葉麗 周笑 余旭芳
[摘要] 目的 分析家庭康復(fù)護(hù)理干預(yù)在自閉癥兒童社會(huì)交往障礙治療中的應(yīng)用效果及影響。 方法 將本院2016年10月~2018年7月研究時(shí)間段內(nèi)收治自閉癥社會(huì)交往障礙患兒共75例納為研究對(duì)象,開展回顧性研究分析。根據(jù)家屬護(hù)理模式的選擇將其分為對(duì)照組36例、研究組39例?;純壕诔R?guī)治療基礎(chǔ)上參與研究,研究期間對(duì)照組接受臨床標(biāo)準(zhǔn)護(hù)理,研究組在對(duì)照組護(hù)理基礎(chǔ)上配合家庭康復(fù)護(hù)理干預(yù)。對(duì)比兩組護(hù)理前后患兒各維度自閉癥、生活質(zhì)量評(píng)分及家屬護(hù)理滿意度情況。 結(jié)果 護(hù)理前兩組患兒各維度自閉癥評(píng)分均無明顯差異(P>0.05);護(hù)理后兩組患者言語/語言/交流、社交、感覺/知覺以及健康/身體/行為評(píng)分明顯降低(P<0.05),研究組各維度自閉癥評(píng)分明顯低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);護(hù)理前兩組患兒生活質(zhì)量評(píng)分均無明顯差異(P>0.05);護(hù)理后兩組患者生理機(jī)能、生理職能、精力、社會(huì)功能以及情感職能評(píng)分明顯提高(P<0.05),研究組各維度生活質(zhì)量評(píng)分明顯高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);研究組護(hù)理滿意度為94.87%,明顯高于對(duì)照組(77.78%),差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。 結(jié)論 予以存在社會(huì)交往障礙的自閉癥兒童家庭康復(fù)護(hù)理干預(yù),可在基礎(chǔ)治療、護(hù)理基礎(chǔ)上,有效改善患兒癥狀,提升其生活質(zhì)量,可在臨床中借鑒推廣。
[關(guān)鍵詞] 自閉癥兒童社會(huì)交往障礙;家庭康復(fù)護(hù)理;應(yīng)用效果;影響分析
[中圖分類號(hào)] R473 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] B ? ? ? ? ?[文章編號(hào)] 1673-9701(2019)31-0143-05
Application effect and influence of family rehabilitation nursing intervention in the treatment of social communication disorders in children with autism
YE Li1 ? ZHOU Xiao2 ? YU Xufang3 ? LIANG Yong4
1.No.10 Ward, Lishui Second People's Hospital in Zhejiang Provinca, Lishui ? 323000, China; 2.Department of Nutrition, Lishui Second People's Hospital in Zhejiang Provinca, Lishui ? 323000, China; 3.No.7 Ward, Lishui Second People's Hospital in Zhejiang Provinca, Lishui ? 323000, China; 4.Hospital Office, Lishui Second People's Hospital in Zhejiang Provinca, Lishui ? 323000, China
[Abstract] Objective To analyze the application effect and influence of family rehabilitation nursing intervention in the treatment of social communication disorders in children with autism. Methods A total of 75 children patients with autism combined with social communication disorder who were admitted in our hospital during the study period from October 2016 to July 2018 were selected as the study subjects, and a retrospective study was conducted. According to the choice of family care model, they were divided into 36 cases in the control group and 39 cases in the study group. All children participated in the study on the basis of conventional treatment. The control group was given clinical standard care during the study period. The study group was given the family rehabilitation nursing intervention on the basis of the control group. Autism with all dimensions, quality of life scores and family nursing satisfaction in the children patients before and after nursing were compared between the two groups. Results There was no significant difference in the scores of autism with all dimensions between the two groups before nursing(P>0.05); after the nursing, the speech/language/communication, social, sensory/perception and health/body/behavioral scores in both groups were significantly decreased(P<0.05); the autism scores in the study group were significantly lower than those in the control group, and the difference was statistically significant(P<0.05); there was no significant difference in the quality of life scores between the two groups before nursing(P>0.05); after nursing, the physiological function, physiological roles, energy, social function, and emotional function scores in both groups were significantly increased(P<0.05); the quality of life scores with all dimensions in the study group were significantly higher than those in the control group, and the difference was statistically significant(P<0.05); the nursing satisfaction in the study group was 94.87%, which was significantly higher than that of 77.78% in the control group, and the difference was statistically significant(P<0.05). Conclusion The family rehabilitation nursing intervention for autistic children with social communication disorders can effectively improve the symptoms of children patients and improve their quality of life on the basis of basic treatment and nursing, which can be used for reference in clinical practice.
