自我效能护理对声带息肉术后发声障碍患者训练期间心理障碍和认知行为的影响
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摘要
目的:探讨自我效能护理对声带息肉术后发声障碍患者训练期间心理障碍和认知行为的影响。方法:选取于我院行声带息肉切除术后拟行发声训练的64例患者为受试对象,按照随机数表分为观察组(n=32)与对照组(n=32)。对照组患者术后仅实施声带息肉切除术围术期常规护理干预,观察组患者则在其基础上予以自我效能护理模式进行干预。比较术后5d及15d时,两组患者自我效能感[一般自我效能感量表(GSES)]、负性情绪[Hamilton抑郁量表(HAMD)、Liebowitz社交焦虑量表(LSAS)]、疾病认知明确率(发声障碍诱因、康复训练程序、嗓音保健措施)、行为反应形式[A型行为问卷(TABQ)]、发声障碍程度[最长发声时间(MPT)、嗓音障碍指数量表(VHI)评分]、嗓音声学指标[基频微扰(jitter)、振幅微扰(shimmer)、噪谐比(NHR)]变化。结果:术后15d时,两组患者GSES评分、MPT水平、VHI评分均较术后5d时有显著提升(P<0.05),且观察组明显高于同期对照组(t=3.182,2.685,2.455;P=0.002,0.009,0.017);两组HAMD评分、LSAS评分、jitter水平、shimmer水平、NHR水平均较术后5d时有明显下降(P<0.05),且观察组明显低于同期对照组(t=-2.571,-2.299,-2.656,-2.427,-2.500;P=0.013,0.025,0.010,0.018,0.015);两组患者发声障碍诱因、康复训练程序、嗓音保健措施明确率均较术后5d时有明显提升(P<0.05),且观察组明显高于同期对照组(χ~2=4.267,5.143,4.433;P=0.039,0.023,0.035);两组患者TABQ分型A型率均较治疗前有显著下降(P<0.05),且观察组明显低于同期对照组(χ~2=4.654;P=0.031)。结论:自我效能护理可有效改善声带息肉术后发声障碍患者训练期间心理障碍和认知行为,有利于其预后康复。
Objective:To explore the effect of self-efficacy nursing on mental disorders and cognitive behavior of patients with dysphonia during training after surgery of vocal cord polyp.Methods:A total of 64 patients who planned to receive voice training after surgery of vocal cord polyp in our hospital were selected as subjects,and they were divided into the observation group(n=32)and the control group(n=32)by the random number table method.The two groups were given routine nursing intervention during the perioperative period while the observation group were additionally given self-efficacy nursing intervention.Changes in self-efficacy[General Self-efficacy Scale(GSES)],negative emotion[Hamilton Depression Scale(HAMD),Liebowitz Social Anxiety Scale(LSAS)],clear awareness rate of the disease(causes of dysphonia,procedures of rehabilitation training,voice care measures),the type of behavior reaction[Type A Behavior Questionnaire(TABQ)],the degree of dysphonia[maximum phonation time(MPT),voice handicap index(VHI)],acoustic indexes of voice[fundamental frequency perturbation(jitter),amplitude perturbation(shimmer),harmonics to noise ratio(NHR)]at 5 days and 15 days after surgery were compared between the two groups.Results:GSES scores,MPT and VHI scores of the two groups at 15 days after surgery were significantly higher than those at 5 days after surgery(P<0.05),and they were significantly higher in the observation group than that in the control group at the same time(t=3.182,2.685,2.455;P<0.05).HAMD scores,LSAS scores,jitter,shimmer and NHR of the two groups at 15 days after surgery were significantly lower than those at 5 days after surgery(P <0.05),and they were significantly lower in the observation group than that in the control group(t=-2.571,-2.299,-2.656,-2.427,-2.500;P<0.05).The clear awareness rates of causes of dysphonia,procedures of rehabilitation training and voice care measures in the two groups at 15 days after surgery were significantly higher than those at 5 days after surgery(P<0.05),and the rates were significantly higher than in the observation group than that in the control group at the same time(χ~2=4.267,5.143,4.433;P<0.05).The rates of TABQ type A in the two groups were significantly lower,compared with those before treatment(P<0.05),and the rate was significantly lower in the observation group than that in the control group(χ~2=4.654,P<0.05).Conclusion:Self-efficacy nursing can effectively improve the mental disorders and cognitive behavior of patients with dysphonia after surgery of vocal cord polyp,and it is beneficial to the prognosis and rehabilitation of patients.
