高秀君++金曼+张丽华

[摘要] 目的 探討认知干预对焦虑症伴发功能性便秘患者生活质量、神经递质、括约肌功能的影响。 方法 选择2013年7月～2016年7月于杭州市第七人民医院接受治疗的焦虑症伴发功能性便秘患者90例，按照单盲随机对照法将患者分为对照组和观察组，每组各45例。对照组给予常规护理干预，观察组给予认知干预。采用便秘患者生活质量量表（PAC-QOL）评估干预前后患者的生活质量，采用放射免疫法检测干预前后患者肠道神经递质含量，采用全消化道胃肠动力仪检测干预前后患者的括约肌功能指标。 结果 干预前，两组患者的生活质量、神经递质含量、括约肌功能比较，差异无统计学意义（P > 0.05）。干预后，观察组PAC-QOL中躯体不适、心理社会不适、担心焦虑、满意度评分均低于对照组，差异均有统计学意义（均P < 0.05）；血清中肠道神经递质一氧化氮、生长抑素含量低于对照组，肽类神经递质、5-羟色胺含量高于对照组；肌功能指标中食管下括约肌静息压高于对照组，肛门括约肌静息压、肛门最大缩榨压低于对照组（P < 0.05）。 结论 认知干预可提高功能性便秘患者的生活质量，均衡肠道神经递质分泌及括约肌功能。

[关键词] 功能性便秘；认知干预；生活质量；神经递质；括约肌功能

[中图分类号] R473 [文献标识码] A [文章编号] 1673-7210（2017）11（a）-0165-04

Influences of cognitive intervention on quality of life， neurotransmitter， sphincter function in anxiety disorder patients with functional constipation

GAO Xiujun JIN Man▲ ZHANG Lihua

Department of Spiritual Section， The Seventh People's Hospital of Hangzhou， Zhejiang Province， Hangzhou 310013， China

[Abstract] Objective To explore the effects of cognitive intervention on quality of life， neurotransmitter， sphincter function in anxiety disorder patients with functional constipation. Methods Ninety cases of anxiety disorder patients with functional constipation in the seventh People′s Hospital of Hangzhou during July 2013 to July 2016 were selected as research subjects and divided into control group（routine nursing intervention） and observation group （cognitive intervention） according to single blind randomized controlled method， with 45 cases in each group. Before and after intervention， quality of life in two groups was evaluated by patient assessment of constipation quality of life scale （PAC-QOL）， serum contents of intestinal neurotransmitters were measured by radioimmunoassay， sphincter function indices were measured by total gastrointestinal motility instrument. Results Before intervention， there were no significant differences in the quality of life， neurotransmitter and sphincter function between the two groups （P > 0.05）. After intervention， scores of physical discomfort， psychosocial discomfort， anxiety and worry， satisfaction in observation group were lower than those of control group； serum contents of intestinal neurotransmitters such as nitric oxide， somatostatin were lower than those of control group， the content of peptide neurotransmitter-substance， 5-hydroxytryptamine was higher than those of control group； muscle function indices such as lower esophageal sphincter pressure was higher than that of control group， anorectal resting pressure， anal maximal squeeze pressure were lower than those of control group （all P < 0.05）. Conclusion Cognitive intervention can improve the quality of life in anxiety disorder patients with functional constipation， balance the secretion of enteric neurotransmitters and sphincter function.endprint

[Keywords] Functional constipation； Cognitive intervention； Quality of life； Neurotransmitter； Sphincter function

功能性便秘是指排除器质性疾病的前提下，持续存在的原发性便秘，其病因主要为肠道功能紊乱，与生活习惯不良、情绪改变也相关[1-2]。较多研究均证实，除辅助性促胃肠动力药物外，恰当的护理干预是决定功能性便秘患者治疗结局的因素之一。功能性便秘患者多存在情绪波动，随着病程延长、便秘程度加重，患者不良情绪也进一步加重，两者形成恶性循环，故干预患者的情绪状态、纠正不良认知是治疗功能性便秘的重要环节之一[3-4]。传统护理干预并未对患者的认知状态干预作出特殊规定，随着护理学进展，较多学者指出应将患者的心理、认知干预作为核心因素列入日常护理工作中，以实现患者的“身心康复”。本研……