综合心理干预对股骨头坏死置换术后病人生活质量的影响及干预研究

杨威，杨艳杰，杨秀贤，乔正学

摘要：[目的]观察股骨头坏死行人工生物型全髋关节置换术后病人的情绪、生活质量、髋关节功能的变化情况，探讨实施综合心理干预对术后病人不良情绪、髋关节功能、生活质量的影响作用。[方法]选择某三级甲等医院股骨头坏死病人200例，随机分为干预组和对照组各100例。对照组给予常规治疗及其护理；干预组在此基础上针对影响生活质量的因素再给予综合心理干预(认知转变、放松训练、支持疗法)。采用焦虑自评量表(SAS)、汉密尔顿他评抑郁量表(HAMD)、健康状况调查问卷(SF-36)、Harris髋关节功能评分量表进行测评。[结果]影响股骨头坏死置换术病人生活质量的因素有焦虑、病程、受教育水平、家庭经济收入、患病时间；干预组心理干预后较对照组病人焦虑、抑郁水平明显降低(P<0.05)，生活质量有所提高(P<0.05)，Harris髋关节功能评分有所提高(P<0.05)，离床活动时间缩短。[结论]对股骨头坏死全髋关节置换术病人实施综合心理干预，可有效改善术后病人的负性情绪，缩短住院时间，帮助和促进股骨头坏死病人康复，进而提高生活质量。

关键词：股骨头坏死；人工全髋关节置换术；生活质量；心理干预；焦虑；抑郁

中图分类号：R473.6

基金项目：国家临床重点专科建设资助项目，编号：2014-A2。

作者简介：杨威，副主任护师，硕士研究生，单位：150001，哈尔滨医科大学附属第一医院；杨艳杰(

Study on influence and intervention of comprehensive psychological intervention on quality of life of patients after osteonecrosis arthroplasty

Yang Wei，Yang Yanjie，Yang Xiuxian，et al(Affiliated First Hospital of Harbin Medical University，Heilongjiang 150001 China)

AbstractObjective：To observe the changes of mood，quality of life and hip joint function of osteonecrosis patients after undergoing bioprosthetic total hip arthroplasty and probe into the influence of implementation of comprehensive psychological intervention on negative emotions，hip joint function and quality of life of patients after surgery.Methods：A total of 200 cases of osteonecrosis patients in a three grade A hospital were randomly divided into intervention group and control group，100 cases in each.The patients in control group were qiven routine treatment and nursing；besides that patients in intervention group were given the comprehensive psychological intervention (cognitive change，relaxation training，supportive therapy) aiming at influencing factors of the quality of life.The self-rating Anxiety Scale (SAS)，Hamilton his rating Depression Scale (HAMD)，health survey questionnaire (SF-36)，Harris hip function scores care were used to evaluate.Results：The influencing factors of quality of life of patients after osteonecrosis arthroplasty included anxiety，course of disease，educational level，family income and the time of illness；the anxiety and depression level of patients in intervention group after psychological intervention were decreased significantly compared with that in control group(P<0.05)，the quality of life was improved(P<0.05)，Harris hip joint function score was improved(P<0.05)，ambulation time was shortened.Conclusion：To implement comprehensive psychological intervention for osteonecrosis patients undergoing total hip replacement can effectively improve the negative emotion of patients after surgery，shorten hospitalization time，help and promote the rehabilitation of osteonecrosis patients，and enhance their quality of life.

Key wordsosteonecrosis；artificial total hip arthroplasty；quality of life；psychological intervention；anxiety；depression

股骨头坏死(necrosis of the femoral head)是骨科领域常见的难治性疾病之一[1]，约占骨科类疾病的30%[2]。并有结果显示，股骨头坏死已取代了髋关节结核的位置，居髋关节疾病的首位[3],我国发病率为19.84%～64.70%[4]，男性高于女性。它不仅严重影响了病人的躯体功能障碍，还影响了病人的生活质量，病残率较高，所以越来越引起关注。……