Orem自理模式对三叉神经射频热凝术后患者自护能力及口腔健康状况的影响

夏建妹; 邓康; 陈德健; 朱志红; 谢可越; 方丽; 姚明

doi:10.16766/j.cnki.issn.1674-4152.003985

Orem自理模式对三叉神经射频热凝术后患者自护能力及口腔健康状况的影响

doi: 10.16766/j.cnki.issn.1674-4152.003985

嘉兴大学附属医院疼痛科，浙江嘉兴 314000

基金项目:

浙江省医药卫生科技计划项目 2022KY1239

嘉兴市科技计划项目 2023AY31013

详细信息

通讯作者:
邓康，E-mail: jxmzdk@163.com

中图分类号: R473.74 R745.1
计量
- 文章访问数: 1
- HTML全文浏览量: 2
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-09-24
- 网络出版日期: 2025-06-30

Effect of Orem self-care mode on self-care ability and oral health in patients after radiofrequency thermocoagulation of trigeminal neuralgia

Department of Pain, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, China

摘要

摘要: 目的为解决三叉神经痛射频热凝术后患者因面部麻木引发无感自伤性口腔溃疡继而导致口腔健康状况恶化的问题，本研究将Orem自理模式应用于三叉神经痛射频热凝术后患者并探讨其在改善患者自护能力及口腔健康状况中的临床价值。方法回顾性选取2016年1月—2022年4月嘉兴大学附属医院疼痛科收治并行三叉神经痛射频热凝手术的患者90例为研究对象，根据术后护理模式不同分为观察组(46例)和对照组(44例)。观察组接受Orem自理模式，对照组接受传统护理模式。比较2组患者干预前后自我护理能力测定量表评分、口腔健康影响程度量表评分、三叉神经痛生活质量量表评分。结果观察组干预3个月后的自我护理能力测定量表各维度(自我概念、自护技能、自护责任感、健康知识水平)评分[(28.78±2.11)分、(21.91±2.02)分、(41.83±3.20)分、(61.13±3.98)分]均明显优于对照组[(25.25±4.11)分、(19.75±3.29)分、(38.45±6.35)分、(54.20±9.64)分，P＜0.05];观察组干预3个月后的口腔健康影响程度量表总分为(13.67±2.87)分，明显优于对照组[(17.73±4.23)分，P＜0.05];观察组干预3个月后的三叉神经痛生活质量量表各维度(三叉神经痛发作、心理维度、社会维度)评分[(9.50±2.25)分、(10.70±2.29)分、(10.16±2.09)分]均明显优于对照组[(7.87±1.64)分、(9.24±2.51)分、(8.30±1.44)分，P＜0.05]。结论 Orem自理模式能有效改善三叉神经射频热凝术后患者自护能力及口腔健康状况，提升生活质量，值得临床推广应用。
- 三叉神经痛 /
- 自护能力 /
- 自护模式 /
- 口腔健康 /
- 生活质量
Abstract: Objective This study aims to address the issue of self-injurious oral ulcers caused by facial numbness in patients following radiofrequency thermocoagulation for trigeminal neuralgia, which contributes to the deterioration in oral health. By applying Orem ' s self-care model, this study explores the clinical value in enhancing self-care abilities and oral health in these patients. Methods A retrospective analysis was conducted on 90 patients who underwent radiofrequency thermocoagulation for trigeminal neuralgia at the Pain Department of Affiliated Hospital of Jiaxing University from January 2016 to April 2022. Based on different postoperative nursing models, patients were divided into an observation group and a control group. The observation group consisted of 46 patients who received Orem ' s self-care model, while the control group included 44 patients who received traditional nursing care. The scores for the exercise of self-care agency scale, oral health impact profile, and quality of life scale for trigeminal neuralgia were compared for both groups before and after the intervention. Results Three months after the intervention, the scores in all dimensions of the self-care ability scale (self-concept, self-care skills, self-care responsibility, health knowledge level) for the observation group [(28.78±2.11) points, (21.91±2.02) points, (41.83±3.20) points, and (61.13±3.98) points] were significantly higher than those of the control group [(25.25±4.11) points, (19.75±3.29) points, (38.45±6.35) points, and (54.20±9.64) points, P < 0.05]. The total score of the oral health impact profile for the observation group was (13.67±2.87) points, which was significantly better than that of the control group [(17.73±4.23) points, P < 0.05]. The scores in all dimensions of the quality of life scale for trigeminal neuralgia (trigeminal neuralgia attacks, psychological dimension, social dimension) for the observation group [(9.50±2.25) points, (10.70±2.29) points, and (10.16±2.09) points] were significantly better than those of the control group [(7.87±1.64) points, (9.24±2.51) points, and (8.30±1.44) points, P < 0.05]. Conclusion Orem self-care model effectively improves the self-care ability, oral health status, and quality of life in patients after radiofrequency thermocoagulation for trigeminal neuralgia. Its effectiveness makes it a valuable approach for clinical promotion and application.
- Trigeminal neuralgia /
- Self-care ability /
- Oral self-care model /
- Oral health /
- Quality of life

