本文選題：MDT術(shù)前訪視　切入點：圍手術(shù)期　出處：《大連醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：研究目的:分析MDT術(shù)前訪視對圍手術(shù)期經(jīng)皮冠狀動脈介入術(shù)患者心理、生理和術(shù)中依從性的影響;研究其術(shù)前訪視模式效果。提高圍手術(shù)期經(jīng)皮冠狀動脈介入治療患者術(shù)中依從性和滿意度,以保障手術(shù)的順利進行,鞏固治療效果,提高護理質(zhì)量。研究方法:本研究為實驗性研究。采用臨床隨機對照的方法,根據(jù)納入和排除標準,選取2015年4月至2015年7月山東省某三級甲等綜合醫(yī)院心血管內(nèi)科接受圍手術(shù)期經(jīng)皮冠狀動脈治療的患者120人,實驗組(心內(nèi)一區(qū))和對照組(心內(nèi)二區(qū))各60人。實驗組給予MDT術(shù)前訪視,按模式為醫(yī)護術(shù)前討論全面評估、集中培訓、問題一對一指導、經(jīng)驗分享、綜合評價的流程對患者進行訪視;對照組給予傳統(tǒng)個體化術(shù)前訪視,模式為進行術(shù)前評估和訪視單宣教。運用狀態(tài)-特質(zhì)焦慮量表(STAI)比較兩組患者術(shù)前焦慮水平。訪視者術(shù)前監(jiān)測兩組患者血壓和心率。由于平均動脈壓是在一個心動周期中持續(xù)地推動血液向前流動的平均推動力,能更精確地反應(yīng)心臟和血管的機能狀態(tài),平均動脈壓=舒張壓+1/3脈壓或1/3(收縮壓+2×舒張壓),本研究計算出患者平均動脈壓,比較患者平均動脈壓和心率的差異;采用自行設(shè)計的記錄單,評價患者術(shù)中依從性和術(shù)后滿意度。應(yīng)用SPSS 17.0 for windows軟件包進行數(shù)據(jù)處理和統(tǒng)計學分析。計量資料以均數(shù)±標準差(xs±)表示,計數(shù)資料以率和構(gòu)成比表示;運用t檢驗、卡方檢驗等統(tǒng)計學方法進行統(tǒng)計分析。研究結(jié)果:1.人口學資料統(tǒng)計結(jié)果兩組患者在年齡、性別、診斷、文化程度、婚姻狀況、職業(yè)、經(jīng)濟狀況、醫(yī)療保障、社會支持等方面差異無統(tǒng)計學意義(P0.05),兩組患者具有可比性。2.兩組患者術(shù)前訪視前后焦慮水平比較兩組患者術(shù)前訪視前焦慮水平相比,差異無統(tǒng)計學意義(P0.05);訪視后對比兩組患者焦慮水平,差異有統(tǒng)計學意義(P0.05)。3.兩組患者術(shù)前、術(shù)中、術(shù)后心率與平均動脈壓比較兩組患者術(shù)前訪視前心率、平均動脈壓比較,差異均無統(tǒng)計學意義(P0.05);比較兩組患者訪視后心率、平均動脈壓,差異有統(tǒng)計學意義(P0.05);比較術(shù)前訪視前后兩組患者心率、平均動脈壓差值、術(shù)中、術(shù)后心率、平均動脈壓,差異均有統(tǒng)計學意義(P0.05)。4.兩組患者術(shù)中依從性和術(shù)后滿意度比較實驗組患者術(shù)中依從率為91.67%(165/180),明顯高于對照組的67.78%(122/180);實驗組術(shù)后滿意度為98.3%(59/60),高于對照組的85%(51/60)(x2=6.982,P0.05)。研究結(jié)論:1.MDT術(shù)前訪視有助于降低圍手術(shù)期經(jīng)皮冠狀動脈介入術(shù)患者術(shù)前的焦慮水平。2.MDT術(shù)前訪視可維持圍手術(shù)期經(jīng)皮冠狀動脈介入術(shù)患者術(shù)前和術(shù)中、術(shù)后的平均動脈壓與心率相對穩(wěn)定。3.MDT術(shù)前訪視可提高圍手術(shù)期經(jīng)皮冠狀動脈介入術(shù)患者術(shù)中依從性和術(shù)后滿意度。4.MDT訪視模式即多學科團隊協(xié)作模式,通過術(shù)前全面系統(tǒng)評估、醫(yī)護人員對患者集中培訓、問題一對一指導、成功患者經(jīng)驗分享與綜合評價,臨床應(yīng)用效果良好,值得推廣。
[Abstract]:Objective: to analyze the MDT of preoperative visit on perioperative percutaneous coronary intervention in patients with psychological, physiological and operative effect of compliance; to study the mode of preoperative interview effect. Improve the perioperative period of percutaneous coronary interventional treatment compliance and satisfaction of patients, in order to ensure the smooth operation to consolidate the treatment effect, improve the quality of nursing. Methods: This is an experimental study. By using the method of randomized controlled clinical trials, according to inclusion and exclusion criteria, select general hospital some three grade from April 2015 to July 2015 in Shandong Province in the cardiovascular system during perioperative period of percutaneous coronary treatment in 120 patients, the experimental group (a heart) and control group (in district two) 60 people each. The experimental group was given MDT preoperative training mode for health care according to the preoperative discussion, comprehensive assessment, problems of one-to-one coaching, experience sharing, comprehensive evaluation of the flow The patients were interviewed; the control group was given conventional individualized preoperative model for preoperative assessment and visit single mission. Using the State Trait Anxiety Inventory (STAI) levels in patients with anxiety were compared between the two groups before the interview. Preoperative blood pressure and heart rate monitoring of patients in the two groups. Due to the