本文選題：過渡期 + 護(hù)理　； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的：本研究旨在對冠脈內(nèi)支架植入術(shù)后患者實施過渡期護(hù)理模式，探討通過此方法以提高患者用藥、復(fù)查、健康生活方式等依從性，改善冠脈內(nèi)支架植入術(shù)后患者生存質(zhì)量，降低再入院率，提高該病的臨床療效，減少患者家庭經(jīng)濟(jì)負(fù)擔(dān)。 方法：1.質(zhì)性研究階段：以質(zhì)性研究中的現(xiàn)象學(xué)方法為指導(dǎo)，采用立意取樣法選取蘇州市某三級甲等醫(yī)院心內(nèi)科接受冠脈內(nèi)支架植入手術(shù)的患者。以半結(jié)構(gòu)訪談法收集16例符合入選標(biāo)準(zhǔn)的患者資料，并以Colaizzi7步分析法分析資料。根據(jù)質(zhì)性研究結(jié)果制定過渡期護(hù)理干預(yù)措施。2.過渡期護(hù)理模式實施階段：采用單盲、隨機(jī)對照實驗方法。用便利取樣法從蘇州市某三甲醫(yī)院心血管內(nèi)科病區(qū)收集行冠狀動脈支架植入術(shù)患者140例作為研究對象。根據(jù)隨機(jī)數(shù)字表將研究對象分為對照組70例和干預(yù)組70例。干預(yù)組在常規(guī)出院指導(dǎo)基礎(chǔ)上，給予個性化的過渡期護(hù)理服務(wù)，對照組接受常規(guī)出院指導(dǎo)，出院后進(jìn)行電話隨訪，解答其疑問。干預(yù)分為兩部分：術(shù)后第2天針對手術(shù)及出院后常見問題，，如飲食、運(yùn)動、藥物服用方法，預(yù)防并發(fā)癥發(fā)生等，對患者采取面對面的方式進(jìn)行教育課程，并發(fā)放《冠脈內(nèi)支架植入后患者過渡期健康教育手冊》；出院后采取電話和上門兩種隨訪方式。效果評價指標(biāo)為研究對象在依從性、生存質(zhì)量、血脂、血壓、體重指數(shù)及再入院率的變化。隨訪時間點(diǎn)為出院后2周、1個月、3個月。所有數(shù)據(jù)用Epidata3.1軟件錄入，用SPSS16.0統(tǒng)計軟件進(jìn)行數(shù)據(jù)分析處理。 結(jié)果：1.質(zhì)性研究階段。深入了解和探索接受冠脈支架植入術(shù)患者在過渡期進(jìn)行自我照護(hù)的的真實體驗后，發(fā)現(xiàn)患者在過渡期存在以下問題：自覺過渡到家庭存在障礙；期望得到家庭、社會的關(guān)懷與支持；缺乏疾病康復(fù)知識；渴望實現(xiàn)自我價值。2.過渡期護(hù)理模式實施階段。使用隨機(jī)分組法將140例冠脈支架植入術(shù)后患者分為干預(yù)組和對照組，干預(yù)組70例，對照組70例。干預(yù)前將對照組和干預(yù)組患者基本資料進(jìn)行均衡性檢驗，未見統(tǒng)計學(xué)差異。干預(yù)結(jié)果：干預(yù)后干預(yù)組治療依從性各維度改變高于對照組（P0.05），其中復(fù)查、控制“高血壓、高血糖、高血脂”、吸煙、運(yùn)動等方面改變顯著（P0.01）。干預(yù)后干預(yù)組生存質(zhì)量總分高于對照組（P0.01），其中癥狀功能、心理社會功能、不良反應(yīng)、治療滿意度方面改變顯著（P0.01）。干預(yù)后干預(yù)組血壓低于對照組（出院后2周、1個月P0.05，出院后3個月P0.01）,干預(yù)組收縮壓較基線下降6.57mmHg（P0.01）。干預(yù)后干預(yù)組總膽固醇較基線下降0.65mmol/L（P0.01）。干預(yù)組體重指數(shù)較基線下降0.66kg/m2（P0.05）。干預(yù)后干預(yù)組再入院率低于對照組（P0.01）。 結(jié)論：本研究表明，對冠脈內(nèi)支架植入后患者實施過渡期護(hù)理模式，切實可行，可有效提高生存質(zhì)量及治療依從性，改善血壓、血脂、體重指數(shù)水平，降低再入院率，值得推廣。
[Abstract]:Objective: the aim of this study was to implement the transitional nursing model for patients after coronary stent implantation, to improve the compliance of patients with medication, reexamination and healthy lifestyle, and to improve the quality of life of patients after coronary stent implantation. Reduce the readmission rate, improve the clinical efficacy of the disease and reduce the family economic burden. Method 1: 1. Qualitative study stage: guided by the phenomenological method in qualitative study, the patients undergoing coronary stent implantation in cardiac department of a Grade 3A hospital in Suzhou were selected by the method of intentional sampling. The data of 16 patients who met the inclusion criteria were collected by semi-structured interview, and the data were analyzed by Colaizzi 7-step analysis method. According to the qualitative study results, the interim nursing intervention measures. 2. 2. Stage of implementation of transitional nursing model: single blind, randomized controlled trial. A total of 140 patients undergoing coronary stent implantation were collected from the Department of Cardiovascular Medicine of a third Class Hospital in Suzhou City by convenient sampling method. The subjects were divided into control group (n = 70) and intervention group (n = 70). On the basis of routine discharge guidance, the intervention group was given individualized transitional nursing service, while the control group received routine discharge guidance, followed up by telephone after discharge to answer their questions. The intervention was divided into two parts: on the second day after operation, the patients were given face-to-face education courses for common problems, such as diet, exercise, drug use, prevention of complications, etc. The health education manual for patients after coronary stent implantation was issued and followed by telephone and door-to-door after discharge. The change of compliance, quality of life, blood lipid, blood pressure, body mass index and readmission rate were evaluated. The follow-up time points were 2 weeks, 1 month and 3 months after discharge. All data were recorded by Epidata 3.1 software and analyzed by SPSS 16.0 statistical software. The result is 1: 1. Qualitative study stage. After deeply understanding and exploring the true experience of self-care of patients undergoing coronary stent implantation during the transition period, we found that the patients had the following problems during the transition period: consciously transition to family obstacles; expectation of a family; Social care and support; lack of disease rehabilitation knowledge; desire to achieve self-worth. 2. Transitional nursing mode implementation stage. 140 patients after coronary stent implantation were randomly divided into intervention group (n = 70) and control group (n = 70). Before intervention, there was no statistical difference between the control group and the intervention group. Intervention results: the intervention group treatment compliance changes were higher than that of the control group (P0.05), including re-examination, control "hypertension, hyperglycemia, hyperlipidemia", smoking, exercise and other aspects of significant changes (P0.01). The total score of quality of life in the intervention group was higher than that in the control group (P0.01), in which symptom function, psycho-social function, adverse reaction and treatment satisfaction changed significantly (P0.01). The blood pressure of the intervention group was lower than that of the control group (2 weeks after discharge, 1 month (P0.05), 3 months after discharge (P0.01), and the systolic blood pressure (SBP) in the intervention group was decreased by 6.57 mmHg (P0.01) compared with the baseline. After intervention, total cholesterol in the intervention group decreased by 0.65 mmol / L (P0.01) compared with the baseline. Body mass index (BMI) of intervention group decreased 0.66kg/m2 compared with baseline (P0.05). The readmission rate of intervention group was lower than that of control group (P0.01). Conclusion: this study shows that the implementation of transitional nursing mode for patients with intracoronary stent implantation is feasible and can effectively improve the quality of life and therapeutic compliance, improve blood pressure, blood lipid, body mass index, and reduce readmission rate. It is worth popularizing.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R473.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張育榮;楊桂蘭;王建華;;冠脈介入治療患者院外服藥依從性調(diào)查及護(hù)理[J];當(dāng)代護(hù)士(專科版);2010年07期

