性不可逆转的功能损害，进而导致体内各种代谢废物毒素大量潴留，导致水、电解质及酸碱平衡失调，可以引起消化系统、心血管系统、神经肌肉系统、血液系统等
