【摘要】：目的分析電話指導(dǎo)式延續(xù)護(hù)理對(duì)冠狀動(dòng)脈腔內(nèi)支架術(shù)后患者健康生活方式,生活質(zhì)量及遵醫(yī)行為的影響,為延續(xù)護(hù)理在冠狀動(dòng)脈腔內(nèi)支架術(shù)后患者護(hù)理中的應(yīng)用提供參考。方法以2014年1月-2015年1月在鄭州市某三級(jí)心血管病醫(yī)院心血管內(nèi)科行經(jīng)皮穿刺冠狀動(dòng)脈腔內(nèi)支架術(shù)(Stent)后并居住在市區(qū)內(nèi)的患者為研究對(duì)象,納入研究的230例患者運(yùn)用隨機(jī)數(shù)字表法分為對(duì)照組和干預(yù)組,兩組患者均有115例,一般資料和病情等基線方面的情況均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。為兩組患者建立患者個(gè)人資料檔案(包括患者基本信息、手術(shù)情況、出院醫(yī)囑及定期隨訪時(shí)間等),在院期間兩組患者給予相同的護(hù)理措施,發(fā)放《冠狀動(dòng)脈腔內(nèi)支架術(shù)后指導(dǎo)手冊(cè)》,出院時(shí)發(fā)放《個(gè)人服藥卡》,根據(jù)手冊(cè)和內(nèi)容由專職人員對(duì)患者及其家屬加以指導(dǎo),囑患者在出院后嚴(yán)格按照指導(dǎo)手冊(cè)及醫(yī)囑內(nèi)容進(jìn)行服藥、運(yùn)動(dòng)和定期復(fù)查等,要求其家屬對(duì)患者進(jìn)行監(jiān)督并如實(shí)記錄。對(duì)照組出院后3天內(nèi)給予常規(guī)電話隨訪1次后不給予其他任何形式的干預(yù)措施；干預(yù)組由經(jīng)過(guò)培訓(xùn)的隨訪人員除常規(guī)電話隨訪1次外即開始進(jìn)行延續(xù)護(hù)理干預(yù),主要采用出院后三個(gè)月內(nèi)定期(第一個(gè)月每周1次,隨后兩個(gè)月每?jī)芍?次)電話指導(dǎo)的方式進(jìn)行干預(yù),每次通話時(shí)間不低于20分鐘,通話內(nèi)容包括：了解患者的飲食(食物種類、量及鹽、油控制的情況)、控?zé)?戒煙情況)、服藥(藥名、劑量、用法是否與出院醫(yī)囑一致,注意觀察大便顏色、皮膚黏膜是否出血)、運(yùn)動(dòng)(運(yùn)動(dòng)形式、運(yùn)動(dòng)量,運(yùn)動(dòng)時(shí)心率變化)、復(fù)查(是否按時(shí),結(jié)果是否異常)、心理狀況(有無(wú)異常)是否再住院等情況,有針對(duì)性的進(jìn)行糾正和指導(dǎo)。兩組分別在患者出院時(shí)、3個(gè)月、6個(gè)月由專職人員進(jìn)行問(wèn)卷調(diào)查。分析兩組患者的生活方式、生活質(zhì)量、遵醫(yī)行為、服藥依從性、再入院等情況,采用HPLP-Ⅱ量表對(duì)患者的健康生活方式進(jìn)行評(píng)價(jià)；采用MOS-SF36評(píng)分表對(duì)患者的生活質(zhì)量進(jìn)行評(píng)價(jià)；通過(guò)患者遵醫(yī)行為調(diào)查表對(duì)遵醫(yī)用藥、定期復(fù)查等情況進(jìn)行統(tǒng)計(jì)。采用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料用(x±s)表示,采用組間方差分析及t檢驗(yàn),計(jì)數(shù)資料采用卡方檢驗(yàn),以P0.05時(shí),差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果(1)兩組患者在男女比例、吸煙史、高血壓病史、糖尿病史、肥胖史以及血管病變情況等方面均無(wú)統(tǒng)計(jì)學(xué)差異,P0.05；(2)所有患者出院時(shí)健康生活評(píng)分項(xiàng)目得分均為中等分?jǐn)?shù),其中健康責(zé)任和人際間的關(guān)系得分比較低；(3)兩組患者出院時(shí)在運(yùn)動(dòng)、營(yíng)養(yǎng)、壓力、自我實(shí)現(xiàn)等生活方式的各個(gè)項(xiàng)目之間的差異均無(wú)明顯的差異性,P=0.17；(4)干預(yù)組患者健康生活評(píng)分中的各個(gè)項(xiàng)目在3個(gè)月、6個(gè)月時(shí)均高于對(duì)照組,P0.05。尤其是在營(yíng)養(yǎng)、人際間支持、健康責(zé)任及自我實(shí)現(xiàn)等方面,干預(yù)組分?jǐn)?shù)提高較明顯；(5)6個(gè)月時(shí)兩組患者在生理功能、生理職能和身體疼痛方面差異不明顯,P0.05；干預(yù)組患者在總體健康、情感職能、心理健康以及生命力等方面較對(duì)照組得分較高,差異明顯,P0.05；(6)出院時(shí)兩組患者的遵醫(yī)率差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05；患者出院6個(gè)月時(shí)干預(yù)組的遵醫(yī)率高于對(duì)照組,P0.05,差異具有統(tǒng)計(jì)學(xué)意義；(7)出院時(shí)兩組患者的服藥依從性差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05；3個(gè)月時(shí)干預(yù)組的依從性(80.87%)高于對(duì)照組(70.43%),6個(gè)月時(shí)干預(yù)組的依從性(82.61%)仍高于對(duì)照組(62.61%)P0.05,差異具有統(tǒng)計(jì)學(xué)意義；(8)患者出院后6個(gè)月時(shí),對(duì)照組再入院率(6.9%),干預(yù)組再入院率(0.9%),P=0.018,差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論電話指導(dǎo)式延續(xù)護(hù)理模式可提高冠狀動(dòng)脈腔內(nèi)支架術(shù)后患者健康生活方式、遵醫(yī)行為等方面的自我管理能力,降低患者再入院率。這一措施簡(jiǎn)便易行,為電話指導(dǎo)式延續(xù)護(hù)理在冠狀動(dòng)脈腔內(nèi)支架術(shù)后患者的護(hù)理應(yīng)用提供臨床參考。