2 曹松梅;趙慶華;張光慧;;冠狀動脈介入治療后生存質(zhì)量測定量表的信效度研究[J];護(hù)士進(jìn)修雜志;2009年06期

3 尹桂榮;魏貞;王青芬;種玲玲;呂建曉;;住院患者回歸家庭連續(xù)性護(hù)理需求的調(diào)查[J];護(hù)理學(xué)雜志;2009年22期

4 李月芹;;冠心病介入治療患者的心理狀態(tài)及心理干預(yù)研究進(jìn)展[J];齊齊哈爾醫(yī)學(xué)院學(xué)報;2009年07期

5 羅燕華;洪蝶玫;蔡志雄;劉少玲;陳平;朱稚丹;;護(hù)理干預(yù)對經(jīng)皮冠狀動脈介入診療術(shù)術(shù)后病人遵醫(yī)依從性及生活質(zhì)量的影響[J];護(hù)理研究;2010年27期

6 馮梅;蔣文慧;;冠心病介入術(shù)后病人康復(fù)的研究進(jìn)展[J];護(hù)理研究;2010年36期

7 屠燕;鄭華;;身心管理體系對冠狀動脈介入病人術(shù)后藥物依從性的影響[J];護(hù)理研究;2011年06期

8 姚云;常麗;朱相華;梁田;;心理干預(yù)對冠心病PCI術(shù)后病人生命質(zhì)量的影響[J];護(hù)理研究;2013年02期

9 王慧;陳琪爾;譚堅鈴;;冠狀動脈介入治療術(shù)后病人生活質(zhì)量狀況調(diào)查[J];護(hù)理研究;2013年17期

10 曹順慶;李安光;;中國的文化“失根”和文化自信力的缺失——以中國文學(xué)領(lǐng)域的表現(xiàn)為例[J];探索與爭鳴;2013年10期

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