呼吸训练辅以叙事心理干预对尘肺病患者康复效果的影响

张红香; 李秀云; 冯玲; 王若方

doi:10.16369/j.oher.issn.1007-1326.2025.240739

呼吸训练辅以叙事心理干预对尘肺病患者康复效果的影响

Effects of respiratory training combined with narrative psychological intervention on rehabilitation of pneumoconiosis patients

摘要

摘要:
目的探讨呼吸训练辅以叙事心理干预对尘肺病患者康复效果的影响。
方法选择2022年4月—2024年3月收治的101例尘肺病患者为研究对象。按入院先后顺序将其分成对照组（50例）和干预组（51例）。对照组接受缩唇-腹式呼吸加全身性呼吸操的呼吸训练，干预组在呼吸训练的同时给予叙事心理干预，两组训练、干预时间均为3个月。干预前后分别测定患者的第1秒用力呼气容积（FEV₁）、最大通气量（MVV），并使用《Borg评分量表》、6 min步行试验（6 MWT）、《焦虑自评量表》（SAS）、《抑郁自评量表》（SDS）、《Herth希望量表》（HHI）以及《圣乔治呼吸问卷》（SGRQ）进行评估，比较两组患者干预前后的康复效果。
结果干预后，干预组FEV₁（2.01±0.20）L、MVV（66.32±6.69）L/min及6 min步行距离（419.40±44.46）m均高于对照组（P < 0.05）。干预后，干预组SAS量表得分（48.22±3.06）分、SDS量表得分（49.65±4.11）分均低于对照组（P < 0.05）；干预组的积极态度、积极行动、亲密关系得分及希望水平总得分分别为（11.33±1.74）分、（9.88±1.56）分、（10.57±1.46）分和（31.78±3.06）分，均高于对照组（P < 0.001）。干预后1个月干预组SGRQ评分为（45.70±2.68）分、3个月为（42.30±3.14）分，均低于对照组（P < 0.05），重复测量方差分析结果显示：SGRQ评分在两组间的组间效应、时间效应、交互效应均有统计学意义(F_组间=13.376、F_时间=35.558、F_交互=4.504，均P < 0.05)，干预组SGRQ评分变化更明显。两组SGRQ评分均呈下降趋势（P < 0.05），干预组在干预后1个月、干预后3个月的SGRQ评分均低于对照组（P < 0.05）。
结论呼吸训练辅以叙事心理干预可有效提高尘肺病患者的呼吸训练效果和运动耐力水平，改善患者的生活质量，减轻心理困扰并提升其希望水平。

Abstract:
Objective To investigate the effects of respiratory training combined with narrative psychological intervention on the rehabilitation of pneumoconiosis patients.
Methods A total of 101 patients with pneumoconiosis admitted between April2022 and March 2024 were enrolled. Based on admission dates, they were divided into a control group (n = 50) and an intervention group (n = 51). The control group received pursed-lip and diaphragmatic breathing training combined with whole-body breathing exercises. The intervention group received the same respiratory training plus narrative psychological intervention. Both interventions lasted for 3 months. Before and after the intervention, the forced expiratory volume in the first second (FEV₁) and maximal voluntary ventilation (MVV) of patients were measured. The Borg Rating of Perceived Exertion, 6-minute walk test (6MWT), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Herth Hope Index (HHI), and St. George's Respiratory Questionnaire (SGRQ) were used to assess the rehabilitation effects of the two groups before and after the intervention.
Results After the intervention, the patients in the intervention group showed significantly better pulmonary function and exercise tolerance, with higher FEV₁ (2.01 ± 0.20) L, MVV (66.32 ± 6.69) L/min, and 6MWT distance (419.40 ± 44.46) m compared to the patients in the control group (P < 0.05). Anxiety and depression levels were significantly reduced in the intervention group, with lower SAS (48.22 ± 3.06) and SDS (49.65 ± 4.11) scores (P < 0.05). The intervention group's scores for positive attitude, positive action, connectedness, and total hope level were (11.33 ± 1.74) points, (9.88 ± 1.56) points, (10.57 ± 1.46) points, and (31.78 ± 3.06) points, respectively, all of which were higher than those of the control group (all P < 0.001). SGRQ scores of patients in the intervention group were significantly lower at both 1 month (45.70 ± 2.68) and 3 months (42.30 ± 3.14) post-intervention (P < 0.05). Repeated-measures ANOVA indicated significant group effect (F = 13.376), time effect (F = 35.558), and interaction effect (F = 4.504) for SGRQ scores (all P < 0.05), with more pronounced SGRQ score improvement in the intervention group. SGRQ scores in both groups showed a downward trend over time (P < 0.05), with the intervention group consistently scoring lower than the control group at 1 month and 3 months post-intervention (P < 0.05).
Conclusions Respiratory training combined with narrative psychological intervention could effectively enhance respiratory function and exercise tolerance in patients with pneumoconiosis, reduce psychological distress, improve quality of life, and increase levels of hope.

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