HTML全文

表 1 2组三叉神经射频热凝术后患者基本资料比较

Table 1. Comparison of baseline characteristics between two groups of patients after radiofrequency thermocoagulation of trigeminal nerve

项目	观察组(n=46)	对照组(n=44)	统计量	P值
性别[例(%)]			1.163^a	0.281
男性	23(50.00)	17(38.64)
女性	23(50.00)	27(61.36)
年龄(x±s，岁)	67.65±12.51	64.95±10.16	1.126^b	0.265
BMI(x±s)	23.27±2.81	22.94±2.86	0.552^b	0.582
ASA分级[例(%)]			0.178^a	0.673
Ⅰ级	36(78.26)	36(81.82)
Ⅱ级	10(21.74)	8(18.18)
病程(x±s，年)	4.26±2.22	3.83±2.19	0.925^b	0.357
基础疾病[例(%)]
高血压	22(47.83)	22(50.00)	0.443^a	0.837
糖尿病	13(28.26)	11(25.00)	0.122^a	0.727
呼吸系统疾病	13(28.26)	8(18.18)	1.263^a	0.261
脑血管疾病	6(13.04)	5(11.36)	0.059^a	0.808
术后麻木分级[例(%)]			0.701^a	0.403
Ⅰ级	0	0
Ⅱ级	35(76.09)	30(68.18)
Ⅲ级	11(23.91)	14(31.82)
Ⅳ级	0	0
注：^a为χ²值，^b为t值。术后麻木分级采用BNI面部麻木分级标准评估面部感觉减退情况^[7]，Ⅰ级为无面部麻木; Ⅱ级为轻度面部麻木，未困扰或轻微困扰生活; Ⅲ级为中度面部麻木，困扰生活; Ⅳ级为重度面部麻木，极大困扰生活。

下载: 导出CSV

表 2 2组三叉神经射频热凝术后患者干预前后自我护理能力测定评分比较(x±s，分)

Table 2. Comparison of self-care ability scores before and after intervention between two groups of patients after radiofrequency thermocoagulation of trigeminal nerve (x±s, points)

组别	例数	自我概念		自护技能		自护责任感		健康知识水平
组别	例数	干预前	干预3个月	干预前	干预3个月	干预前	干预3个月	干预前	干预3个月
观察组	46	22.11±4.74	28.78±2.11	18.13±3.83	21.91±2.02	35.39±7.74	41.83±3.20	51.98±11.02	61.13±3.98
对照组	44	22.61±5.56	25.25±4.11	18.18±5.38	19.75±3.29	34.95±9.12	38.45±6.35	49.77±14.02	54.20±9.64
统计量		0.464^a	41.413^b	0.052^a	19.363^b	0.245^a	24.687^b	0.832^a	16.499^b
P值		0.644	＜0.001	0.958	0.009	0.807	＜0.001	0.408	＜0.001
注：^a为t值，^b为F值。

下载: 导出CSV

表 3 2组三叉神经射频热凝术后患者干预前后口腔健康影响程度评分比较(x±s，分)

Table 3. Comparison of oral health impact scores before and after intervention between two groups of patients undergoing trigeminal nerve radiofrequency thermocoagulation (x±s, points)

