【作者】 王瑞；

【导师】 张伟宏；

【作者基本信息】 郑州大学 ， 护理学， 2017， 硕士

【摘要】 目的分析特色延续性护理健康教育能否改善不停跳冠脉搭桥术后老年患者的生活质量。通过对不停跳冠脉搭桥术后老年患者实施延续性护理及与常规延续护理对照,探讨不停跳冠脉搭桥术后健康教育内容和方法的有效性及可行性,及各种护理方式在临床应用的可行性。方法1.2013年11月至2015年3月期间,选取郑州大学第一附属医院符合条件的行不停跳冠状动脉旁路移植术的老年患者160例,采用随机数字表法,按照住院号的先后顺序随机分为对照组(80例)：1-80号和干预组(80例)：81-160号。在选择完研究对象后即对其进行一般资料采集,建立患者通讯录,并创建详细的资料库,对每位患者的资料进行统计记录,并且签订知情同意书。对照组患者在住院期间由责任护士进行常规系统的健康教育和出院指导,干预组患者除接受常规疾病护理外,还由研究者在患者出院前1天对其进行不停跳冠脉搭桥术后相关健康教育,宣教结束后发放《不停跳冠脉搭桥术后健康教育知识手册》及录音,录音与手册内容相同。通过《不停跳冠脉搭桥术后康复知识手册》对患者进行营养、运动、伤口保护和处理、药物管理、复查五个方面的教育和帮助。延续性护理以护理门诊为主要方式,电话随访,宣传册及随身听等为辅助的方式进行。集中干预为出院时,出院后1个月、2个月、3个月利用患者门诊复查时由专科门诊坐诊护士进行健康教育,每次健康教育时间约40分钟。院外第1、5、9、13周根据《不停跳冠脉搭桥术后康复知识手册》进行电话随访。录音的播放,患者根据自身情况,由患者自己或者照顾者定时播放。2.采用调查问卷的方式,对160例患者进行调查。两组分别于入院时、出院时、出院后4个月收集调查问卷资料。生活质量以患者入院时的相关功能为基准完成基线调查问卷。采用短期健康调查表(the Short Form Health Survey, SF-36)对术后患者生活质量进行评价。采用自制冠心病知识调查表来评价患者对疾病相关知识的认知水平。了解两组患者术后早期生活质量变化,探讨延续性护理对患者的影响。3.首先收集数据资料,然后应用SPSS 17.0软件对数据进行处理分析,主要采用的以下统计方法：Logistic回归分析、妲检验、描述性统计分析、两样本独立t检验等。结果1.本研究纳入160例符合条件患者,其中干预组院外死亡2人,院外失访3人,对照组院外死亡3人,院外失访6人。两组不停跳冠脉搭桥术后患者入院时和出院时临床基线资料间(短期健康调查表、冠心病知识调查表)比较差异无统计学意义(P>0.05)。2.延续性护理后统计干预组和对照组短期健康量表,干预组生活质量各维度得分均高于对照组,说明干预组患者生活质量有所提高；但只有在生理功能、生理职能、总体健康和活力四个方面差异有统计学意义。3.通过对不停跳冠脉搭桥手术后老年患者实施延续性护理,干预后干预组冠心病知识得分(89.35±3.56)较对照组得分(70.47±6.99)高,差异有统计学意义(P<0.05)4.干预组出现并发症患者为5人,并发症发生率约为6.7%；对照组并发症患者为9人,并发症发生率为12.7%。通过t检验分析两组患者术后并发症发生率,干预组显著低于对照组。5. Logistic回归分析示：文化程度高(初中、高中、大专及以上)、用药依从性好(是否规律服药)可使患者有较高的健康量表评分,其OR值分别为11.624(95%CI：1.884-71.735,P=0.008)和8.700(95%CI：1.642～46.105,P=0.011)。结论延续性护理模式可以提高术后患者冠心病知识得分,提高患者对疾病的认知能力,通过知信行,提高不停跳冠脉搭桥术后患者的生活质量,有效的降低了术后并发症发生率。采取护理门诊干预方式在临床应用是可行的。临床护理工作中应推广此模式。更多还原

