【作者】 李敏；

【导师】 张俊梅；

【作者基本信息】 郑州大学 ， 护理学， 2025， 硕士

【摘要】 目的1.构建良性气道狭窄患者介入治疗术后多维度健康管理方案。2.验证该管理方案在良性气道狭窄患者介入治疗术后康复中的应用效果。方法1.良性气道狭窄患者介入治疗术后多维度健康管理干预方案构建。基于国内外文献研究及半结构化访谈结果,构建良性气道狭窄术后多维度健康管理干预方案初稿。采用专家咨询,邀请16位相关领域的专家参与两轮专家函询,依据专家反馈意见对管理方案进行优化调整。选取10例符合条件的良性气道狭窄患者进行预试验,根据预试验结果对干预方案进一步完善,最终形成多维度健康管理方案施测稿。2.良性气道狭窄患者介入治疗术后多维度健康管理干预方案应用。采用类试验性研究,选取河南省郑州市某三级甲等医院呼吸内科病房良性气道狭窄介入治疗后的72例患者为研究对象。为避免组间沾染,按照患者入院的先后顺序,分为对照组和干预组,对照组均出院后,再开始纳入干预组。将2024年6月至2024年8月入院患者随机筛选36例设为对照组,2024年9月至2024年11月入院患者随机筛选36例设为干预组。比较两组患者介入治疗术后并发症发生情况,在干预前、干预后3个月采用自我护理能力测定量表(ESCA)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、6min步行试验(6MWT)以及生活质量评分(SF-36)评价多维度健康管理方案效果。结果1.良性气道狭窄患者介入治疗术后多维度健康管理干预方案构建(1)文献回顾:对有关良性气道狭窄术后健康管理方案中英文文献进行检索,经筛选后,采用结构化分析方法,从题目、年份、研究类型、研究对象、干预形式、干预方法等方面进行分析,最终选取7篇干预类文献和1篇专家共识作为参考。(2)半结构化访谈:选取15位良性气道狭窄术后患者进行访谈,提取出以下4个主题:“良性气道狭窄介入术后相关知识缺乏”“介入术后康复行为指导需求”“情感关怀和社会支持需求”“多元持续性健康指导需求”。(3)专家咨询:在文献研究及质性访谈的基础上,构建多维度健康管理方案初稿,通过两轮的专家咨询和预试验对干预方案初稿进行修订,两轮专家咨询问卷的有效回收率分别为100%、93.8%,专家的权威系数为0.9,最终形成多维度健康管理方案施测稿。2.良性气道狭窄患者介入治疗术后多维度健康管理干预方案应用根据筛选标准纳入72例介入治疗术后的良性气道狭窄患者,研究过程中有5例退出,最终完成本研究67例,其中,对照组36例患者脱落3例,脱落率为8.33%。干预组36例患者中脱落2例,脱落率为5.55%,完成样本量干预组34例,对照组33例。统计分析显示,两组研究对象基线资料无显著差异(P>0.05)。此外,在干预实施前,两组患者在各项评价指标上的结果无显著差异(P>0.05)。(1)干预后两组并发症发生率为:干预组和对照组分别为24.24%和58.82%,两组差异具有统计学意义(P<0.05)。(2)两组干预后自护能力评分比较:在自我概念、自我责任感、自我护理技能和健康知识水平方面,干预组得分均高于对照组,两组差异具有统计学意义(P<0.05)。(3)两组干预后SAS评分、SDS评分比较:在焦虑、抑郁评分方面,干预组明显低于对照组,两组差异具有统计学意义(P<0.05)。(4)两组干预后6MWT比较:两组患者的6MWT测试结果均高于干预前,而干预组患者的6MWT结果高于对照组患者,差异具有统计学意义(P<0.05)。(5)两组干预后患者生活质量SF-36各维度评分比较:在生理功能、生理职能、情感职能、躯体疼痛、精神健康、社交功能方面,干预组得分均高于对照组,两组差异具有统计学意义(P<0.05),但干预组在活力、总体健康得分与对照组无统计学意义(P>0.05)。结论1.良性气道狭窄患者介入治疗术后多维度健康管理方案的构建,经文献研究、质性访谈、研究小组讨论、专家咨询及预试验等环节,过程合理,并且咨询专家权威程度高,均经验丰富、积极性高,该管理方案具有合理性和实用性。2.多维度健康管理方案应用于良性气道狭窄介入治疗术后患者效果显著,能够减少术后并发症,提升自护能力,有效缓解其负性情绪,提高6min步行试验(6MWT)距离,改善生活质量。更多还原