组别	例数	对饮食不满		进餐中途停止		不能得到很好休息		味觉变差		出现明显疼痛
组别	例数	干预前	干预3个月	干预前	干预3个月	干预前	干预3个月	干预前	干预3个月	术后1 d	术后1个月
观察组	46	1.39±0.74	1.00±0.70	1.48±1.07	0.91±0.69	1.62±0.97	0.98±0.77	1.35±0.82	0.91±0.76	1.50±0.78	0.98±0.58
对照组	44	1.52±0.95	1.32±0.86	1.59±1.04	1.30±0.90	1.50±1.02	1.34±0.86	1.43±0.95	1.27±0.97	1.55±0.93	1.36±0.94
统计量		0.722^a	3.518^b	0.495^a	4.797^b	0.571^a	4.372^b	0.427^a	1.699^b	0.276^a	3.068^b
P值		0.236	0.064	0.311	0.031	0.286	0.039	0.335	0.196	0.392	0.083

组别	例数	进食不适		在他人面前感觉不适		紧张不安		存在尴尬		影响发音
组别	例数	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月
观察组	46	1.35±0.48	0.85±0.56	1.54±0.50	0.89±0.77	1.48±0.98	0.87±0.65	1.43±1.07	0.93±0.61	1.43±0.62	0.78±0.76
对照组	44	1.36±0.81	1.16±0.75	1.48±0.90	1.25±0.87	1.39±0.84	1.18±0.90	1.45±1.21	1.20±0.88	1.41±1.04	1.20±0.88
统计量		0.071^a	0.656^b	0.389^a	5.258^b	0.468^a	0.872^b	0.083^a	3.221^b	0.110^a	1.817^b
P值		0.420	0.420	0.349	0.024	0.320	0.353	0.467	0.076	0.456	0.181

组别	例数	易发脾气		日常工作难以完成		自觉对生活不满意		自觉什么都干不好		总分
组别	例数	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月
观察组	46	1.37±0.90	0.89±0.67	1.46±1.09	0.91±0.78	1.52±0.81	1.07±0.80	1.24±0.82	0.87±0.78	19.89±5.17	13.67±2.87
对照组	44	1.34±1.16	1.23±0.74	1.57±0.82	1.43±0.95	1.66±1.14	1.36±0.69	1.32±0.93	1.11±0.81	20.57±6.01	17.73±4.23
统计量		0.137^a	5.434^b	0.543^a	8.387^b	0.669^a	4.259^b	0.432^a	2.459^b	0.312^a	13.634^b
P值		0.446	0.022	0.294	0.005	0.253	0.042	0.333	0.120	0.378	< 0.001
注：^a为t值，^b为F值。

下载: 导出CSV

表 4 2组三叉神经射频热凝术后患者干预前后三叉神经痛生活质量评分比较(x±s，分)

Table 4. Comparison of trigeminal neuralgia quality of life scores pre- and post-intervention between two groups of trigeminal nerve patients after radiofrequency thermocoagulation (x±s, points)

组别	例数	三叉神经痛发作		躯体症状		心理维度		社会维度
组别	例数	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月
观察组	46	23.09±3.54	9.50±2.25	28.41±3.53	24.78±2.28	19.04±3.71	10.70±2.29	19.30±3.91	10.16±2.09
对照组	44	23.30±4.17	7.87±1.64	28.09±3.40	23.59±2.57	19.09±3.96	9.24±2.51	19.43±4.06	8.30±1.44
统计量		0.256^a	16.538^b	0.441^a	2.264^b	0.059^a	7.474^b	0.152^a	23.202^b
P值		0.798	＜0.001	0.660	0.136	0.953	＜0.001	0.880	＜0.001
注：^a为t值，^b为F值。

下载: 导出CSV

参考文献(23)