[Key words] Children with autism combined with social communication disorder; Family rehabilitation nursing care; Application effect; Effect analysis
自閉癥,又稱孤獨(dú)癥,是一類臨床常見的廣泛性發(fā)育障礙疾病,且其在男童中的發(fā)病率明顯高于女童,目前臨床中對(duì)于自閉癥的發(fā)病誘因研究尚未得出明確結(jié)論[1-3],但多認(rèn)為與遺傳、感染、免疫、孕期理化因子刺激等高危風(fēng)險(xiǎn)因素有關(guān),患兒起病后,可隨病情進(jìn)展逐漸出現(xiàn)社會(huì)交往障礙、交流障礙及興趣狹窄、刻板重復(fù)行為的臨床癥狀表現(xiàn),并合并有不同程度的言語、智能或情感障礙,且尚無特效治療藥物[4-5],僅可通過一定藥物治療及干預(yù)治療手段對(duì)患兒癥狀進(jìn)行緩解,而且上述臨床治療手段,雖可起到一定治療干預(yù)效果,但由于完善護(hù)理模式的缺乏導(dǎo)致患兒治療干預(yù)效果局限性大,故需采取相應(yīng)護(hù)理模式配合干預(yù)治療,進(jìn)一步提升臨床有效性[6]。因此,為分析家庭康復(fù)護(hù)理干預(yù)在自閉癥兒童社會(huì)交往障礙治療中的應(yīng)用效果及影響,特開展本次研究,現(xiàn)報(bào)道如下。
1 資料與方法
1.1 一般資料
將本院2016年10月~2018年7月研究時(shí)間段內(nèi)收治自閉癥兒童社會(huì)交往障礙患兒共75例納為研究對(duì)象,開展回顧性研究分析。根據(jù)家屬護(hù)理模式的選擇將其分為對(duì)照組36例、研究組39例。
對(duì)照組36例患兒,男29例,女7例,年齡3~10歲,平均(6.52±2.81)歲,經(jīng)DSM-5分級(jí)后,Ⅰ級(jí)患兒9例,Ⅱ級(jí)患兒21例,Ⅲ級(jí)患兒6例。研究組39例患兒,男31例,女8例,年齡2.5~10歲,平均(6.25±2.67)歲,經(jīng)DSM-5分級(jí)后,Ⅰ級(jí)患兒10例,Ⅱ級(jí)患兒24例,Ⅲ級(jí)患兒5例。研究經(jīng)本院倫理委員會(huì)審核批準(zhǔn),兩組患兒基線資料經(jīng)統(tǒng)計(jì)學(xué)方法對(duì)比后,組間對(duì)比結(jié)果無明顯差異(P>0.05),研究結(jié)果具有可比性。
對(duì)照組患兒主要照顧家屬,男15例,女21例,年齡25~34歲,平均(29.52±3.68)歲,初中學(xué)歷5例、高中學(xué)歷17例,??萍耙陨蠈W(xué)歷14例;研究組患兒主要照顧家屬,男16例,女23例,年齡25~37歲,平均(31.02±3.75)歲,初中學(xué)歷7例、高中學(xué)歷19例,??萍耙陨蠈W(xué)歷13例。家屬一般資料組間對(duì)比無差異(P>0.05)。
納入標(biāo)準(zhǔn):經(jīng)詢問患兒綜合病史、神經(jīng)功能檢查等輔助診斷檢查后均符合DSM-5自閉癥臨床診斷標(biāo)準(zhǔn);家屬經(jīng)詳解研究內(nèi)容后自愿確認(rèn)參與研究,并簽署《知情書》,且家屬均無疾病史,可有效配合護(hù)理[7]。排除標(biāo)準(zhǔn):排除合并腦部器質(zhì)性病變患兒;排除存在精神疾病家族史者[8]。