【Abstract】 ObjectivesTo analyze whether the characteristic continuity of care including health education could improve the quality of life in old patients with off-CABG outside the hospital.The elderly patients with coronary artery bypass surgery were implemented contrast special continuity of care with conventional continue nursing.To discuss the effectiveness and feasibility of content and methods of health education with coronary artery bypass surgery outside the hospital,and the feasibility of clinical application of various ways in nursing.Methods1.To choose 160 eligible cases of elderly patients with off coronary artery bypass surgery from November 2013 to March 2015 in the First Affiliated Hospital of Zhengzhou University. All patients were divided into control group (80 cases) and intervention group (80 cases) according to the number of hospitalization by random number table. Selection after the object of study in its general data acquisition, establishing patient contacts, and create a database in detail, for statistical data for each patient records, and signed the informed consent. To carry out discharge guidance during their hospitalization according to cardiac surgery routine care for patients of control group,in addition to routine care for the intervention group,there were researchers completing health education that related off coronary artery bypass surgery in the day before discharge, to issue the" Health Education Handbook of off Coronary Artery Bypass Grafting"and its audiotape to patients after the education, the content of audiotape is same with the handbook, to educate and help the patients with the five aspects that were daily life, food, protection and wound treatment, medication, review by "Knowledge of Rehabilitation Handbook after off Coronary Artery Bypass Grafting". Specialist nurses visit as the main way, telephone follow-up, brochures and a walkman for auxiliary way. There were health education that were 40 minutes every times by using the patient outpatient care by the nurse specialist outpatient visit when discharged from hospital after 1 month,2 months,3 months, and respectively at 1,5, 9,13 weeks by telephone follow-up according to "Knowledge of Rehabilitation Handbook after off Coronary Artery Bypass Grafting". Patients according to their own situation, play the walkman regularly by the patients themselves or caregivers.2.160 cases were investigated by questionnaire survey, to collected questionnaire data when were at the time of admission, discharge, four months after discharge. The baseline related the time of admission. Evaluating rely on Short-term health survey questionnaire (the Short Form Health Survey, SF-36).the patients of intervention group and control group educated in hospital by the researchers on the postoperative routine health education.Through designed simple coronary heart disease health education evaluation form,to evaluate patients’cognitive level of health knowledge. To understand the change of quality of life of patients with early postoperative, discusseing the influence of the continuity of care for patients.3.First, collecting data and then using SPSS 17.0 software, there were Logistic regression analysis Chi-square test, descriptive statistics analysis, t test of two independent sample.Results1.The study included 160 cases of eligible patients, two people died in hospital and three people lost outside the hospital in intervention group. Three people died in hospital and lost six people outside the hospital in control group,there were no significant difference between two groups with the baseline clinical data(Short-term health survey questionnaire and coronary heart disease health education evaluation form)(P>0.05).2.After the continuity of care,the scores of each dimension of quality of life in the intervention group were higher than control group, but only statistically significant differences in physical function, physical function, general health and vitality.3.Knowledge scores of the intervention group (89.35±3.56) was higher than the control group score (70.47+6.99) by continuity of care for elderly patients after off coronary artery bypass surgery,The difference was statistically significant (P<0.05).4. After the continuity of care, complications of patients in the intervention group were 5 people, complication rates are about 6.7%, patients with complications in the control group were 9 people,complication rates are about 12.7%,there was statistically significant difference of the incidence of complications after surgery between the two groups, The former was significantly lower than the latter (P<0.05).5.Logistic regression analysis showed:Patients with high levels of education (junior high school, high school, college and above) and good medication compliance (whether regular medication) can have high health rating scale,OR values were 11.624 (95% CI:1.884-71.735, P= 0.008) and 8.700 (95% CI:1.642-46.105, P= 0.011).ConclusionsContinuity of care can improve knowledge score of coronary heart disease of the patients and improve cognitive abilities in patients, throuth "Knowledge-Attitude-Practice" improve the quality of life of patients with off-CABG,there are depressed on complication of patients. At the same time,the continuity of care of the visit of specialist nurses were workable in clinical application,this pattern should be to promote in the clinical nursing work.更多还原