目的：探讨接纳与承诺疗法（ACT）在首诊癫痫患儿父母家庭抗逆力中的应用效果。方法：选取2022年5月—2022年8月在湖南省某三甲儿童医院神经内科住院的首次诊断为癫痫的患儿父母85例,按随机数字表法随机分为对照组和干预组。对照组（n=43）实施常规护理,干预组（n=42）在常规护理的基础上实施接纳与承诺疗法,干预时间持续4周,比较两组干预前、干预结束4周后、12周后的家庭抗逆力、焦虑、抑郁、照顾负担得分。结果：干预前（T0）,两组家庭抗逆力、焦虑、抑郁及照顾负担得分均无统计学意义;干预结束4周后（T1）,干预组家庭抗逆力得分（111.46±6.584）高于对照组（93.71±8.107）;干预组焦虑得分（9.20±0.715）低于对照组（14.32±2.652）;干预组抑郁得分（11.68±1.474）低于对照组（16.37±2.898）,差异均有统计学意义;干预组照顾负担得分（47.85±12.312）低于对照组（53.21±15.037）,差异无统计学意义;干预结束12周后,干预组家庭抗逆力得分（112.76±5.957）高于对照组（95.58±7.314）;干预组焦虑得分（7.88±0.640）低于对照组（14.05±2.536）;干预组抑郁得分（11.68±1.474）低于对照组（16.37±2.898）,干预组照顾负担得分（46.10±11.970）低于对照组（52.50±14.197）,差异均有统计学意义。结论：接纳与承诺疗法能提高首诊癫痫患儿父母家庭抗逆力水平,减轻癫痫患儿父母焦虑、抑郁情绪和照顾负担。
Abstract
Objective To explore the effect of acceptance and commitment therapy (ACT) in the family resilience among parents of children with first diagnosis of epilepsy. Methods A total of 85 children with epilepsy diagnosed for the first time in the Department of Neurology of the hospital from May 2022 to August 2022 were selected and randomly divided into control group and intervention group according to random number table method. The control group (n=43) received routine care, and the intervention group (n=42) received acceptance and commitment therapy (ACT) on the basis of routine care. The intervention lasted for 4 weeks. The scores of family resilience, anxiety, depression and care burden were compared between the two groups before intervention,4 weeks after intervention and 12 weeks after intervention. Results Before the intervention (T0), there was no significant difference in the scores of family resilience, anxiety, depression and care burden in two groups.However, at 4 weeks after the intervention (T1), the family resilience score of the intervention group (111.46±6.584) was higher than that of the control group (93.71±8.107). The anxiety score in the intervention group (9.20±0.715) was lower than that in the control group (14.32±2.652). The depression score in the intervention group (11.68±1.474) was lower than that in the control group (16.37±2.898), and the differences were statistically significant. The care burden score of the intervention group (47.85±12.312) was lower than that of the control group (53.21±15.037), and the difference was not statistically significant. After 12 weeks of intervention, the family resilience score of the intervention group (112.76±5.957) was higher than that of the control group (95.58±7.314). The ACT intervention group showed lower scores in anxiety symptoms (7.88±0.640 vs 14.05±2.536) compared to the control group. The depression score in the intervention group (11.68±1.474) was lower than that in the control group (16.37±2.898), and the care burden score in the intervention group (46.10±11.970) was lower than that in the control group (52.50±14.197), with statistical significance. Conclusion Acceptance and commitment therapy can improve the family resilience of the parents of children with epilepsy, while also reducing the levels of their anxiety, depression and caring burden.
关键词
癫痫 /
患儿 /
父母 /
家庭抗逆力 /
接纳与承诺疗法
Key words
epilepsy /
children /
parents /
family resilience /
acceptance and commitment therapy
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参考文献
[1] 郭松领, 颜莉, 郑显兰, 等. 儿童癫痫急性发作院外管理的最佳证据总结[J]. 护士进修杂志, 2024.
[2] 秦凯芹, 朱立红, 张琳惠, 等. 家庭二元正念干预方案在学龄期癫痫患儿中的应用研究[J]. 护理学杂志, 2024, 39(09): 99-102.
[3] 李彩云, 徐成, 许青国, 等. 探讨奥卡西平联合左乙拉西坦治疗小儿癫痫的效果及对患儿认知功能的影响[J]. 中国实用医药, 2024, 19(02): 19-23.
[4] OPERTO F F, PASTORINO G, VIGGIANO A, et al.Epilepsy and Cognitive Impairment in Childhood and Adolescence: A Mini-Review[J]. Curr Neuropharmacol, 2023, 21(8): 1646-1665.
[5] Rozensztrauch A, Koltuniuk A.The Quality of Life of Children with Epilepsy and the Impact of the Disease on the Family Functioning[J]. Int J Environ Res Public Health, 2022, 19(4): 2277.
[6] POKHAREL R, POUDEL P, LAMA S.Quality of life among caregivers of children with epilepsy: A cross-sectional study at Eastern Nepal[J]. Epilepsia Open, 2021, 6(1): 120-126.
[7] 杨蕾, 车小露, 曹瑜嘉, 等. 新诊断癫痫患儿主要照顾者情绪状态调查研究[J]. 癫痫与神经电生理学杂志, 2021, 30(02): 76-79.
[8] BEGHI E, GIUSSANI G, NICHOLS E, et al.Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. The Lancet Neurology, 2019, 18(4): 357-375.
