陈瑛 段晓诚 张月娟

[摘要]目的：探讨医患共同决策模式在痤疮患者中的应用效果。方法：采用随机抽样法将130例面部痤疮患者随机分为对照组和观察组，每组65例。对照组予常规痤疮医疗护理沟通，观察组在常规医疗护理沟通的基础上实施医患共同决策模式，在治疗护理各环节使患者及家属参与决策。比较两组患者的负性情绪、遵医行为及治疗效果。结果：两组患者治疗后皮损消退率显著改善，观察组治疗有效率为84.62%高于对照组的73.85%，差异有统计学意义（P<0.05）。两组患者治疗后SAS及SDS得分均有所降低，且观察组干预后SAS得分（36.55±6.51）分低于对照组（45.83±4.62）分，观察组干预后SDS得分（33.67±4.15）分低于对照组（44.04±6.18）分，差异有统计学意义（P<0.05）。观察组患者遵医行为及自我护理知识得分均优于对照组，差异有统计学意义（P<0.05）。结论：医患共同决策模式能够改善痤疮患者的负性情绪、遵医行为及治疗效果，值得在临床推广应用。

[关键词]医患共同決策;痤疮;负性情绪;抑郁;焦虑;遵医行为;治疗效果

[中图分类号]R473    [文献标志码]B    [文章编号]1008-6455（2021）03-0156-04

The Influence of Shared Decision-making on Negative Emotion， Compliance Behavior and Treatment Effect in Patients with Acne

CHEN Ying1，2，DUAN Xiao-cheng1，2，ZHANG Yue-juan1，2

（1.Hunan University of Traditional Chinese Medicine，Changsha 410000，Hunan，China;2.Department of Dermatology，First Affiliated Hospital of Hunan University of Traditional Chinese Medicine，Changsha 410000，Hunan，China）

Abstract： Objective  To explore the application effect of shared decision-making in acne patients. Methods  130 patients with facial acne were randomly divided into the control group and the observation group， with 65 patients in each group. The control group received routine medical care communication for acne， while the observation group implemented the shared decision-making model on the basis of routine medical care communication. Patients and their families were involved in decision-making in each link of treatment and care， and the negative emotions， treatment compliance and treatment effect of the two groups of patients were compared. Results  After treatment， the skin lesion regression rate of the two groups was significantly improved， the effective rate of the observation group was 84.62%， which was higher than that of the control group（73.85%）， the difference was statistically significant（P<0.05）. The SAS and SDS scores of the two groups were decreased after treatment， and the SAS score of the observation group （36.55±6.51） was lower than that of the control group （45.83±4.62）， and the SDS score of the observation group （33.67±4.15） was lower than that of the control group （44.04±6.18）， the differences were statistically significant（P<0.05）. The scores of compliance behavior and self-care knowledge in the observation group were better than those in the control group（P<0.05）. Conclusion  Shared decision-making model can improve the negative mood， treatment compliance and treatment effect of acne patients， and is worthy of clinical promotion and application.

Key words： shared decision-making model; acne; negative emotion; depression; anxiety; compliance behavior; treatment effect

痤瘡好发于青少年头面部，发病率在80%以上，是一种累及毛囊皮脂腺的慢性炎症性皮肤病[1]。由于疾病原因，痤疮患者面部容貌受到一定影响，常导致患者出现焦虑、抑郁等负性情绪[2]。同时，由于患者对痤疮预防、治疗及预后情况不了解，缺乏对疾病治疗的信心以及对自身容貌受损程度的担忧，常常会加重这种负性情绪，导致遵医行为差及治疗效果不理想等。医患共同决策（Shared decision making，SDM）是指在医疗决策的各环节邀请患者或其照顾者参与，对某一医疗决策的利弊进行充分沟通，最终根据患者文化背景、教育经济水平等因素，做出医患双方共同决策的医疗服务模式[3]。因此，本研究通过对痤疮患者进行医患共同决策，探讨医患共同决策模式应用于痤疮患者降低负性情绪、提高遵医行为及治疗效果的作用。……