【作者】 陈霞；

【导师】 刘桂芝；

【作者基本信息】 青岛大学 ， 护理硕士（专业学位）， 2017， 硕士

【摘要】 目的运用聚焦解决模式对冠心病PCI术后患者进行临床干预,从患者自身优势及资源出发,调动患者的积极主动性,降低患者的负性情绪及疾病不确定感,患者的负性情绪包括焦虑情绪和抑郁情绪,进而改变患者行为活动。方法选取自2015年12月-2016年6月,于青岛某三甲医院心血管内科,收集PCI成功术后患者110例,自愿参加临床干预研究并签署知情同意书;采用随机数字表法将患者分为对照组和干预组各55人,随访过程中,有2人自动退出,4人失访,最终对照组和干预组各52人;对照组和干预组在干预前均填写焦虑自评量表(SAS)、抑郁自评量表(SDS)、Mishel疾病不确定感量表(MUIS)以及一般资料量表;对照组患者术后接受常规健康宣教,干预组在接受常规健康宣教的基础上予以聚焦解决模式进行临床干预实验;两组患者出院当天均填写MUIS量表;出院后1个月内每周电话随访一次并进行院外持续干预,来院复查填写SAS、SDS;出院后3个月内每2周电话随访1次并进行院外持续干预,回院复查患者再次填写SAS、SDS、服药依从性量表,及收集患者各项血脂指标和院外吸烟、饮酒、锻炼情况。结果1.冠心病PCI术后患者在年龄、性别、文化程度等一般资料,焦虑评分、抑郁评分、疾病不确定感评分等基线资料均无统计学意义(P>0.05);2.冠心病PCI术后患者接受临床聚焦解决模式干预后,出院当天对照组和干预组患者疾病不确定感总分及其各维度比较差异有统计学意义(P<0.01);且与术后当天患者疾病不确定感比较,两组患者均有统计学差异(P<0.01);3.随访1个月、3个月后冠心病PCI术后患者,对照组和干预组焦虑、抑郁评分差异均有统计学意义(P<0.01);4.随访3个月后复查各项危血脂指标,对照组和干预组差异无统计学意义(P>0.05)。5.患者出院3个月来院复查,对照组和干预组患者的服药依从性以及吸烟饮酒锻炼情况比较,结果只有两组患者的吸烟情况统计学无差异(P>0.05),服药依从性、饮酒、锻炼情况比较结果(P<0.01)。结论聚焦解决模式临床护理干预有效的降低患者术后焦虑、抑郁情绪及疾病不确定感;聚焦解决模式可以提高患者的院外依从性,还通过缓解患者的焦虑、抑郁情绪调节患者的血脂指标。更多还原

【Abstract】 ObjectiveClinical intervention of patients with coronary artery disease after PCI was performed by focused mode,from the patient’s own advantages and resources,mobilize the patient’s initiative,reduce the patient’s negative emotions and disease uncertainty,the patient’s negative emotions include the patient’s anxiety and depression change patient behavior.MethodsSelected since December 2015-June 2016,IN Qingdao a tertiary hospital cardiovascular medical collection after PCI success operation 110 cases patients and voluntary participate in clinical intervention research signed informed consent;By random number table were divided into control group and intervention group consisted of55 people,In the follow-up process,2 people quit,4 persons lost to follow-up,eventually each group of 52 people;Control group and intervention group were before the intervention to fill in Self-rating anxiety scale(SAS)and self-rating depression scale(SDS),Mishel uncertainty in illness scale(MUIS)as well as general information on scale;Patients in the control group received conventional health education,intervention group received conventional health education focusing on the basis of clinical intervention in solving experiments;Two groups of patients discharged from hospital the same day to fill in MUIS scale;One month after discharge,the telephone was followed weekly and continued outside the hospital,To the hospital to fill in SAS,SDS;3 months after discharge every 2 weeks of telephone follow-up 1 and outside the hospital for continuous intervention,back to the hospital review patients to fill out the SAS,SDS,medication compliance scale,and the collection of various biochemical indicators and hospital smoking,drinking,exercise.Results1.There were no significant differences in the baseline data such as age,sex,educational level,and so on.There was no significant difference in baseline data such asanxiety score,depression score and disease uncertainty score(P> 0.05).2.Coronary heart disease patients after PCI by clinical focus model after intervention,patients in the control group and the intervention group in the discharged from hospital the same day uncertainty in illness scores and its dimensions’ scores,the other was a significant difference(P<0.01);And compared with the sense of uncertainty in illness in patients with postoperative day was a significant difference(P<0.01);3.Followed up for 1 month,3 months after coronary heart disease patients after PCI,Anxiety and depression in control group and intervention Group score compare with significant differences(P<0.01);4.Followed up for 1 month,3 months after twice reviewed the risk factor indicators,control group and intervention group with significant differences(P>0.05);the mean value of the intervention group compared with the control closer to the normal range;5.Patients discharged from 3 months to check,medication compliance of patients in the control group and the intervention group,as well as smoking,drinking,exercise,only two groups of patients with smoking has no difference in statistics(P>0.05);compliance,drinking,exercise compare with significant differences(P<0.01);ConclusionFocused model of clinical nursing interventions can effectively reduce the postoperative patients with anxiety,depression and a sense of uncertainty;Focus on the solution model can improve the patient’s hospital compliance,but also by relieving the patient’s anxiety and depression to regulate the patient’s lipid index.更多还原