电话指导式延续护理对冠状动脉腔内支架术后患者遵医行为及生活质量的影响

发布时间：2018-10-19 12:38

【摘要】：目的分析电话指导式延续护理对冠状动脉腔内支架术后患者健康生活方式,生活质量及遵医行为的影响,为延续护理在冠状动脉腔内支架术后患者护理中的应用提供参考。方法以2014年1月-2015年1月在郑州市某三级心血管病医院心血管内科行经皮穿刺冠状动脉腔内支架术(Stent)后并居住在市区内的患者为研究对象,纳入研究的230例患者运用随机数字表法分为对照组和干预组,两组患者均有115例,一般资料和病情等基线方面的情况均无统计学差异(P0.05)。为两组患者建立患者个人资料档案(包括患者基本信息、手术情况、出院医嘱及定期随访时间等),在院期间两组患者给予相同的护理措施,发放《冠状动脉腔内支架术后指导手册》,出院时发放《个人服药卡》,根据手册和内容由专职人员对患者及其家属加以指导,嘱患者在出院后严格按照指导手册及医嘱内容进行服药、运动和定期复查等,要求其家属对患者进行监督并如实记录。对照组出院后3天内给予常规电话随访1次后不给予其他任何形式的干预措施；干预组由经过培训的随访人员除常规电话随访1次外即开始进行延续护理干预,主要采用出院后三个月内定期(第一个月每周1次,随后两个月每两周1次)电话指导的方式进行干预,每次通话时间不低于20分钟,通话内容包括：了解患者的饮食(食物种类、量及盐、油控制的情况)、控烟(戒烟情况)、服药(药名、剂量、用法是否与出院医嘱一致,注意观察大便颜色、皮肤黏膜是否出血)、运动(运动形式、运动量,运动时心率变化)、复查(是否按时,结果是否异常)、心理状况(有无异常)是否再住院等情况,有针对性的进行纠正和指导。两组分别在患者出院时、3个月、6个月由专职人员进行问卷调查。分析两组患者的生活方式、生活质量、遵医行为、服药依从性、再入院等情况,采用HPLP-Ⅱ量表对患者的健康生活方式进行评价；采用MOS-SF36评分表对患者的生活质量进行评价；通过患者遵医行为调查表对遵医用药、定期复查等情况进行统计。采用SPSS17.0统计学软件进行统计分析,计量资料用(x±s)表示,采用组间方差分析及t检验,计数资料采用卡方检验,以P0.05时,差异具有统计学意义。结果(1)两组患者在男女比例、吸烟史、高血压病史、糖尿病史、肥胖史以及血管病变情况等方面均无统计学差异,P0.05；(2)所有患者出院时健康生活评分项目得分均为中等分数,其中健康责任和人际间的关系得分比较低；(3)两组患者出院时在运动、营养、压力、自我实现等生活方式的各个项目之间的差异均无明显的差异性,P=0.17；(4)干预组患者健康生活评分中的各个项目在3个月、6个月时均高于对照组,P0.05。尤其是在营养、人际间支持、健康责任及自我实现等方面,干预组分数提高较明显；(5)6个月时两组患者在生理功能、生理职能和身体疼痛方面差异不明显,P0.05；干预组患者在总体健康、情感职能、心理健康以及生命力等方面较对照组得分较高,差异明显,P0.05；(6)出院时两组患者的遵医率差异无统计学意义,P0.05；患者出院6个月时干预组的遵医率高于对照组,P0.05,差异具有统计学意义；(7)出院时两组患者的服药依从性差异无统计学意义,P0.05；3个月时干预组的依从性(80.87%)高于对照组(70.43%),6个月时干预组的依从性(82.61%)仍高于对照组(62.61%)P0.05,差异具有统计学意义；(8)患者出院后6个月时,对照组再入院率(6.9%),干预组再入院率(0.9%),P=0.018,差异具有统计学意义。结论电话指导式延续护理模式可提高冠状动脉腔内支架术后患者健康生活方式、遵医行为等方面的自我管理能力,降低患者再入院率。这一措施简便易行,为电话指导式延续护理在冠状动脉腔内支架术后患者的护理应用提供临床参考。
[Abstract]:Objective To analyze the influence of telephone-guided continuous nursing on the way of healthy life, quality of life and medical behavior of patients after coronary angioplasty, and to provide reference for the application of continuous nursing care in patients after intracoronary stent implantation. Methods From January 2014 to January 2015, the cardiovascular department of a three-level cardiovascular hospital in Zhengzhou City underwent percutaneous coronary angioplasty (stent) and the patients residing in the city were the subjects. 230 patients included in the study were randomly divided into two groups: control group and intervention group, and there were 115 cases in both groups, and there was no statistical difference between general information and disease condition (P0.05). The patient's profile of personal data (including patient's basic information, operation condition, discharge advice and regular follow-up time, etc.) was established for two groups of patients, and the same nursing measures were given to two groups of patients during the hospital. When discharged from the hospital, the individual drug administration card shall be issued. According to the manual and the contents, the full-time personnel shall guide the patients and their families, and the patients shall take medicine, exercise and regular reexamination in strict accordance with the instruction manual and the contents of the doctor's advice after discharge, and ask their families to supervise the patients and record them as they are. No other forms of intervention were given after 1 dose of routine telephone follow-up within 3 days after the control group was discharged; the intervention group was followed up by trained follow-up personnel for 1 time except routine telephone follow-up, i.e. beginning with continued nursing intervention, Interventions are mainly conducted on a regular basis within three months of discharge (once a week in the first month and once every two weeks thereafter), each time being not less than 20 minutes, and the contents of the call include: knowing the patient's diet (food category, quantity and salt, Control of oil (case of smoking cessation), control tobacco (smoking cessation), take medicine (drug name, dosage, usage is consistent with discharge order, pay attention to observation of stool color, skin mucous membrane bleeding), motion (motion form, movement amount, heart rate change during exercise), review (whether on time, Whether the result is abnormal or not, whether the psychological condition (whether abnormal) is re-hospitalization, and so on, has targeted correction and guidance. When the patients were discharged from the hospital, three months and 6 months were investigated by full-time staff. The quality of life of patients was evaluated by HPLP-鈪，

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