[9] 马梅, 惠沼沼, 张月, 等. 癫痫患儿主要照护者负担与社会支持的相关性研究[J]. 解放军护理杂志, 2018, 35(02): 25-29.
[10] WALSH F.Applying a Family Resilience Framework in Training, Practice, and Research: Mastering the Art of the Possible[J]. Family Process, 2016, 55(4): 616-632.
[11] 魏文静. 癫痫患儿家庭复原力影响因素及结构方程模型的研究[D]. 沈阳: 中国医科大学, 2022.
[12] 陈阅薇, 刘珊, 蔡佳. 癫痫患儿照顾者家庭抗逆力现状及影响因素分析[J]. 全科护理, 2023, 21(10): 1417-1420.
[13] MA Q, YAN Z, CHANG L, et al.Family resilience and subjective responses to caregiving for children with epilepsy[J]. Epilepsy Behav, 2021, 125: 108417.
[14] LI S, CHEN Z, YONG Y, et al.Effectiveness of acceptance and commitment therapy-based interventions for improving the psychological health of parents of children with special health care needs: A systematic review and meta-analysis[J]. Compr Psychiatry, 2023, 127(127): 152426.
[15] 马湖萍, 任蓉, 侯梅, 等. 新型抗癫痫发作药物吡仑帕奈添加治疗0~18岁儿童难治性癫痫的临床观察研究[J]. 中国全科医学, 2025, 28(02): 250-256.
[16] SPECCHIO N, WIRRELL E C, SCHEFFER I E, et al.International League Against Epilepsy classification and definition of epilepsy syndromes with onset in childhood: Position paper by the ILAE Task Force on Nosology and Definitions[J]. Epilepsia, 2022, 63(6): 1398-1442.
[17] 孙振球, 徐勇勇. 医学统计学[M]. 第四版. 北京: 人民卫生出版社, 2014.
[18] RUSS HARRIS.ACT就这么简单[M]. 祝卓宏, 张婍, 曹慧, 译. 第1版. 北京: 机械工业出版社, 2016.
[19] 李汝钊, 宋洁, 鹿笑寒, 等. 接纳与承诺疗法在痴呆患者家庭照顾者中应用的研究进展[J]. 护士进修杂志, 2023, 38(13): 1179-1182.
[20] LI Y, ZHAO Y, ZHANG J, et al.Psychometric Properties of the Shortened Chinese Version of the Family Resilience Assessment Scale[J]. J Child and Fam Stud, 2016, 25(9): 2710-2717.
[21] 何筱衍, 李春波, 钱洁, 等. 广泛性焦虑量表在综合性医院的信度和效度研究[J]. 上海精神医学, 2010, 22(4): 200-203.
[22] 曲姗, 胜利. 广泛性焦虑量表在综合医院心理科门诊筛查广泛性焦虑障碍的诊断试验[J]. 中国心理卫生杂志, 2015, 29(12): 939-944.
[23] ZUITHOFF N P, VERGOUWE Y, KING M, et al.The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crosssectional study[J]. BMC Family Practice, 2010, 11(1): 98.
[24] 陈然, 王瑜, 余建英, 等. PHQ-9在综合医院住院患者中信效度研究[J]. 四川精神卫生, 2017, 30(02): 149-153.
[25] ZARIT S H, REEVER K E, BACH-PETERSON J.Relatives of the impaired elderly: correlates of feelings of burden[J]. Gerontologist, 1980, 20(6): 649-655.
[26] 王烈, 杨小湜, 侯哲, 等. 护理者负担量表中文版的应用与评价[J]. 中国公共卫生, 2006, 22(8): 970-972.
[27] WEI W, YANG R, ZHANG J, et al.The Mediating Roles of Family Resilience and Social Support in the Relationship Between Illness Severity and Depressive Symptoms Among Primary Caregivers of Children With Epilepsy in China[J]. Front Neurol, 2022, 13: 831899.
[28] 袁滨. 接纳承诺疗法对首诊孤独症患儿父母心理干预研究[D]. 南昌: 南昌大学, 2021.
[29] YANG H, FENG Y, ZHU Z, et al.Evaluation of anxiety, depression, and sleep quality among parents of children with epilepsy in Southern China[J]. Epilepsy Behav, 2020, 112: 107340.
[30] 张存玲, 袁学谦, 李艳艳, 等. 癫痫患儿父母焦虑和抑郁情况调查[J]. 中华实用诊断与治疗杂志, 2020, 34(03): 312-314.
[31] 王彦利, 辛晓龙, 王席娟, 等. 癫痫患儿主要照顾者照顾负担影响因素分析[J]. 临床心身疾病杂志, 2022, 28(05): 49-53.
[32] 刘玉明. 癫痫患儿父母照顾负担、社会支持和生活质量的相关性研究[D]. 长沙: 湖南师范大学, 2020.
[33] 张雨, 袁举, 李亚杰, 等. 接纳与承诺疗法对痴呆照顾者照顾负担影响的Meta分析[J]. 全科护理, 2022, 20(22): 3030-3035.
[34] MOSHER C E, SECINTI E, WU W, et al.Acceptance and commitment therapy for patient fatigue interference and caregiver burden in advanced gastrointestinal cancer: Results of a pilot randomized trial[J]. Palliat Med, 2022, 36(7): 1104-1117.
基金
湖南省卫生健康委基金项目“模拟居家护理干预在新诊断癫痫患儿中的应用研究”（202214043965）
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