Objective:To explore the effect of self-efficacy nursing on mental disorders and cognitive behavior of patients with dysphonia during training after surgery of vocal cord polyp.Methods:A total of 64 patients who planned to receive voice training after surgery of vocal cord polyp in our hospital were selected as subjects,and they were divided into the observation group(n=32)and the control group(n=32)by the random number table method.The two groups were given routine nursing intervention during the perioperative period while the observation group were additionally given self-efficacy nursing intervention.Changes in self-efficacy[General Self-efficacy Scale(GSES)],negative emotion[Hamilton Depression Scale(HAMD),Liebowitz Social Anxiety Scale(LSAS)],clear awareness rate of the disease(causes of dysphonia,procedures of rehabilitation training,voice care measures),the type of behavior reaction[Type A Behavior Questionnaire(TABQ)],the degree of dysphonia[maximum phonation time(MPT),voice handicap index(VHI)],acoustic indexes of voice[fundamental frequency perturbation(jitter),amplitude perturbation(shimmer),harmonics to noise ratio(NHR)]at 5 days and 15 days after surgery were compared between the two groups.Results:GSES scores,MPT and VHI scores of the two groups at 15 days after surgery were significantly higher than those at 5 days after surgery(P<0.05),and they were significantly higher in the observation group than that in the control group at the same time(t=3.182,2.685,2.455;P<0.05).HAMD scores,LSAS scores,jitter,shimmer and NHR of the two groups at 15 days after surgery were significantly lower than those at 5 days after surgery(P <0.05),and they were significantly lower in the observation group than that in the control group(t=-2.571,-2.299,-2.656,-2.427,-2.500;P<0.05).The clear awareness rates of causes of dysphonia,procedures of rehabilitation training and voice care measures in the two groups at 15 days after surgery were significantly higher than those at 5 days after surgery(P<0.05),and the rates were significantly higher than in the observation group than that in the control group at the same time(χ~2=4.267,5.143,4.433;P<0.05).The rates of TABQ type A in the two groups were significantly lower,compared with those before treatment(P<0.05),and the rate was significantly lower in the observation group than that in the control group(χ~2=4.654,P<0.05).Conclusion:Self-efficacy nursing can effectively improve the mental disorders and cognitive behavior of patients with dysphonia after surgery of vocal cord polyp,and it is beneficial to the prognosis and rehabilitation of patients.