[Abstract]:Objective To analyze the influence of telephone-guided continuous nursing on the way of healthy life, quality of life and medical behavior of patients after coronary angioplasty, and to provide reference for the application of continuous nursing care in patients after intracoronary stent implantation. Methods From January 2014 to January 2015, the cardiovascular department of a three-level cardiovascular hospital in Zhengzhou City underwent percutaneous coronary angioplasty (stent) and the patients residing in the city were the subjects. 230 patients included in the study were randomly divided into two groups: control group and intervention group, and there were 115 cases in both groups, and there was no statistical difference between general information and disease condition (P0.05). The patient's profile of personal data (including patient's basic information, operation condition, discharge advice and regular follow-up time, etc.) was established for two groups of patients, and the same nursing measures were given to two groups of patients during the hospital. When discharged from the hospital, the individual drug administration card shall be issued. According to the manual and the contents, the full-time personnel shall guide the patients and their families, and the patients shall take medicine, exercise and regular reexamination in strict accordance with the instruction manual and the contents of the doctor's advice after discharge, and ask their families to supervise the patients and record them as they are. No other forms of intervention were given after 1 dose of routine telephone follow-up within 3 days after the control group was discharged; the intervention group was followed up by trained follow-up personnel for 1 time except routine telephone follow-up, i.e. beginning with continued nursing intervention, Interventions are mainly conducted on a regular basis within three months of discharge (once a week in the first month and once every two weeks thereafter), each time being not less than 20 minutes, and the contents of the call include: knowing the patient's diet (food category, quantity and salt, Control of oil (case of smoking cessation), control tobacco (smoking cessation), take medicine (drug name, dosage, usage is consistent with discharge order, pay attention to observation of stool color, skin mucous membrane bleeding), motion (motion form, movement amount, heart rate change during exercise), review (whether on time, Whether the result is abnormal or not, whether the psychological condition (whether abnormal) is re-hospitalization, and so on, has targeted correction and guidance. When the patients were discharged from the hospital, three months and 6 months were investigated by full-time staff. The quality of life of patients was evaluated by HPLP-鈪，

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