1.2方法
患兒均在常規(guī)治療基礎(chǔ)上參與研究,基礎(chǔ)治療指臨床中根據(jù)患兒病情予以其一定劑量抗精神病藥物(如氟哌啶醇、舒必利等)、抗抑郁藥(如舍曲林、氟伏沙明等)、中樞神經(jīng)興奮藥及腦細(xì)胞功能改善藥物進(jìn)行治療。
研究期間對(duì)照組接受臨床標(biāo)準(zhǔn)護(hù)理,即在患兒服藥治療期間予以患兒必要院內(nèi)基礎(chǔ)干預(yù)治療,如異常行為矯正、語言功能訓(xùn)練等治療內(nèi)容,其后根據(jù)患兒身體發(fā)育情況及時(shí)進(jìn)行營養(yǎng)補(bǔ)充,并按時(shí)給藥、服藥治療等。
研究組在對(duì)照組護(hù)理基礎(chǔ)上配合家庭康復(fù)護(hù)理干預(yù):(1)干預(yù)宣教:在進(jìn)行家庭康復(fù)護(hù)理干預(yù)實(shí)際操作前,需由院方組織患兒家屬進(jìn)行集中干預(yù)宣教及指導(dǎo),特別是對(duì)于如何在家庭護(hù)理干預(yù)中與患兒建立有效溝通、轉(zhuǎn)移其注意力進(jìn)行詳細(xì)宣教。在宣教期間,還應(yīng)予以患兒家屬心理指導(dǎo)及疏導(dǎo),幫助家屬積極消除負(fù)面情緒,以積極心態(tài)配合護(hù)理實(shí)施,予以患兒護(hù)理干預(yù)。(2)生活干預(yù):生活干預(yù)的實(shí)施,需以改善患兒異常行為,培養(yǎng)其正常飲食、活動(dòng)行為主要目的。對(duì)此,首先需要患兒家屬在生活干預(yù)中根據(jù)患兒飲食愛好及偏向,制定相應(yīng)食譜,通過食物引導(dǎo),使患兒可在注意力轉(zhuǎn)移、集中過程中,逐步改善飲食習(xí)慣,逐步自主進(jìn)食,并逐漸增加其攝食量,改善自身免疫機(jī)能[9-10]。其次,需對(duì)患兒進(jìn)行運(yùn)動(dòng)引導(dǎo),以患兒所喜歡的注意力轉(zhuǎn)移元素為誘導(dǎo),引導(dǎo)其每日進(jìn)行運(yùn)動(dòng)鍛煉,并通過音樂播放的形式,逐漸轉(zhuǎn)移患兒注意力,適當(dāng)延長運(yùn)動(dòng)時(shí)間,并需注意患兒情緒變化,及時(shí)停止運(yùn)動(dòng),避免患兒情緒過激引發(fā)不良預(yù)后情況。(3)心理干預(yù):心理干預(yù)的實(shí)施需建立在與患兒建立有效溝通的基礎(chǔ)上,對(duì)此則需家屬在護(hù)理干預(yù)中,通過玩耍、肢體互動(dòng)等形式逐步與患兒建立交流,并不斷嘗試與患兒進(jìn)行溝通交流。與患兒成功建立交流后,需在引導(dǎo)其語言交流的同時(shí),耐心傾聽患兒語言表達(dá),并在此基礎(chǔ)上對(duì)其情緒變化進(jìn)行預(yù)判,并及時(shí)予以其心理干預(yù)措施,以暗示的方法,逐步引導(dǎo)患兒積極溝通,實(shí)現(xiàn)情緒自主表達(dá)[11-13]。