规范化术前访视对围手术期经皮冠状动脉介入术患者的身心影响研究

发布时间：2018-03-23 08:04

本文选题：MDT术前访视　切入点：围手术期　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的:分析MDT术前访视对围手术期经皮冠状动脉介入术患者心理、生理和术中依从性的影响;研究其术前访视模式效果。提高围手术期经皮冠状动脉介入治疗患者术中依从性和满意度,以保障手术的顺利进行,巩固治疗效果,提高护理质量。研究方法:本研究为实验性研究。采用临床随机对照的方法,根据纳入和排除标准,选取2015年4月至2015年7月山东省某三级甲等综合医院心血管内科接受围手术期经皮冠状动脉治疗的患者120人,实验组(心内一区)和对照组(心内二区)各60人。实验组给予MDT术前访视,按模式为医护术前讨论全面评估、集中培训、问题一对一指导、经验分享、综合评价的流程对患者进行访视;对照组给予传统个体化术前访视,模式为进行术前评估和访视单宣教。运用状态-特质焦虑量表(STAI)比较两组患者术前焦虑水平。访视者术前监测两组患者血压和心率。由于平均动脉压是在一个心动周期中持续地推动血液向前流动的平均推动力,能更精确地反应心脏和血管的机能状态,平均动脉压=舒张压+1/3脉压或1/3(收缩压+2×舒张压),本研究计算出患者平均动脉压,比较患者平均动脉压和心率的差异;采用自行设计的记录单,评价患者术中依从性和术后满意度。应用SPSS 17.0 for windows软件包进行数据处理和统计学分析。计量资料以均数±标准差(xs±)表示,计数资料以率和构成比表示;运用t检验、卡方检验等统计学方法进行统计分析。研究结果:1.人口学资料统计结果两组患者在年龄、性别、诊断、文化程度、婚姻状况、职业、经济状况、医疗保障、社会支持等方面差异无统计学意义(P0.05),两组患者具有可比性。2.两组患者术前访视前后焦虑水平比较两组患者术前访视前焦虑水平相比,差异无统计学意义(P0.05);访视后对比两组患者焦虑水平,差异有统计学意义(P0.05)。3.两组患者术前、术中、术后心率与平均动脉压比较两组患者术前访视前心率、平均动脉压比较,差异均无统计学意义(P0.05);比较两组患者访视后心率、平均动脉压,差异有统计学意义(P0.05);比较术前访视前后两组患者心率、平均动脉压差值、术中、术后心率、平均动脉压,差异均有统计学意义(P0.05)。4.两组患者术中依从性和术后满意度比较实验组患者术中依从率为91.67%(165/180),明显高于对照组的67.78%(122/180);实验组术后满意度为98.3%(59/60),高于对照组的85%(51/60)(x2=6.982,P0.05)。研究结论:1.MDT术前访视有助于降低围手术期经皮冠状动脉介入术患者术前的焦虑水平。2.MDT术前访视可维持围手术期经皮冠状动脉介入术患者术前和术中、术后的平均动脉压与心率相对稳定。3.MDT术前访视可提高围手术期经皮冠状动脉介入术患者术中依从性和术后满意度。4.MDT访视模式即多学科团队协作模式,通过术前全面系统评估、医护人员对患者集中培训、问题一对一指导、成功患者经验分享与综合评价,临床应用效果良好,值得推广。
[Abstract]:Objective: to analyze the MDT of preoperative visit on perioperative percutaneous coronary intervention in patients with psychological, physiological and operative effect of compliance; to study the mode of preoperative interview effect. Improve the perioperative period of percutaneous coronary interventional treatment compliance and satisfaction of patients, in order to ensure the smooth operation to consolidate the treatment effect, improve the quality of nursing. Methods: This is an experimental study. By using the method of randomized controlled clinical trials, according to inclusion and exclusion criteria, select general hospital some three grade from April 2015 to July 2015 in Shandong Province in the cardiovascular system during perioperative period of percutaneous coronary treatment in 120 patients, the experimental group (a heart) and control group (in district two) 60 people each. The experimental group was given MDT preoperative training mode for health care according to the preoperative discussion, comprehensive assessment, problems of one-to-one coaching, experience sharing, comprehensive evaluation of the flow The patients were interviewed; the control group was given conventional individualized preoperative model for preoperative assessment and visit single mission. Using the State Trait Anxiety Inventory (STAI) levels in patients with anxiety were compared between the two groups before the interview. Preoperative blood pressure and heart rate monitoring of patients in the two groups. Due to the flat both the average arterial pressure is the driving force in a cardiac cycle continuously promote blood flow forward, can more accurately reflect cardiac and vascular function, mean arterial pressure, diastolic pressure, pulse pressure or 1/3 = +1/3 (systolic diastolic pressure, +2 *) this study calculated the mean arterial pressure in patients with, compared with the average arterial pressure and heart rate; the record of self design, evaluation and compliance in patients with postoperative satisfaction. The application of SPSS 17 for Windows software package for data processing and statistical analysis. The measurement data to mean + standard deviation (XS +), count data The rate and constituent ratio; using t test and chi square test were used for statistical analysis. Results: the statistical results of 1. demographic data of the two groups in age, gender, diagnosis, education level, marital status, occupation, economic status, medical security, there were no significant differences of social support (P0.05), the two groups were comparable in.2. of two groups of patients before visiting the level of anxiety before and after operation were compared between the two groups before the interview anxiety level before compared, the difference was not statistically significant (P0.05); after the visit of Jiao Lvshui were compared between the two groups, the difference was statistically significant (P0.05.3.) two groups of patients before operation. During the surgery, postoperative heart rate and mean arterial pressure of patients between the two groups before the interview before the heart rate, mean arterial pressure, there were no significant differences (P0.05) were compared between the two groups; visit after the heart rate, mean arterial pressure, the difference was statistically significant (P0.05); comparison Preoperative interview of two groups of patients before and after the heart rate, mean arterial pressure difference, intraoperative, postoperative heart rate, mean arterial pressure, the differences were statistically significant (P0.05.4.) of two groups of patients with compliance and postoperative satisfaction experimental group patients compliance rate was 91.67% (165/180), significantly higher than the control group 67.78% (122/180); postoperative satisfaction of the experimental group was 98.3% higher than that of the control group (59/60), 85% (51/60) (x2=6.982, P0.05). Conclusion: 1.MDT preoperative visit can help reduce the perioperative period of percutaneous coronary intervention in patients with preoperative anxiety level.2.MDT preoperative visit can be maintained during the perioperative period of percutaneous coronary intervention in patients with preoperative and intraoperative, postoperative mean arterial pressure and heart rate relatively stable.3.MDT preoperative visit can improve the perioperative period of percutaneous coronary intervention compliance and postoperative patients visit satisfaction.4.MDT modes: the multi disciplinary team collaboration as Mode, through preoperative comprehensive system assessment, medical staff training for patients, one to one guidance, successful patient experience sharing and comprehensive evaluation, clinical application effect is good, it is worth promoting.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.5

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