韦丽芳等

【摘要】目的了解居家腹膜透析（CAPD）患者焦虑、抑郁和简易应对方式，并探讨干预方法。方法将焦虑自评量表（SAS）、抑郁自评量表（SDS）和简易应对方式问卷（SCSQ）发放给44例居家腹膜透析患者，根据调查结果实施持续护理干预。结果干预前CAPD患者SAS总得分为（60.02±4.59）分，与全国常模得分（29.78±0.46）分比较差异有统计学意义（t=176.9473，P=0.0000）；抑郁平均得分（65.73±5.63）分，其中轻度抑郁6例（13.64%），中度抑郁24例（54.54%），重度抑郁14例（31.81%）。CAPD患者积极应对方式得分低于全国常模，消极应对方式高于全国常模，比较差异均有统计学意义（P<0.01）。实施持续护理干预后，CAPD患者焦虑、抑郁明显下降，比较差异均有统计学意义（P<0.01）。CAPD患者积极应对方式平均得分高于干预前，消极应对方式平均得分低于干预前，比较差异均有统计学意义（P<0.01）。结论对居家腹膜透析患者实施持续护理干预后，能减轻患者焦虑与抑郁，提高患者积极应对方式能力，减少消极应对方式，从而改善患者的负性心理，提高患者的生活质量。

【关键词】护理干预；腹膜透析；焦虑；抑郁；应对方式

中图分类号：R459.5 文献标识码：ADOI：10.3969/j.issn.10031383.2015.04.009

【Abstract】ObjectiveTo understand anxiety，depression and simplified coping styles of patients with continuous ambulatory peritoneal dialysis （CAPD），as well as to discuss the intervention methods.MethodsSelfrating anxiety scale （SAS），selfrating depression scale （SDS） and simplified coping style questionnaire （SCSQ） were provided to 44 CAPD patients，and sustain nursing intervention was carried out according to results of the investigation afterward.Results Before the intervention，SAS score of CAPD patients was （60.02±4.59），and compared with that of national norm （29.78±0.46），difference was statistically significant （t=176.9473，P=0.0000）.Average score of depression was （65.73±5.63），6 cases （13.64%） had slight depression，24 （54.54%） had moderate depression and 14 （31.81%） had severe depression.Score of optimistic coping styles of CAPD patients was lower than that of the national norm，while the score of negative coping styles was higher，so the differences were statistically significant （P<0.01）.After sustain nursing intervention，the anxiety and depression of CAPD patients decreased apparently，so the differences were statistically significant （P<0.01）.Average score of optimistic coping styles of CAPD patients was higher than that before intervention，while the average score of negative coping styles was lower，so the differences were statistically significant（P<0.01）.ConclusionTo implement sustain nursing intervention on CAPD patients can reduce the anxiety and depression，improve the optimistic coping ability，eliminate negative coping styles，so as to improve the negative psychology of patients and their quality of life.

【Key words】nursing intervention；peritoneal dialysis；anxiety；depression；coping style

终末期肾病（endstage renal disease，ESRD）是由慢性肾病及其他慢性疾病引起的肾脏衰竭，其发生率呈逐年上升趋势[1]。因患者的肾脏功能发生不可逆转的衰退，只能依赖肾替代治疗以维持正常生命。目前国内外ESRD主要治疗手段包括肾移植、血液透析与居家持续性不卧床腹膜透析（Continuous Ambulatory Peritoneal Dialysis，CAPD）三种方式。CAPD是一项长期、持续性、家庭化的治疗方法，具有操作简便、经济、安全、节省人力、有效等优点。但其治疗效果与患者及家属掌握透析知识、透析态度、透析行为及行为的依从性有关。由于CAPD患者长期受到疾病的折磨，社会角色和家庭角色均发生了明显变化，加之对疾病认识的不足，透析过程中出现不良反应，透析费用较高等，CAPD患者易出现焦虑、抑郁等不良心理[2]。应对是个体对应激的认知评价和评价后为平衡自身的精神状态所采取的措施，良好的应对方式能改变个体的主观认识，有提高个体处理问题的能力及改善情绪等作用[3～4]。……