杨 杰　汪灵燕

[关键词]认知行为疗法;机械性眼外伤;疾病认知;自我管理;整形修复;生活质量

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）12-0160-03

Effect of Cognitive Behavior Therapy on Disease Cognition and Self-Management of Patients with Mechanical Ocular Trauma and Plastic Repair

YANG Jie，WANG Ling-yan

（Department of Ophthalmology，Jiangsu Provincial People’s Hospital，Nanjing 210029，Jiangsu，China）

Abstract：  Objective  To investigate the effect of cognitive behavioral therapy （CBT） on disease cognition and self-management of patients with mechanical ocular trauma.  Methods  A sample of 46 mechanical ocular trauma plastic repair patients who were treated at the author’s hospital from January 2019 to December 2020 were selected as the research objects. Using convenience sampling， they were divided into a control group （n=24） and an observation group （n=22）. The control group was given routine care for mechanical eye injury plastic surgery， and the observation group received cognitive behavioral therapy intervention on the basis of routine care. The two groups were compared with disease cognition level， self-management ability， and quality of life evaluation.  Results  Compared with before the intervention， the two groups’ disease cognition level at discharge was improved， and the difference was statistically significant （P<0.05）， and the observation group had a more significant increase in sleep management， eye management， and review dimensions （P<0.05）. 6 months after discharge， the self-management ability and quality of life evaluation of the two groups were improved compared with that before the intervention （P<0.05）， and the observation group was significantly higher than the control group （P<0.05）. Conclusion  Cognitive behavioral therapy can improve patients' disease awareness and self-management ability， improve patients' quality of life， and is worthy of clinical application.

Key words： cognitive behavioral therapy; mechanical eye trauma; disease cognition; self management; plastic repair; living quality

機械性眼外伤主要是指眼部受到车祸、锐器戳伤、硬物撞击等外力性刺激[1]，导致眼部出现眼球和眶内结构的损伤，是眼科常见的急性病症[2]。不同眼外伤患者病情不一，早期通过手术进行整形修复，可在恢复眼功能及眼外观的基础上，尽可能地避免后期出现眼睑畸形、瘢痕增生及眼球暴露等问题[3-4]。多数眼外伤患者出于对疾病不了解、手术恐惧及担心预后不佳等原因，会表现出不同程度的不配合治疗、情绪焦虑、自我管理能力低下等问题，此时使用常规护理干预效果大多不甚理想[5-6]。认知行为疗法（Cognitive behavior intervention，CBT）是指通过有效的认知和行为干预，纠正患者不合理的认知，提高认知水平，从而建立规范性健康行为以达到有效管理疾病的目的[7-8]。因此，本研究对机械性眼外伤整形修复患者使用认知行为疗法进行干预，旨在探讨其在改善患者疾病认知水平及自我管理能力方面的临床意义，为临床工作提供参考依据。

1  资料和方法

1.1 一般资料：采用便利抽样法，抽取2019年1月-2020年12月于笔者医院就诊的机械性眼外伤整形修复患者46例作为研究对象。纳入标准：①机械性眼外伤整形修复患者;②未合并其他系统损伤或疾病;③沟通理解能力正常;④知情同意且愿意配合。排除标准：①有精神障碍或认知障碍;②伴有严重听力障碍者。将符合标准46例患者中的24例患者纳入对照组;其中男16例，女8例;年龄16～37岁，平均年龄（28.31±4.75）岁;开放性眼外伤患者17例，闭合性眼外伤7例。……