(4)社會(huì)行為干預(yù):社會(huì)行為干預(yù)即通過與外界接觸,逐步培養(yǎng)患兒社會(huì)干預(yù)行為及交流行為,對(duì)此則需家屬盡量為患兒創(chuàng)造與社會(huì)接觸的機(jī)會(huì),先從親近自熱環(huán)境開始,逐步引導(dǎo)患兒對(duì)自然環(huán)境進(jìn)行探索,逐步輔助其建立對(duì)基礎(chǔ)自然環(huán)境認(rèn)知,其后可逐步引導(dǎo)患兒進(jìn)入人口較為密集的商場、游樂園等基礎(chǔ)設(shè)施環(huán)境,促使患兒逐漸適應(yīng)此類社會(huì)環(huán)境,待患兒適應(yīng)環(huán)境后,引導(dǎo)其參與同齡人集體性活動(dòng),并在活動(dòng)過程中幫助其建立正常社會(huì)行為,逐漸與身邊同齡人家里正常溝通及交流,使患兒通過交流與行為模仿等方式,進(jìn)一步鞏固社會(huì)行為,起到提升社會(huì)功能的作用。
1.3 觀察指標(biāo)
對(duì)比兩組護(hù)理前后患兒各維度自閉癥、生活質(zhì)量評(píng)分及家屬護(hù)理滿意度情況。
(1)自閉癥評(píng)分采用ATEC量表測評(píng)[14],包括言語/語言/交流(共14題,每題分值0~2,總分為28分)、社交(共20題,每題分值0~2,總分為40分)、感覺/知覺(共18題,每題分值0~2,總分為36分)及健康/身體/行為(共25題,每題分值0~3,總分為75分),且各項(xiàng)得分與癥狀嚴(yán)重程度呈正比例關(guān)系。(2)生活質(zhì)量采用SF-36量表測評(píng),得分與患兒生活質(zhì)量呈正比[15]。(3)護(hù)理滿意度采用本院自制問卷由家屬在護(hù)理3個(gè)月后填寫,總分為100分,得分>70分為滿意,分為40~70分為較滿意,得分<40分為不滿意。
1.4 統(tǒng)計(jì)學(xué)方法
使用SPSS23.0統(tǒng)計(jì)學(xué)軟件處理分析,連續(xù)性變量資料如各維度自閉癥、生活質(zhì)量評(píng)分用(x±s)表示,采用t檢驗(yàn),計(jì)數(shù)資料用(%)表示,采用χ2檢驗(yàn),P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2 結(jié)果
2.1 兩組患兒自閉癥評(píng)分比較
護(hù)理前兩組患兒各維度自閉癥評(píng)分均無明顯差異(P>0.05);護(hù)理后兩組患者言語/語言/交流、社交、感覺/知覺以及健康/身體/行為評(píng)分明顯降低(P<0.05),研究組各維度自閉癥評(píng)分明顯低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。見表1。
2.2 兩組患兒生活質(zhì)量評(píng)分比較
護(hù)理前兩組患兒生活質(zhì)量評(píng)分均無明顯差異(P>0.05);護(hù)理后兩組患者生理機(jī)能、生理職能、精力、社會(huì)功能以及情感職能評(píng)分明顯提高(P<0.05),研究組各維度生活質(zhì)量評(píng)分明顯高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。見表2。
2.3兩組家屬護(hù)理滿意度比較
研究組護(hù)理滿意度為94.87%,明顯高于對(duì)照組(77.78%),差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。見表3。
3討論