引文
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[9]杨红.闫冬梅,李先宾,等.患者健康问卷抑郁量表在综合医院心身疾病门诊的应用[J].中华行为医学与脑科学杂志,2015,24(5):473-476
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[11]吴爱勤.心身医学分类诊断评估策略[J].实用医院临床杂志,2015,12(6):1-6
[12]Verdonckde Leeuw I M,Kuik D J,De B M,et al.Validation of the voice handicap index by assessing equivalence of European translations[J].Folia Phoniatr Logop,2014,60(4):173-178
[13]Lin L,Sun N,Yang Q,et al.Effect of voice training in the voice rehabilitation of patients with vocal cord polyps after surgery[J].Experimental&Therapeutic Medicine,2014,7(4):877-880
[14]崔卫新,徐文,程丽宇.功能性发声障碍的临床特征及预后分析[J].听力学及言语疾病杂志,2016,24(6):565-569
[15]余明强,潘晗,周莉,等.气流相关检查参数对嗓音功能评估的意义[J].中华耳鼻咽喉头颈外科杂志,2015,50(12):983-988
[16]郭文俊,何霞,郝红丽,等.声带息肉诊断与治疗[J].国际耳鼻咽喉头颈外科杂志,2017,41(5):254-257
[17]汤苏成,王跃建,陈伟雄,等.声带息肉和小结术后发声障碍患者嗓音训练疗效观察[J].听力学及言语疾病杂志,2017,25(2):200-202
[18]和娟.一般自我效能感在感戴、生活满意度间的中介效应[J].中国健康心理学杂志,2015,23(7):1011-1014
[19]梁发雅,杨金珊,蔡谦,等.嗓音训练前后对女性肌紧张性发声障碍患者发声空气动力学结果分析[J].听力学及言语疾病杂志,2014,22(4):371-374
[2]楚红梅,王高君,杨曦.规范化优质护理在声带息肉摘除术中的应用分析[J].实用临床医药杂志,2016,20(10):151-153
[3]李毅,徐宇红,王珂.临床护理路径在声带息肉切除术病人中的应用[J].护理研究,2014,28(6):715-716
[4]徐姝娟,张志云,汪爱梅,等.自我效能干预对肠造口患者生活质量的影响[J].广东医学,2016,37(10):1588-1590
[5]黄选兆.实用耳鼻咽喉科学[M].北京:人民卫生出版社,1998:46-49
[6]张小伯,于萍.嗓音显微手术学[M].北京:中国协和医科大学出版社,2005:57-64
[7]黄昭鸣,杜晓新.言语障碍的评估与矫治[M].上海:华东师范大学出版社,2006:22-27
[8]周英,杨从艳.赵梅君,等.自我效能感在喉癌术后患者自我护理和生活质量间的中介作用分析[J].蚌埠医学院学报,2014,39(12):1707-1711
[9]杨红.闫冬梅,李先宾,等.患者健康问卷抑郁量表在综合医院心身疾病门诊的应用[J].中华行为医学与脑科学杂志,2015,24(5):473-476
[10]Gentili C,Vanello N,Cristea I,et al.Proneness to social anxiety modulates neural complexity in the absence of exposure:A resting state fMRI study using Hurst exponent[J].Psychiatry Research,2015,232(2):135-144
[11]吴爱勤.心身医学分类诊断评估策略[J].实用医院临床杂志,2015,12(6):1-6
[12]Verdonckde Leeuw I M,Kuik D J,De B M,et al.Validation of the voice handicap index by assessing equivalence of European translations[J].Folia Phoniatr Logop,2014,60(4):173-178
[13]Lin L,Sun N,Yang Q,et al.Effect of voice training in the voice rehabilitation of patients with vocal cord polyps after surgery[J].Experimental&Therapeutic Medicine,2014,7(4):877-880
[14]崔卫新,徐文,程丽宇.功能性发声障碍的临床特征及预后分析[J].听力学及言语疾病杂志,2016,24(6):565-569
[15]余明强,潘晗,周莉,等.气流相关检查参数对嗓音功能评估的意义[J].中华耳鼻咽喉头颈外科杂志,2015,50(12):983-988
[16]郭文俊,何霞,郝红丽,等.声带息肉诊断与治疗[J].国际耳鼻咽喉头颈外科杂志,2017,41(5):254-257
[17]汤苏成,王跃建,陈伟雄,等.声带息肉和小结术后发声障碍患者嗓音训练疗效观察[J].听力学及言语疾病杂志,2017,25(2):200-202
[18]和娟.一般自我效能感在感戴、生活满意度间的中介效应[J].中国健康心理学杂志,2015,23(7):1011-1014
[19]梁发雅,杨金珊,蔡谦,等.嗓音训练前后对女性肌紧张性发声障碍患者发声空气动力学结果分析[J].听力学及言语疾病杂志,2014,22(4):371-374