[1]	SCHOLZ J, FINNERUP N B, ATTAL N, et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain[J]. Pain, 2019, 160(1): 53-59. doi: 10.1097/j.pain.0000000000001365
[2]	郭燕, 王立奎, 朱本藩, 等. 半月神经节射频热凝治疗不同程度血管关联性三叉神经痛的效果分析[J]. 中华全科医学, 2022, 20(6): 914-918. doi: 10.16766/j.cnki.issn.1674-4152.002486 GUO Y, WANG L K, ZHU B F, et al. Analysis of the effect of radiofrequency thermocoagulation of semilunar ganglion in the treatment of trigeminal neuralgia with different degrees of vascular association[J]. Chinese Family Medicine, 2022, 20(6): 914-918. doi: 10.16766/j.cnki.issn.1674-4152.002486
[3]	ALIZADEH Y, HAYAK H, KHOSHNEVISAN A. Microvascular decompression versus gamma knife surgery in patients with drug-resistant trigeminal neuralgia: a systematic review and meta-analysis[J]. World Neurosurg, 2022, 167: 67-73. doi: 10.1016/j.wneu.2022.08.020
[4]	WANG B S, ZHANG L, YU Y B. Treatment of redo-microvascular decompression or internal neurolysis plus microvascular decompression for recurrent trigeminal neuralgia: a review of long-term effectiveness and safety[J]. J Int Med Res, 2022, 50(3): 3000605221080721. DOI: 10.1177/03000605221080721.
[5]	XIE K Y, LIU S L, HUANG B, et al. Effects of supraorbital foramen variations on the treatment efficacy of radiofrequency therapy for V1 trigeminal neuralgia: a retrospective study[J]. Pain Res Manag, 2020, 2020: 8142489. DOI: 10.1155/2020/8142489.
[6]	WANG T T, XU S J, HE Q L, et al. efficacy and safety of radiofrequency thermocoagulation with different puncture methods for treatment of V1 trigeminal neuralgia: a prospective study[J]. Pain Physician, 2021, 24(2): 145-152.
[7]	叶钢, 谢可越, 黄兵, 等. 眶上孔变异情况对射频治疗原发性三叉神经V1支疼痛的影响[J]. 中华医学杂志, 2020, 100(7): 527-528, 532. doi: 10.3760/cma.j.issn.0376-2491.2020.07.010 YE G, XIE K Y, HUANG B, et al. Influence of supraorbital foraminal variations on radiofrequency treatment of primary trigeminal V1 branch pain[J]. Chinese Medical Journal, 2020, 100(7): 527-528, 532. doi: 10.3760/cma.j.issn.0376-2491.2020.07.010
[8]	孔芳芳, 谢丹. Orem自护模式结合支持性护理干预对妇科肿瘤患者生活质量的影响[J]. 中华现代护理杂志, 2022, 28(20): 2765-2769. doi: 10.3760/cma.j.cn115682-20220125-00416 KONG F F, XIE D. Effect of Orem self-care model combined with supportive nursing intervention on the quality of life of gynecologic oncology patients[J]. Chinese Journal of Modern Nursing, 2022, 28(20): 2765-2769. doi: 10.3760/cma.j.cn115682-20220125-00416
[9]	邓凯彤, 黎星阳, 何霞, 等. 张口训练对伴张口受限的颞下颌关节紊乱病患者最大开口度恢复的短期影响[J]. 中华口腔医学研究杂志(电子版), 2022, 16(3): 150-154. DENG K T, LAI X Y, HE X, et al. Short-term effects of mouth opening training on the recovery of maximal mouth opening in temporomandibular joint disorder patients with limited mouth opening[J]. Chinese Journal of Oral Medicine Research(Electronic Edition), 2022, 16(3): 150-154.
[10]	HWANG W J, HUANG K, HUANG J S. Amyotrophic lateral sclerosis presenting as the temporomandibular disorder: a case report and literature review[J]. Cranio, 2019, 37(3): 196-200. doi: 10.1080/08869634.2017.1407117
[11]	丁清清, 赵瑶, 丁子钰, 等. 骶神经调控术后一期患者自我护理能力现状调查及影响因素分析[J]. 中华现代护理杂志, 2022, 28(24): 3288-3292. DING Q Q, ZHAO Y, DING Z Y, et al. Survey on the current status of patients ' self-care ability after sacral neuromodulation surgery and analysis of influencing factors[J]. Chinese Journal of Modern Nursing, 2022, 28(24): 3288-3292.