目前自閉癥也稱孤獨(dú)癥,病因在臨床上并不完全清楚,但在目前的研究中表明,多種危險(xiǎn)因素可能與自閉癥的發(fā)病相關(guān),包括遺傳因素、感染與免疫和孕期理化因子刺激等。該癥一般起病于36個(gè)月以內(nèi),主要表現(xiàn)為社會(huì)交往障礙、交流障礙、興趣狹窄和刻板重復(fù)的行為方式[16-18]。目前臨床中對(duì)于自閉癥患兒的治療,由于尚未明確病因,故尚無特效治療方法,僅可通過多類藥物的服用,實(shí)現(xiàn)對(duì)患兒大腦功能的調(diào)節(jié),并采取一定干預(yù)治療措施,實(shí)現(xiàn)對(duì)患兒行為的部分干預(yù),但僅通過醫(yī)療干預(yù)的介入,治療效果有限,故仍需進(jìn)一步完善干預(yù)內(nèi)容,提升治療干預(yù)效果,以起到對(duì)患兒各項(xiàng)生理功能及社會(huì)功能改善、培養(yǎng)的作用[19-20]。僅可通過一定藥物治療及干預(yù)治療手段對(duì)患兒癥狀進(jìn)行緩解,而且上述臨床治療手段,雖可起到一定治療干預(yù)效果,但由于完善護(hù)理模式的缺乏導(dǎo)致患兒治療干預(yù)效果局限性大,故需采取相應(yīng)護(hù)理模式配合干預(yù)治療,進(jìn)一步提升臨床有效性。
研究結(jié)果表明:所有患兒治療前各維度自閉癥、生活質(zhì)量評(píng)分組間對(duì)比均無明顯差異(P>0.05);經(jīng)不同模式護(hù)理干預(yù)后,較同期對(duì)照組與護(hù)理前,研究組各維度自閉癥評(píng)分均有明顯緩解,且生活質(zhì)量獲得明顯提升(P<0.05);且研究組家屬護(hù)理滿意度明顯較高(P<0.05)。分析原因:家庭康復(fù)護(hù)理干預(yù)在社會(huì)交往障礙自閉癥兒童治療中的開展實(shí)施,主要具有以下優(yōu)勢:(1)通過干預(yù)前對(duì)患兒家屬干預(yù)操作內(nèi)容宣教、心理健康指導(dǎo)等準(zhǔn)備工作的開展,為家庭康復(fù)護(hù)理干預(yù)的有效開展提供基礎(chǔ);(2)通過生活干預(yù)的實(shí)施以食物、運(yùn)動(dòng)為主要媒介,有效轉(zhuǎn)移患兒注意力,其后通過飲食、運(yùn)動(dòng)行為的有效干預(yù),糾正患兒特異行為,使自身生活行為逐步趨于正?;^而使患兒實(shí)現(xiàn)對(duì)自身行為的自主控制,提升自控能力[21];(3)通過心理干預(yù)的實(shí)施,幫助家屬與患兒積極建立有效溝通,并通過與患兒對(duì)話、傾聽對(duì)話內(nèi)容,對(duì)其心理狀況進(jìn)行有效評(píng)估,便于家屬及時(shí)對(duì)患兒開展心理干預(yù)措施,改善其情緒[22];(4)通過社會(huì)行為干預(yù)的實(shí)施,為患兒創(chuàng)造與社會(huì)主動(dòng)接觸機(jī)會(huì),并逐步引導(dǎo)患兒在社會(huì)環(huán)境中與同齡人建立交流,并促使患兒在交流中逐步通過行為模仿,進(jìn)一步提升行為糾正、言語功能鍛煉效果,促使患兒行為逐步恢復(fù)正常,提升臨床治療干預(yù)效果。
綜上所述,給予存在社會(huì)交往障礙的自閉癥兒童家庭康復(fù)護(hù)理干預(yù),可在基礎(chǔ)治療、護(hù)理基礎(chǔ)上,有效改善患兒癥狀,提升其生活質(zhì)量,可在臨床中借鑒推廣。
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(收稿日期:2019-04-29)