过渡期护理模式在冠脉内支架植入患者中的应用研究

发布时间：2018-06-27 10:32

本文选题：过渡期 + 护理　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：本研究旨在对冠脉内支架植入术后患者实施过渡期护理模式，探讨通过此方法以提高患者用药、复查、健康生活方式等依从性，改善冠脉内支架植入术后患者生存质量，降低再入院率，提高该病的临床疗效，减少患者家庭经济负担。方法：1.质性研究阶段：以质性研究中的现象学方法为指导，采用立意取样法选取苏州市某三级甲等医院心内科接受冠脉内支架植入手术的患者。以半结构访谈法收集16例符合入选标准的患者资料，并以Colaizzi7步分析法分析资料。根据质性研究结果制定过渡期护理干预措施。2.过渡期护理模式实施阶段：采用单盲、随机对照实验方法。用便利取样法从苏州市某三甲医院心血管内科病区收集行冠状动脉支架植入术患者140例作为研究对象。根据随机数字表将研究对象分为对照组70例和干预组70例。干预组在常规出院指导基础上，给予个性化的过渡期护理服务，对照组接受常规出院指导，出院后进行电话随访，解答其疑问。干预分为两部分：术后第2天针对手术及出院后常见问题，，如饮食、运动、药物服用方法，预防并发症发生等，对患者采取面对面的方式进行教育课程，并发放《冠脉内支架植入后患者过渡期健康教育手册》；出院后采取电话和上门两种随访方式。效果评价指标为研究对象在依从性、生存质量、血脂、血压、体重指数及再入院率的变化。随访时间点为出院后2周、1个月、3个月。所有数据用Epidata3.1软件录入，用SPSS16.0统计软件进行数据分析处理。结果：1.质性研究阶段。深入了解和探索接受冠脉支架植入术患者在过渡期进行自我照护的的真实体验后，发现患者在过渡期存在以下问题：自觉过渡到家庭存在障碍；期望得到家庭、社会的关怀与支持；缺乏疾病康复知识；渴望实现自我价值。2.过渡期护理模式实施阶段。使用随机分组法将140例冠脉支架植入术后患者分为干预组和对照组，干预组70例，对照组70例。干预前将对照组和干预组患者基本资料进行均衡性检验，未见统计学差异。干预结果：干预后干预组治疗依从性各维度改变高于对照组（P0.05），其中复查、控制“高血压、高血糖、高血脂”、吸烟、运动等方面改变显著（P0.01）。干预后干预组生存质量总分高于对照组（P0.01），其中症状功能、心理社会功能、不良反应、治疗满意度方面改变显著（P0.01）。干预后干预组血压低于对照组（出院后2周、1个月P0.05，出院后3个月P0.01）,干预组收缩压较基线下降6.57mmHg（P0.01）。干预后干预组总胆固醇较基线下降0.65mmol/L（P0.01）。干预组体重指数较基线下降0.66kg/m2（P0.05）。干预后干预组再入院率低于对照组（P0.01）。结论：本研究表明，对冠脉内支架植入后患者实施过渡期护理模式，切实可行，可有效提高生存质量及治疗依从性，改善血压、血脂、体重指数水平，降低再入院率，值得推广。
[Abstract]:Objective: the aim of this study was to implement the transitional nursing model for patients after coronary stent implantation, to improve the compliance of patients with medication, reexamination and healthy lifestyle, and to improve the quality of life of patients after coronary stent implantation. Reduce the readmission rate, improve the clinical efficacy of the disease and reduce the family economic burden. Method 1: 1. Qualitative study stage: guided by the phenomenological method in qualitative study, the patients undergoing coronary stent implantation in cardiac department of a Grade 3A hospital in Suzhou were selected by the method of intentional sampling. The data of 16 patients who met the inclusion criteria were collected by semi-structured interview, and the data were analyzed by Colaizzi 7-step analysis method. According to the qualitative study results, the interim nursing intervention measures. 2. 2. Stage of implementation of transitional nursing model: single blind, randomized controlled trial. A total of 140 patients undergoing coronary stent implantation were collected from the Department of Cardiovascular Medicine of a third Class Hospital in Suzhou City by convenient sampling method. The subjects were divided into control group (n = 70) and intervention group (n = 70). On the basis of routine discharge guidance, the intervention group was given individualized transitional nursing service, while the control group received routine discharge guidance, followed up by telephone after discharge to answer their questions. The intervention was divided into two parts: on the second day after operation, the patients were given face-to-face education courses for common problems, such as diet, exercise, drug use, prevention of complications, etc. The health education manual for patients after coronary stent implantation was issued and followed by telephone and door-to-door after discharge. The change of compliance, quality of life, blood lipid, blood pressure, body mass index and readmission rate were evaluated. The follow-up time points were 2 weeks, 1 month and 3 months after discharge. All data were recorded by Epidata 3.1 software and analyzed by SPSS 16.0 statistical software. The result is 1: 1. Qualitative study stage. After deeply understanding and exploring the true experience of self-care of patients undergoing coronary stent implantation during the transition period, we found that the patients had the following problems during the transition period: consciously transition to family obstacles; expectation of a family; Social care and support; lack of disease rehabilitation knowledge; desire to achieve self-worth. 2. Transitional nursing mode implementation stage. 140 patients after coronary stent implantation were randomly divided into intervention group (n = 70) and control group (n = 70). Before intervention, there was no statistical difference between the control group and the intervention group. Intervention results: the intervention group treatment compliance changes were higher than that of the control group (P0.05), including re-examination, control "hypertension, hyperglycemia, hyperlipidemia", smoking, exercise and other aspects of significant changes (P0.01). The total score of quality of life in the intervention group was higher than that in the control group (P0.01), in which symptom function, psycho-social function, adverse reaction and treatment satisfaction changed significantly (P0.01). The blood pressure of the intervention group was lower than that of the control group (2 weeks after discharge, 1 month (P0.05), 3 months after discharge (P0.01), and the systolic blood pressure (SBP) in the intervention group was decreased by 6.57 mmHg (P0.01) compared with the baseline. After intervention, total cholesterol in the intervention group decreased by 0.65 mmol / L (P0.01) compared with the baseline. Body mass index (BMI) of intervention group decreased 0.66kg/m2 compared with baseline (P0.05). The readmission rate of intervention group was lower than that of control group (P0.01). Conclusion: this study shows that the implementation of transitional nursing mode for patients with intracoronary stent implantation is feasible and can effectively improve the quality of life and therapeutic compliance, improve blood pressure, blood lipid, body mass index, and reduce readmission rate. It is worth popularizing.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.6

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