【Abstract】 Objective1.Construct a multi-dimensional health management program for patients with benign airway stenosis after bronchoscopic interventional therapy.2.To verify the application effect of this management scheme in the rehabilitation of patients with benign airway stenosis after interventional therapy.Methods1.To construct a multi-dimensional management scheme for patients with benign airway stenosis after interventional therapy.Based on domestic and international literature research and semi-structured interview results,an initial draft of a multidimensional health management intervention plan for post-operative benign airway stenosis was developed.The expert consultation method is adopted,inviting16 experts in related fields to participate in two rounds of expert consultation.The management plan was optimized and adjusted according to the feedback from these experts.A pre-trial was conducted with 10 eligible patients with benign airway stenosis,and the intervention plan was further refined based on the pre-trial results,ultimately forming the final version of the multidimensional health management plan for implementation.2.Application of Multidimensional Health Management Intervention Program for Patients with Benign Airway Stenosis After Interventional Therapy.A quasi-experimental study was conducted on 72 patients with benign airway stenosis who underwent interventional treatment in the respiratory department of a tertiary hospital in Zhengzhou,Henan Province.To avoid contamination between groups,participants were divided into a control group and an intervention group based on their order of admission.The intervention group was included only after all patients in the control group had been discharged.From June to August 2024,36 patients were randomly selected for the control group,and from September to November 2024,36patients were randomly selected for the intervention group.The occurrence of postoperative complications in both groups was compared.The effectiveness of a multidimensional health management plan was evaluated using the Self-Care Ability Measurement Scale(ESCA),Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),6-minute Walk Test(6MWT),and Quality of Life Score(SF-36)before the intervention and three months after the intervention.Results1.Construction of a multi-dimensional management intervention scheme for benign airway stenosis patients after interventional therapy.(1)Literature Review:A search was conducted for Chinese and English literature on health management protocols following surgery for benign airway stenosis.After screening,a structured analysis method was employed to examine aspects such as the title,year,type of study,subject of research,form of intervention,and methods of intervention.Finally,7 interventional literature articles and 1 expert consensus were selected as references.(2)Semi-structured Interviews:Fifteen postoperative patients with benign airway stenosis were selected for interviews,from which the following four themes were extracted:"Lack of knowledge related to benign airway stenosis post-intervention""Behavioral guidance needs for post-intervention rehabilitation""Emotional care and social support needs""Multiple Continuing Health Guidance Needs".(3)Expert Consultation:Based on the literature research and qualitative interviews,a preliminary draft of a multidimensional health management plan was constructed.The draft intervention plan was revised through two rounds of expert consultations and preliminary trials.The effective response rates for the two rounds of expert consultation questionnaires were 100%and 93.8%,respectively,with an expert authority coefficient of 0.9.The final version of the multidimensional health management plan was then formed for implementation.2.Application of a multi-dimensional health management intervention program for benign airway stenosis patients after interventional therapy.According to the screening criteria,72 patients with benign airway stenosis after interventional therapy were included in the study.During the research process,5 patients withdrew,resulting in 67 patients who ultimately completed the study.Among them,3 out of 36 patients in the control group dropped out,with a dropout rate of 8.33%.In the intervention group,2 out of 36 patients dropped out,with a dropout rate of 5.55%.The final sample size consisted of 34 patients in the intervention group and 33 in the control group.Statistical analysis showed no significant differences in baseline characteristics between the two groups(P>0.05).Additionally,there were no significant differences in the results of various evaluation indicators between the two groups before the intervention was implemented(P>0.05).(1)The incidence of complications in the two groups after intervention was24.24%in the intervention group and 58.82%in the control group,with a statistically significant difference between the two groups(P<0.05).(2)Comparison of self-care ability scores between the two groups after intervention:The intervention group scored higher than the control group in terms of self-concept,sense of self-responsibility,self-care skills,and health knowledge level,with statistically significant differences between the two groups(P<0.05).(3)Comparison of SAS and SDS scores between the two groups after intervention:The intervention group had significantly lower scores in anxiety and depression than the control group,with statistically significant differences between the two groups(P<0.05).(4)Comparison of 6MWT between the two groups after intervention:The6MWT results of both groups were higher than those before the intervention,and the6MWT results of the intervention group were significantly higher than those of the control group,with a statistically significant difference(P<0.05).(5)Comparison of SF-36 quality of life dimension scores between the two groups after intervention:The intervention group scored higher than the control group in physical functioning,role-physical,role-emotional,bodily pain,mental health,and social functioning,with statistically significant differences between the two groups(P<0.05).However,there was no statistically significant difference between the intervention group and the control group in vitality and general health scores(P>0.05).Conclusions1.The development of a multidimensional health management plan for patients with benign airway stenosis after interventional therapy was conducted through literature research,qualitative interviews,research group discussions,expert consultations,and preliminary trials.The process was reasonable,and the consulting experts were highly authoritative,experienced,and motivated.The management plan is both rational and practical.2.The application of the multidimensional health management plan in patients with benign airway stenosis after interventional therapy has shown significant effectiveness.It reduces postoperative complications,enhances self-care ability,effectively alleviates negative emotions,increases the distance in the 6-minute walk test(6MWT),and improves their quality of life.更多还原