孫海燕
[摘 要]目的 探討鼻整形軀體變形障礙(BDD)患者應(yīng)用心理干預(yù)聯(lián)合優(yōu)質(zhì)護(hù)理的效果。方法 選擇我院2022年9月-2023年10月收治的106例有鼻整形訴求的BDD患者,按入院時(shí)間分為對(duì)照組和觀察組,各53例。對(duì)照組予以常規(guī)護(hù)理干預(yù),觀察組在其基礎(chǔ)上予以心理干預(yù)聯(lián)合優(yōu)質(zhì)護(hù)理。比較兩組SCL-90評(píng)分、ITAQ評(píng)分、鼻整形手術(shù)率、手術(shù)滿意度及醫(yī)患糾紛率。結(jié)果 觀察組干預(yù)后SCL-90各維度評(píng)分低于對(duì)照組,ITAQ各維度評(píng)分高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組鼻整形手術(shù)率為64.15%,高于對(duì)照組的28.30%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組手術(shù)滿意度為82.35%,高于對(duì)照組的33.33%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組醫(yī)患糾紛率為0,低于對(duì)照組的7.55%,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。結(jié)論 實(shí)施心理干預(yù)聯(lián)合優(yōu)質(zhì)護(hù)理可有效減輕鼻整形BDD患者心理壓力,提高其自知力,使其對(duì)整形手術(shù)有合理的認(rèn)知與期望,能一定程度提高手術(shù)滿意度,值得臨床應(yīng)用。
[關(guān)鍵詞] 心理干預(yù);優(yōu)質(zhì)護(hù)理;軀體變形障礙;鼻整形
[中圖分類號(hào)] R473 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1004-4949(2024)09-0151-05
Application Effect of Psychological Intervention Combined with High Quality Nursing in BDD Patients with Rhinoplasty
SUN Hai-yan
(Plastic Surgery Department of Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, Jiangsu, China)
[Abstract]Objective To explore the effect of psychological intervention combined with high quality nursing in body dysmorphic disorder (BDD)patients with rhinoplasty. Methods A total of 106 BDD patients with rhinoplasty demands admitted to our hospital from September 2022 to October 2023 were selected and divided into control group and observation group according to admission time, with 53 patients in each group. The control group was given routine nursing intervention, and the observation group was given psychological intervention combined with high quality nursing on the basis of the control group. The SCL-90 score, ITAQ score, nasal plastic surgery rate, surgical satisfaction and doctor-patient dispute rate were compared between the two groups. Results After intervention, the scores of each dimension of SCL-90 in the observation group were lower than those in the control group, and the scores of each dimension of ITAQ were higher than those in the control group, the differences were statistically significant (P<0.05). The rate of nasal plastic surgery in the observation group was 64.15%, which was higher than 28.30% in the control group, and the difference was statistically significant (P<0.05). The surgical satisfaction of the observation group was 82.35%, which was higher than 33.33% of the control group, and the difference was statistically significant (P<0.05). The rate of doctor-patient disputes in the observation group was 0, which was lower than 7.55% in the control group, but the difference was not statistically significant(P>0.05). Conclusion Psychological intervention combined with high quality nursing can effectively reduce the psychological pressure of BDD patients with rhinoplasty, improve their insight, make them have reasonable cognition and expectation of plastic surgery, and improve the satisfaction of surgery to a certain extent, which is worthy of clinical application.
