| 沈雁,王奇,陶丹红,钟继红,倪思忆,刘英超.四段式叙事疗法联合痛泻要方对肝郁脾虚型UC患者感知病耻感、自我效能和生存质量的影响[J].浙江中西医结合杂志,2024,34(5): |
| 四段式叙事疗法联合痛泻要方对肝郁脾虚型UC患者感知病耻感、自我效能和生存质量的影响 |
| Effects of four-stage narrative therapy combined with Tongxieyaofang Decocation on perceived stigma, self-efficacy and quality of life in UC patients with liver-stagnation and spleen-deficiency |
| 投稿时间：2023-09-03 修订日期：2023-12-23 |
| DOI： |
| 中文关键词: 溃疡性结肠炎 感知病耻感 自我效能 生存质量 叙事疗法 心理治疗 痛泻要方 中医药 |
| 英文关键词:ulcerative colitis perceived stigma self-efficacy quality of life narrative therapy psychotherapy Tongxieyaofang Decocation traditional Chinese medicine |
| 基金项目:浙江省中医药科技计划项目(2023ZL060) |
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| 中文摘要: |
| 目的 探讨四段式叙事疗法联合痛泻要方（TXYFD）对肝郁脾虚型溃疡性结肠炎（UC）患者的感知病耻感、自我效能和生存质量的影响。方法 选择2020年6月至2023年6月在浙江中医药大学附属第二医院就诊的肝郁脾虚型UC患者120例，随机分为对照组、中药组和联合组，每组40例。对照组予UC常规治疗，中药组在对照组基础上予痛泻要方口服，联合组在对照组基础上予四段式叙事疗法干预联合痛泻要方口服。评估各组患者8周治疗前后中医证候积分变化，以及问卷调查的感知病耻感、自我效能感和生存质量得分变化。共获得117 份有效问卷。结果 联合组治疗后的中医主症积分、次症积分和总积分均较同组治疗前显著下降（P<0.05），且其对临床病情的改善效果明显优于同期中药组和对照组（P<0.05）。与治疗前相比，联合组治疗后各维度和总体的感知病耻感得分均显著下降（P<0.05），各维度和总体的自我效能感得分均显著升高（P<0.05），各维度和总体的生存质量得分均显著提高（P<0.05）。此外，联合组对临床病情、感知病耻感、自我效能感和生存质量的改善效果均具有具有一定持续性，即停药后1月的上述指标与停药后1天相比，差异无统计学意义（P＞0.05）。结论 四段式叙事疗法联合痛泻要方可有效改善肝郁脾虚型UC患者的临床病情，降低其感知病耻感，提高其自我效能感和生存质量，辅助治疗方案可成为UC综合治疗的重要补充和优化选择之一。 |
| 英文摘要: |
| Objective To explore the effects of four-stage narrative therapy combined with Tongxieyaofang Decocation (TXYFD) on perceived stigma, self-efficacy and quality of life in ulcerative colitis (UC) patients with liver-stagnation and spleen-deficiency. Methods A total of 120 UC patients with liver-stagnation and spleen-deficiency who were treated in the gastroenterology department of the Second Affiliated Hospital of Zhejiang Chinese Medicine University from June 2021 to June 2023 were selected and randomly divided into control group, TCM group and combination group, with 40 cases in each group. The patients was given conventional UC treatment, conventional UC treatment with TXYFD, and conventional UC treatment with four-stage narrative therapy and TXYFD, respectively. The changes of TCM syndrome scores, perceived stigma, self-efficacy and quality of life scores were evaluated before and after 8-week treatment in each group. A total of 117 valid questionnaires were obtained. Results After treatment, the main disease score, the secondary disease score and the total score of combination group were all significantly decreased compared with that of before treatment (P<0.05), and its improvement effect on clinical condition was obviously better than that of TCM group and control group (P<0.05). Compared to pre-treatment score, the perceived stigma score in all dimensions and the overall score were all markedly decreased in combination group after treatment (P<0.05), the self-efficacy score in all dimensions and the overall score were all dramatically increased (P<0.05), and the score of quality of life in all dimensions and the overall score were all observably increased too (P<0.05). In addition, the improvement effects on clinical condition, perceived stigma, self-efficacy and quality of life in combination group were sustained to a certain extent, that is, there was no statistically significant difference between the above indicators 1 month after withdrawal and 1 day after withdrawal (P> 0.05). Conclusion Four-stage narrative therapy combined with TXYFD can effectively improve the clinical condition of UC patients with liver-stagnation and splenic deficiency, reduce their perceived stigma, and improve their self-efficacy and quality of life. This adjuvant therapy can be an important supplement and optimization choice for UC comprehensive treatment. |
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