褚庆文 孙秋芳 陆怡 张展星 宋风

[摘要] 目的 探討综合干预在重性精神障碍患者康复中的临床效果。 方法 选择2014年7月～2015年6月上海市宝山区精神卫生中心收治并登记在册的重性精神障碍患者83例，所有患者均接受综合干预，包括健康教育、心理干预、饮食干预、运动干预等。比较干预前后患者的病情程度、遵医嘱情况、劳动能力及生活质量。 结果 干预前、后患者病情稳定程度比较，差异有统计学意义（P < 0.05），干预后康复期患者占比明显高于干预前，干预后复发期患者占比明显低于干预前，差异有统计学意义（P < 0.05）；干预前、后患者劳动能力比较，差异有统计学意义（P < 0.05），干预后无劳动能力占比明显低于干预前，差异有统计学意义（P < 0.05）；干预前、后患者遵医嘱服药依从性比较，差异有统计学意义（P < 0.05），干预后完全遵医嘱患者所占比高于干预前，不遵医嘱占比低于干预前，差异有统计学意义（P < 0.05）；干预后患者躯体功能、心理功能、社会功能、物质生活及总GQOLI-74评分均明显高于干预前，差异有统计学意义（P < 0.05）。 结论 综合干预能够明显改善社区重性精神障碍患者的病情，增加治疗依从性，同时提高患者的劳动能力及生活质量，促进疾病康复，具有重要的应用价值，值得在临床推广。

[关键词] 综合干预；重性精神障碍；临床效果；生活质量

[中图分类号] R749 [文献标识码] A [文章编号] 1673-7210（2018）02（b）-0127-04

[Abstract] Objective To discuss the clinical effect of comprehensive intervention on the rehabilitation of patients with severe mental disorders. Methods From July 2014 to June 2015， 83 patients with severe mental disorders and registered in Mental Health Center of Shanghai Baoshan District were selected， all patients received comprehensive intervention included health education， psychological intervention， diet intervention， exercise intervention. The patient′s condition， the doctor′s advice， labor ability and quality of life before and after the intervention were compared. Results The stability degree of patients before and after intervention was compared， the difference was statistically significant （P < 0.05）. After the intervention， the proportion of convalescent patients was significantly higher than before the intervention， and the proportion of patients with recurrence after intervention was significantly lower than before intervention， the differences were statistically significant （P < 0.05）. The labor ability of the patients before and after intervention were compared， the difference was statistically significant （P < 0.05）. After the intervention， the proportion of no working ability was significantly lower than that before the intervention， the difference was statistically significant （P < 0.05）. The prescribed medication compliance of patients before and after the intervention were compared， the differences were statistically significant （P < 0.05）. After the intervention， the proportion of full compliance was higher than before the intervention， the noncompliance ratio was lower than before the intervention， the differences were statistically significant （P < 0.05）. The physical function， psychological function， social function， material life and the total scores of GQOLI-74 after intervention were significantly higher than those before intervention， the differences were statistically significant （P < 0.05）. Conclusion Comprehensive intervention can significantly improve the community patients with severe mental disorders disease， increase the treatment compliance， and improve the ability to work and quality of life of patients， promote the rehabilitation of diseases， which has important application value， worthy of promotion.

[Key words] Comprehensive intervention； Severe mental disorder； Clinical effect； Quality of life

精神疾病是一种以心理活动、行为异常及神经系统功能紊乱为主要特征的慢性疾病，其发病原因尚无明确定论，主要认为与社会、家庭、环境等外界因素、遗传、自身神经生化等因素共同作用所致[1]。重性精神疾病是癥状较重的精神疾病，严重神经功能缺损，造成自知力及日常生活能力严重缺损，出现妄想、幻觉、行为怪异等症状，甚至出现自杀及攻击他人的行为，已成为危害社会安全的突出问题[2-3]。同时国内外研究发现[4-5]，综合干预不仅能增加康复措施执行率，且通过心理、饮食、健康教育等干预，可明显提高患者的治疗依从性，提高临床治疗效果。本研究笔者就采用综合干预对重性精神疾病患者的康复效果进行分析，旨在为临床提供指导。

1 资料与方法

1.1 一般资料

选择2014年7月～2015年6月上海市宝山区精神卫生中心收治并登记在册的重性精神障碍患者83例，所有患者中男39例、女44例；……