[Key words] Psychological intervention; High quality nursing; Body deformation disorder; Rhinoplasty
軀體變形障礙(body deformation disorder,BDD)是一種精神障礙,表現(xiàn)為過(guò)分關(guān)注身體不存在或輕微的外觀缺陷,并伴有回避和耗時(shí)的強(qiáng)迫行為[1]?;谂c強(qiáng)迫癥的相似之處,BDD通常被認(rèn)為是一種強(qiáng)迫譜系障礙[2]。盡管在精神衛(wèi)生服務(wù)中這種疾病往往未被充分發(fā)現(xiàn)和診斷,但流行病學(xué)研究表明[3],這是一種常見的精神問(wèn)題,在一般人群中的患病率為2.21%~56.67%,在整形人群中的患病率尤其高,在鼻整形人群中達(dá)到29%,明顯高于其他部位的整形人群。BDD患者通常會(huì)通過(guò)整形手術(shù)來(lái)消除外表缺陷,但其根源在于心理障礙,即便接受整形手術(shù)也會(huì)因不切實(shí)際的期望而對(duì)整形手術(shù)不滿意,甚至引發(fā)更嚴(yán)重的不良事件?;诖?,本研究結(jié)合我院2022年9月-2023年10月收治的106例鼻整形BDD患者的臨床資料,分析心理干預(yù)聯(lián)合優(yōu)質(zhì)護(hù)理在鼻整形BDD患者中的應(yīng)用效果,現(xiàn)報(bào)道如下。
1.1 一般資料 選擇2022年9月-2023年10月江蘇省中醫(yī)院整形外科收治的有鼻整形訴求的BDD患者106例,按入院時(shí)間分為對(duì)照組和觀察組,各53例。對(duì)照組男4例,女49例;年齡20~37歲,平均年齡(28.14±7.62)歲。觀察組男6例,女47例;年齡21~34歲,平均年齡(29.08±8.33)歲。兩組性別、年齡比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),研究可比。
1.2 納入與排除標(biāo)準(zhǔn) 納入標(biāo)準(zhǔn):①年齡≥18歲;②經(jīng)中文版軀體變形障礙問(wèn)卷(BDD)篩查,評(píng)分>20分,焦慮自評(píng)量表(SAS)評(píng)分>50分;③依從性高。排除標(biāo)準(zhǔn):①有腦部器質(zhì)性病變;②有精神活性藥品依賴或?yàn)E用;③有明確的精神分裂癥史。
1.3 方法
1.3.1對(duì)照組 予常規(guī)優(yōu)質(zhì)護(hù)理:①環(huán)境創(chuàng)設(shè):保持良好的衛(wèi)生條件,及時(shí)更換污染的床單被套,消除異味;②微笑服務(wù):工作期間以微笑示人,為患者樹立一個(gè)儀表端莊、熱情主動(dòng)、有耐心、負(fù)責(zé)任的形象;③標(biāo)準(zhǔn)化溝通:在合適的時(shí)機(jī)與患者進(jìn)行3次標(biāo)準(zhǔn)化溝通,30 min/次。第1次為交際性溝通,向患者介紹相關(guān)醫(yī)護(hù)人員、科室的管理制度等,了解患者的一般情況,與家屬進(jìn)行交流,彼此建立友好的關(guān)系;第2次為評(píng)估性溝通,評(píng)估患者的外觀缺陷、對(duì)自我的認(rèn)識(shí)、心理特征、對(duì)整容的期望、家庭社會(huì)支持等;第3次為治療性溝通,由責(zé)任護(hù)士和治療醫(yī)生共同就患者的實(shí)際情況給出合理方案,鼓勵(lì)患者表達(dá)情緒,聯(lián)同家庭支持系統(tǒng)共同糾正患者的心理障礙。
