【作者】 王颖；

【导师】 单伟颖；

【作者基本信息】 承德医学院 ， 护理学， 2017， 硕士

【摘要】 目的:探讨延续期护理干预对出院后心肌梗死患者健康相关行为及生存质量的影响。以期丰富延续期护理理论,改善心肌梗死患者健康结局,为今后临床医务人员进行针对性延续期护理干预提供科学的实证依据。方法:本研究为实验性研究,具体研究方法为:选取2015年11月-2016年2月入住河北省某三级甲等医院心内科的60名首次发病的心肌梗死患者作为研究对象,将其随机分为实验组和对照组,每组各30例。对照组给予常规护理,实验组在此基础上施以为期6个月的延续期护理干预。干预内容包括:制作、发放并按阶段讲解健康教育手册;专业化、规范化且系统化的家庭访视及电话随访。研究对象的一般资料及临床资料由延续护理小组成员收集;出院前1天(T)、出院后1个月(T1)、3个月(T3)、6个月(T6)采用健康相关行为问卷及西雅图心绞痛生存质量测量量表(SAQ)对两组患者不同时点的健康相关行为及生存质量进行评价;出院后6个月收集两组患者生理指标(左心室射血分数、左心室内径)并评价两组患者再入院次数。将收集到的资料及数据核对录入,采用SPSS 21.0软件进行统计分析,包括描述性分析、t检验、χ2检验、重复测量方差分析等。结果:1.健康相关行为:实施延续期护理干预后,在T1、T3和T6时点,实验组患者在健康相关行为总分及营养、运动、压力应对、药物管理四个维度的得分均高于对照组,差异具有统计学意义(P<0.05)。2.生存质量:实施延续期护理干预后,在T1、T3和T6时点,实验组患者在生存质量总分、治疗满意程度和疾病认识程度两个维度的得分高于对照组,差异具有统计学意义(P<0.05);在T3和T6时点,实验组患者躯体活动受限程度和心绞痛发作情况两个维度的得分高于对照组,差异具有统计学意义(P<0.05);在T6时点,实验组患者心绞痛稳定状态得分高于对照组,差异具有统计学意义(P<0.05)。3.生理指标:实施延续期护理干预后,在T6时点,实验组患者的左室射血分数高于对照组,差异具有统计学意义(P<0.05);心脏左室内径值处于正常范围内的患者数量高于对照组,差异具有统计学意义(P<0.05)。4.再住院次数:实施延续期护理干预后,在T6时点,实验组患者再入院次数(0.27±0.45)少于对照组(0.50±0.63),但差异无统计学意义(P>0.05)。结论:延续期护理可有效提高心肌梗死患者健康相关行为,促进患者身心康复,进而改善其延续期生存质量,临床工作中可推广此种护理模式。更多还原

【Abstract】 Objectives:To investigate the effect of continuing nursing on health related behaviors and quality of life in myocardial infarction patients.In order to enrich the theory of continuing nursing,improve the health outcomes of myocardial infarction patients,and to provide scientific evidences for medical staff to carry out special continuing nursing interventions.Methods:This research is a experimental study,the specific research method is: 60 myocardial infarction patients of cardiology department of a Class III Grade I hospital who were hospitalized from November 2015 to February 2016 were included in this study.They were randomly divided into study group and control group,each group included 30 patients.Control group was given routine nursing care,on this basis,study group was given continuous nursing intervention during a period of 6 months,which includes make,distribute and explain health education books,specialized,systematized,normalized telephone and home follow-up visits.The basic information and clinical data was collected by continuous nursing group members.Before nursing intervention(T),after nursing intervention 1months(T1),3months(T3),6months(T6)using Seattle Angina Questionnaire(SAQ)and health related behavior questionnaire to investigate the health related behavior and quality of life.Physiological parameters(left ventricular ejection fraction,left ventricular inner diameter)and the numbers of readmission were collected after discharge 6 months.The collected information and study data were imputed into database,and were analysed using SPSS 21.0,include descriptive analysis,t test,χ2 test,repetitive measure analysis of variance,etc.Results:1.Health related behavior: after nursing intervention,the scores of study group on the total score of health related behavior and nutrition dimension,exercise dimension,stress management dimension,medicine management dimension were higher than control group at T1,T3 and T6,the differences were statistically significant(P<0.05).2.Quality of life: after nursing intervention,the scores of study group on the total score of life quality,treatment satisfaction dimension and disease perception dimension were higher than control group at T1,T3 and T6,the differences were statistically significant(P<0.05);the scores of study group on physical limitation and anginal frequency were higher than control group at T3 and T6,the differences were statistically significant(P<0.05);the score of study group on anginal stability is higher than control group at T6,the difference was statistically significant(P<0.05).3.Physiological index: after nursing intervention,the score of study group on left ventricular ejection fraction is higher than control group at T6,the difference was statistically significant(P<0.05);the number of patients in the study group whose left ventricular interior diameter within the normal range is more than control group,the difference was statistically significant(P <0.05).4.Re-hospitalization times: after nursing intervention,the times of study group on re-hospitalization(0.27±0.45)is less than control group(0.50±0.63)at T6,but the difference had no statistical significance(P>0.05).Conclusion:Continuing nursing intervention can improve the health related behavior of myocardial infarction patients,promote the rehabilitation of patients,and improve the quality of life,this nursing mode should be applied and popularized in clinical practice.更多还原