[12]	刘芬, 胡传国. 胃食管反流病患者口腔健康相关生活质量现状及影响因素[J]. 中华胃食管反流病电子杂志, 2023, 10(3): 139-143. LIU F, HU C G. Current status and influencing factors of oral health-related quality of life in patients with gastroesophageal reflux disease[J]. Chinese Gastroesophageal Reflux Disease Electron, 2023, 10(3): 139-143.
[13]	杨鸿雅. 三叉神经痛患者生活质量量表研究[D]. 泸州: 泸州医学院, 2013. YANG H Y. Research on quality of life scale for patients with trigeminal neuralgia[D]. Luzhou: Luzhou Medical College, 2013.
[14]	ZHANG E M, FAN H R, XU P, et al. Analysis of the risk factors and a prediction model for postherpetic trigeminal neuralgia recurrence after extracranial nonsemilunar ganglion radiofrequency thermocoagulation[J]. Pain Physician, 2023, 26(6): E719-E724. doi: 10.36076/ppj.2023.26.E719
[15]	MOISAK G I, AMELINA E V, ZUBOK N A, et al. Psychological status before and after surgery in patients with trigeminal neuralgia[J]. Clin Neurol Neurosurg, 2021, 203: 106578. DOI: 10.1016/j.clineuro.2021.106578.
[16]	张云茜, 王然, 赵定亮, 等. 改良Hartel入路在半月节射频热凝术治疗原发性三叉神经痛的疗效及安全性分析[J]. 中华医学杂志, 2023, 103(15): 1134-1139. ZHANG Y X, WANG R, ZHAO D L, et al. Efficacy and safety analysis of modified Hartel approach in the treatment of primary trigeminal neuralgia by radiofrequency thermocoagulation in the semilunar node[J]. Chinese Medical Journal, 2023, 103(15): 1134-1139.
[17]	ELAMIN A, GAREMO M, MULDER A. Determinants of dental caries in children in the Middle East and North Africa region: a systematic review based on literature published from 2000 to 2019[J]. BMC Oral Health, 2021, 21(1): 237. DOI: 10.1186/s12903-021-01482-7.
[18]	杨秋云, 李娟, 朱姝. Orem自理护理模式对胃癌患者化学药物治疗后癌因性疲乏与生存质量的影响[J]. 中华消化病与影像杂志(电子版), 2021, 11(5): 233-235. YANG Q Y, LI J, ZHU S. Effects of Orem self-care model on cancer-caused fatigue and survival quality of gastric cancer patients after chemotherapy[J]. Chinese Journal of Gastroenterology and Imaging Electronic Edition, 2021, 11(5): 233-235.
[19]	李灵艳, 王红雨, 刘双池, 等. Orem自护理论对恶性梗阻性黄疸行经皮肝穿刺胆道引流术患者的影响分析[J]. 中华全科医学, 2022, 20(3): 514-518. doi: 10.16766/j.cnki.issn.1674-4152.002390 LI L Y, WANG H Y, LIU S C, et al. Analysis of the effect of Orem ' s self-care theory on patients with malignant obstructive jaundice undergoing percutaneous hepatic puncture biliary drainage[J]. Chinese Family Medicine, 2022, 20(3): 514-518. doi: 10.16766/j.cnki.issn.1674-4152.002390
[20]	杨娥, 钟良燕, 梁珊. 量化式健康教育在牙周炎患者龈下刮治术围手术期的应用价值[J]. 国际医药卫生导报, 2024, 30(13): 2268-2272. YANG E, ZHONG L Y, LIANG S. The value of quantitative health education in the perioperative period of subgingival curettage in patients with periodontitis[J]. International Journal of Medicine and Health, 2024, 30(13): 2268-2272.
[21]	范罗丹, 余华, 陈红, 等. 奥瑞姆自护理论在临床护理应用中的研究进展[J]. 中西医结合护理(中英文), 2020, 6(1): 181-184. FAN L D, LUO Q, YU H, et al. Research progress of Orem ' s self-care theory in clinical nursing application[J]. Integrative Nursing in Chinese and Western Medicine, 2020, 6(1): 181-184.
[22]	徐灵燕, 汤来云. 脑动脉瘤介入治疗中应用奥瑞姆自我护理模式的效果及对生活质量的影响[J]. 国际护理学杂志, 2022, 41(1): 119-122. XU L Y, TANG L Y. Effect of applying Orem self-care model in cerebral aneurysm interventional therapy and its impact on quality of life[J]. International Journal of Nursing, 2022, 41(1): 119-122.
[23]	王秀英. 基于Orem自理理论的护理干预对放射性食管炎患者自理能力、并发症及生活质量的影响[J]. 国际护理学杂志, 2020, 39(12): 2255-2257. WANG X Y. Effects of nursing intervention based on Orem ' s self-care theory on self-care ability, complications and quality of life of patients with radiation esophagitis[J]. International Journal of Nursing, 2020, 39(12): 2255-2257.