1.3.2觀察組 在對(duì)照組基礎(chǔ)上予以心理干預(yù)聯(lián)合優(yōu)質(zhì)護(hù)理:①心理干預(yù):○a 邀請(qǐng)精神衛(wèi)生科醫(yī)生對(duì)護(hù)士進(jìn)行系統(tǒng)培訓(xùn),掌握BDD臨床表現(xiàn)、病因及發(fā)病機(jī)制、干預(yù)方法等知識(shí),學(xué)習(xí)認(rèn)知行為療法(CBT);○b 將患者安排至安靜房間,與患者一對(duì)一訪談,講解BDD相關(guān)知識(shí),告知心理治療的必要性,并對(duì)患者的問(wèn)題進(jìn)行耐心解釋,另針對(duì)其焦慮情緒進(jìn)行開導(dǎo);○c 開展認(rèn)知行為療法,向患者講解CBT的方法及目的,增強(qiáng)患者主觀能動(dòng)性及治療動(dòng)機(jī),提高配合度;對(duì)有認(rèn)知歪曲、妄想者,采取蘇格拉底式提問(wèn)、正念認(rèn)知、事件-想法-繼發(fā)反應(yīng)等方法重塑認(rèn)知;對(duì)有焦慮、抑郁者,采取深呼吸療法、冥想、接受和承諾等方法;對(duì)有進(jìn)食障礙者,采取辯證行為療法;對(duì)有社交焦慮障礙者,采用人際關(guān)系心理療法;②中醫(yī)護(hù)理技術(shù):○a 耳穴壓豆:取心、肝、垂前、神門、枕、皮質(zhì)下等耳穴,局部消毒后貼上王不留行籽耳貼,早、中、晚進(jìn)行揉按,每處揉按3~5 min,以產(chǎn)生酸、麻、脹、痛感為度;○b 耳尖、肝陽(yáng)穴放血:按摩局部使其充血,進(jìn)行局部消毒,用三棱針快速點(diǎn)刺,深度1 mm左右,至其出血,約放血3~5滴,血滴用棉球吸取,隔日1次,3次/周;○c 耳部刮痧:局部消毒,涂抹潤(rùn)滑油,使用耳穴專業(yè)刮痧板,采用點(diǎn)刮法、快刮法進(jìn)行刮耳,20 min/次,隔日1次,3次/周。
1.4 觀察指標(biāo)
1.4.1評(píng)估兩組心理癥狀 采用癥狀自評(píng)量表(SCL-90)[4],涉及10個(gè)因子,包括軀體化、強(qiáng)迫、人際關(guān)系、抑郁、焦慮、敵對(duì)性、恐怖、偏執(zhí)、精神病性及其他,共90個(gè)條目,每個(gè)條目1~5分,分?jǐn)?shù)越高表明患者心理癥狀越嚴(yán)重。
1.4.2評(píng)估兩組自知力障礙 采用自知力與治療態(tài)度問(wèn)卷(ITAQ)[5],包含4個(gè)維度,分別是對(duì)疾病認(rèn)知、對(duì)用藥態(tài)度的認(rèn)知、對(duì)病情復(fù)發(fā)及求助方法的認(rèn)知、對(duì)住院的認(rèn)知,共11個(gè)條目,每個(gè)條目0~2分,總分0~22分,分?jǐn)?shù)越高表明患者自知力障礙越輕。
1.4.3記錄兩組鼻整形手術(shù)率、醫(yī)患糾紛率、手術(shù)滿意度 經(jīng)過(guò)干預(yù)后,在不違反倫理道德的前提下,對(duì)有鼻部瑕疵且對(duì)整形手術(shù)期望合理的患者可開展手術(shù),統(tǒng)計(jì)鼻整形手術(shù)率、醫(yī)患糾紛率及手術(shù)滿意度。其中手術(shù)滿意度采用自制調(diào)查問(wèn)卷評(píng)估,滿分為100分,≥70分則記為滿意。
1.5 統(tǒng)計(jì)學(xué)方法 采用SPSS 20.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析,計(jì)數(shù)資料用[n(%)]表示,行χ2檢驗(yàn);符合正態(tài)分布的計(jì)量資料用(x±s)表示,采用兩獨(dú)立樣本t檢驗(yàn);P<0.05表示差異有統(tǒng)計(jì)學(xué)意義。
2.1 兩組心理癥狀比較 觀察組干預(yù)后SCL-90各維度評(píng)分及總分低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見表1。
2.2 兩組自知力障礙比較 觀察組干預(yù)后ITAQ各維度評(píng)分及總分高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見表2。
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收稿日期:2024-1-8 編輯:周思雨