flat both the average arterial pressure is the driving force in a cardiac cycle continuously promote blood flow forward, can more accurately reflect cardiac and vascular function, mean arterial pressure, diastolic pressure, pulse pressure or 1/3 = +1/3 (systolic diastolic pressure, +2 *) this study calculated the mean arterial pressure in patients with, compared with the average arterial pressure and heart rate; the record of self design, evaluation and compliance in patients with postoperative satisfaction. The application of SPSS 17 for Windows software package for data processing and statistical analysis. The measurement data to mean + standard deviation (XS +), count data The rate and constituent ratio; using t test and chi square test were used for statistical analysis. Results: the statistical results of 1. demographic data of the two groups in age, gender, diagnosis, education level, marital status, occupation, economic status, medical security, there were no significant differences of social support (P0.05), the two groups were comparable in.2. of two groups of patients before visiting the level of anxiety before and after operation were compared between the two groups before the interview anxiety level before compared, the difference was not statistically significant (P0.05); after the visit of Jiao Lvshui were compared between the two groups, the difference was statistically significant (P0.05.3.) two groups of patients before operation. During the surgery, postoperative heart rate and mean arterial pressure of patients between the two groups before the interview before the heart rate, mean arterial pressure, there were no significant differences (P0.05) were compared between the two groups; visit after the heart rate, mean arterial pressure, the difference was statistically significant (P0.05); comparison Preoperative interview of two groups of patients before and after the heart rate, mean arterial pressure difference, intraoperative, postoperative heart rate, mean arterial pressure, the differences were statistically significant (P0.05.4.) of two groups of patients with compliance and postoperative satisfaction experimental group patients compliance rate was 91.67% (165/180), significantly higher than the control group 67.78% (122/180); postoperative satisfaction of the experimental group was 98.3% higher than that of the control group (59/60), 85% (51/60) (x2=6.982, P0.05). Conclusion: 1.MDT preoperative visit can help reduce the perioperative period of percutaneous coronary intervention in patients with preoperative anxiety level.2.MDT preoperative visit can be maintained during the perioperative period of percutaneous coronary intervention in patients with preoperative and intraoperative, postoperative mean arterial pressure and heart rate relatively stable.3.MDT preoperative visit can improve the perioperative period of percutaneous coronary intervention compliance and postoperative patients visit satisfaction.4.MDT modes: the multi disciplinary team collaboration as Mode, through preoperative comprehensive system assessment, medical staff training for patients, one to one guidance, successful patient experience sharing and comprehensive evaluation, clinical application effect is good, it is worth promoting.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R473.5

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