Целью исследования явилось изучение влияния выраженности психологического дистресса на эффективность санаторного этапа реабилитации больных с хроническими заболеваниями легких. В исследование были включены 117 больных с хронической патологией легких (105 мужчин и 12 женщин), средний возраст – 59,6±0,9 года. Всем пациентам проводили спирометрию, тест 6-минутной ходьбы (ТШХ), психологическое тестирование (опросники DS-14, самочувствия, активности и настроения – САН, шкала депрессии, Спилбергера–Ханина). Больные прошли курс санаторной пульмональной реабилитации. Согласно опроснику DS-14 выделены группы пациентов с типом личности Д (n=39) и не-Д (n=78). В этих группах сопоставлены результаты ТШХ и опросника САН после лечения. Пациенты с типом личности Д не отличались от больных с типом не-Д по тяжести патологии легких, наличию сопутствующих заболеваний, дистанции ТШХ. При типе Д был выше, чем при типе не-Д, уровень депрессии (р=0,00004), личностной (р=0,01) и ситуационной тревожности (р=0,02). После курса реабилитации при типе Д отмечено существенное улучшение психологического статуса по шкалам опросника САН (на 14,9–18,6%) по сравнению с типом не-Д (на 3,9–5,6%). С приростом толерантности к нагрузке коррелировали показатели функции внешнего дыхания, уровень депрессии и наличие типа личности Д. Улучшение психологического состояния по подшкалам опросника САН зависело от исходного уровня депрессии, тревожности и наличия типа личности Д.
Таким образом, у больных с хроническими заболеваниями легких наличие типа личности Д не зависит от тяжести нарушений функции внешнего дыхания, связано с более высоким уровнем тревожности и депрессии и более низкой самооценкой психологического состояния. Отмеченная связь между наличием типа личности Д и результатами санаторной реабилитации делает целесообразной его оценку в клинической практике для повышения эффективности реабилитационных программ.
Ключевые слова: тип личности Д, эффективность пульмональной реабилитации.
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The investigation was undertaken to study the impact of the magnitude of psychological distress on the efficiency of sanatorium rehabilitation in 117 patients (105 men and 12 women; mean age 59,6±0,9 years) with chronic lung diseases. All the patients underwent spirometry, 6-minute walk test (6’WT), psychological testing (DS14 and heath, activity, mood (HAM) questionnaires, depression inventory, and Spilberger-Khanin scale) and received a course of sanatorium pulmonary rehabilitation. Groups of Type D (n=39) and non-Type D (n=78) patients were identified according to the DS14 questionnaire. The results of 6’WT and HAM questionnaire were compared in these groups after treatment. The Type D patients did not differ from non-Type D patients in lung disease severity, comorbidity, and 6’WT distance. The Type D patients had higher levels of depression (р=0,00004) and personality (р=0,01) and situational (р=0,02) anxiety. After the course of rehabilitation, the Type D patients showed a substantial psychological improvement according the HAM questionnaire (by 14,9–18,6%) compared to the non-Type D patients (by 3,9–5,6%). The parameters of external respiratory function, the level of depression, and Type D personality were correlated with an increase in exercise tolerance. Psychological improvement according to HAM subscales depended on the baseline level of depression, anxiety, and Type D personality. Thus, Type D personality in patients with chronic lung diseases does not depend on the severity of external respiratory dysfunction and is related to the higher level of anxiety and depression and a lower psychological self-evaluation. The mentioned relationship between Type D personality and sanatorium rehabilitation results makes its assessment expedient in clinical practice to enhance the effectiveness of rehabilitation programs.
Key words: Type D personality, effectiveness of pulmonary rehabilitation.
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Авторы
А.Н.Сумин*1, Е.В.Недосейкина2, О.Г.Архипов2
1 УРАМН Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний СО РАМН, Кемерово;
2 ФГУ Центр реабилитации ФСС РФ «Топаз», Мыски
*sumian@cardio.kem.ru
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A.N.Sumin1*, E.V.Nedoseikina2, O.G.Arkhipov2
1 Ural Research Institute for Complex Problems of Cardiovascular Diseases, Siberian Branch of the Russian Academy of Medical Sciences, Kemerovo;
2 «Topaz» Rehabilitation Center, Social Insurance Fund of the Russian Federation, Myski
*sumian@cardio.kem.ru