标题：基于斯金纳强化理论的健康教育联合CICARE沟通对脊髓损伤患者间歇性导尿依从性、负性情绪及生活质量的影响

      作者：周晓燕 1，吕开月 1，程树锦 1，农瑾雯 1，付晶晶 1，李雨航 1，刘海兰 1，韦钰晴 2，刘海华 3    周晓燕 1，吕开月 1，程树锦 1，农瑾雯 1，付晶晶 1，李雨航 1，刘海兰 1，韦钰晴 2，刘海华 31.广西中医药大学附属瑞康医院康复医学科，广西 南宁 530011；2.广西医科大学第一附属医院急诊科，广西 南宁 530021；3.广西医科大学第一附属医院神经外科，广西 南宁 530021

      卷次： 2024年35卷12期

      【摘要】 目的 探讨基于斯金纳强化理论的健康教育联合CICARE沟通对脊髓损伤患者间歇性导尿依从性、负性情绪及生活质量的影响。方法 采用目的抽样法，选取2021年12月至2022年11月在广西中医药大学附属瑞康医院康复医学科住院的85例脊髓损伤患者作为研究对象，按病区分为观察组43例和对照组42例，对照组接受常规护理，观察组在对照组的基础上给予基于斯金纳强化理论的健康教育联合CICARE沟通干预。在干预1个月后采用间歇性导尿依从性评估量表(ICAS)评估患者的导尿依从性；在干预前和干预1个月后分别采用神经源性膀胱症状评分表(NBSS)、焦虑自评量表(SAS)和抑郁自评量表(SDS)、WHO生活质量测定量表简表(WHOQOL-BREF)评估患者的神经源性膀胱症状、负性情绪(焦虑、抑郁症状)和生活质量。结果 观察组患者干预1个月后的 ICAS分级明显优于对照组，差异具有统计学意义(P<0.05)；干预1个月后，两组患者的SAS评分和SDS评分均降低，且观察组患者SAS评分、SDS评分分别为(38.55±3.10)分、(39.83±3.59)分，明显低于对照组的(50.77±3.75)分、(51.67±4.92)分，差异均有统计学意义(P<0.05)；干预1个月后，观察组患者的NBSS总分为(26.44±7.34)分，明显低于对照组的(34.71±12.56)分，差异有统计学意义(P<0.05)；干预1个月后，观察组患者的WHOQOL-BREF总分为(51.12±5.89)分，明显高于对照组的(44.98±7.22)分，差异具有统计学意义(P<0.05)。结论 基于斯金纳强化理论的健康教育联合CICARE沟通可提高脊髓损伤患者间歇性导尿依从性，改善其负性情绪和神经源性膀胱症状，提高生活质量。
      【关键词】 脊髓损伤；神经源性膀胱；斯金纳强化；CICARE沟通；间歇性导尿；依从性；负性情绪；生活质量
      【中图分类号】 R473.6 【文献标识码】 A 【文章编号】 1003—6350（2024）12—1797—06

Effect of health education based on Skinner's reinforcement theory combined with CICARE communication oncompliance of intermittent catheterization, negative emotions, and quality of life in patients with spinal cordinjury.
ZHOU Xiao-yan 1, LYU Kai-yue 1, CHENG Shu-jin 1, NONG Jin-wen 1, FU Jin-jin 1, LI Yu-hang 1, LIU Hai-lan 1,WEI Yu-qing 2, LIU Hai-hua 3. 1. Department of Rehabilitation Medicine, Ruikang Hospital Affiliated to Guangxi Universityof Chinese Medicine, Nanning 530011, Guangxi, CHINA; 2. Department of Emergency, the First Affiliated Hospital ofGuangxi Medical University, Nanning 530021, Guangxi, CHINA; 3. Department of Neurosurgery, the First AffiliatedHospital of Guangxi Medical University, Nanning 530021, Guangxi, CHINA
【Abstract】 Objective To explore the effect of health education based on Skinner's reinforcement theory com-bined with CICARE communication on compliance of intermittent catheterization, negative emotions, and quality of lifein patients with spinal cord injury. Methods Using purposive sampling method, eighty-five patients with spinal cord in-jury who were hospitalized in the Department of Rehabilitation Medicine, Ruikang Hospital Affiliated to Guangxi Univer-sity of Chinese Medicine from December 2021 to November 2022 were selected as objects. According to the ward, the pa-tients were divided into an observation group (n=43) and a control group (n=42). The patients in the control group re-ceived routine nursing, and those in the observation group were given health education based on Skinner's reinforcementtheory combined with CICARE communication. The Intermittent Catheterization Adherence Scale (ICAS) was used toevaluate the compliance of catheterization after 1 month of intervention. Neurogenic Bladder Symptom Score (NBSS),Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and WHO quality of life scale (WHOQOL-BREF)were used to evaluate neurogenic bladder symptoms, negative emotions (anxiety, depression), and quality of life before in-tervention and at 1 month after intervention. Results At one month after intervention, the ICAS grade in the observationgroup was significantly better than that in the control group (P<0.05); the SAS score and SDS score of the two groups de-creased, and the SAS score and SDS score in the observation group were (38.55±3.10) points, (39.83±3.59) points, respec-tively, which were significantly lower than (50.77±3.75) points, (51.67±4.92) points in the control group, with statistical-ly significant differences (P<0.05); the total score of NBSS in the observation group was (26.44±7.34) points, which wassignificantly lower than (34.71±12.56) points in the control group (P<0.05); the total score of WHOQOL-BREF in theobservation group was (51.12±5.89) points, which was significantly higher than (44.98±7.22) points in the control group(P<0.05). Conclusion Health education based on Skinner's reinforcement theory combined with CICARE communica-tion can improve the compliance of intermittent catheterization in patients with spinal cord injury, improve their negativeemotions and neurogenic bladder symptoms, and improve their quality of life.
      【Key words】 Spinal cord injury; Neurogenic bladder; Skinner's reinforcement theory; CICARE communication;Intermittent catheterization; Compliance; Negative emotions; Quality of life