The Effect Of Cognitive Behavior Intervention To The Stress In Patients Undergoing PCI

Objective:1 To explore the reasons and stressor of negative psychological state in patients with stress state coronary intervention preoperative, by using the half structured depth interview.2 Formulate corresponding cognitive behavioral intervention strategies according to the interviews results.3 To explore whether cognitive behavioral intervention can effectively reduce the psychological stress reaction and improve coping level in patients with stress state coronary intervention preoperative.Methods:1 Extract 9 patients who undergoing PCI in first affiliated hospital of Zhengzhou university as the qualitative research objects through purpose sampling method.2 Extract 62 patients who undergoing PCI in Zhengzhou university first affiliated hospital in March 2010 to September into control group and intervention group respectively throughing convenient sampling method according to random number table method,31cases in each group. The control group was given health education and psychological care by ward nurse.On this basis, intervention group were also given cognitive behavioral intervention by the researcher. All the patients were proceeded psychological stress evaluation in 24h after admisson,12h preoperative and 12h before discharge. Statistical analysis of the data, statistical method including: statistical description, chi-square, non-parametric test, repetitive measure anova, two independent sample t-test.Results:1 The stressors of patient are lack of information about disease and operation, unfamiliar environment, worry about surgery outcomes, lack of famility support, little communication with medical staffs.2 Two factors by two levels of repetitive measure anova was using to make comparison of HR, SBP, DBP, and the score of SAI, MCMQ between two groups on the three time point. Showed that the main effects of time on HR,SAI,coping style were statistical significance(P< 0.05), HR, SAI, MCMQ were different with the change of time without considering intervention; the main effects of intervention were statistical significance(P< 0.05), HR,SAI, MCMQ were different with the change of intervention without considering time; There were significance interaction between time factors and intervention level.The main effects of time on SBP and DBP were statistical significance(P<0.05), SBP and DBP were different with the change of time without considering intervention; The main effects of intervention were not statistical significance(P>0.05), the different intervention has little effect on SBP and DBP without considering time; There were significance interaction between time factors and intervention level(P<0.05). There were statistical significance difference between HR, SAI, confrontation and avoidance factors of MCMQ in the two groups on the time 12h preoperative and 12h before discharge (P< 0.05); SBP and resignation factor had statistical significance difference between two groups on 12h preoperative (P<0.05), no statistical difference on 12h before discharge (P>0.05); There were no statistical difference on DBP between two groups at any time (P> 0.05). Conclusions:Patients undergoing PCI have serious preoperative psychological anxiety, and avoidance and resignation factors were their primary medical coping modes. Cognitive behavior intervention can relieve the fluctuations of HR and BP of patients undergoing PCI; reduce the state anxiety of patients undergoing PCI and adjust their coping modes. Active confrontation tend to be developed.