基于时机理论的延续护理在房颤合并慢性心力衰竭患者中的应用

郑爱娣; 王咏梅; 徐静; 邹海英

doi:10.16766/j.cnki.issn.1674-4152.002572

基于时机理论的延续护理在房颤合并慢性心力衰竭患者中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002572

浙江大学医学院附属杭州市第一人民医院心内科，浙江杭州 310006

基金项目:

浙江省医药卫生科技计划项目 2020KY208

详细信息

通讯作者:
王咏梅，E-mail：ymwang0129@163.com

中图分类号: R541.6R473.54
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- 文章访问数: 183
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出版历程
- 收稿日期: 2021-06-02
- 网络出版日期: 2022-09-23

Application of continuous nursing based on timing theory in patients with atrial fibrillation and chronic heart failure

Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, China

摘要

摘要: 目的探讨基于时机理论的延续性护理干预对房颤合并慢性心力衰竭患者抗凝药物用药依从性及抗凝效果的影响。方法选取浙江省杭州市第一人民医院2019年1—6月收治的100例房颤合并慢性心衰患者，按随机数字表法分为观察组和对照组各50例，对照组患者实施常规护理及出院指导，观察组患者在对照组的基础上实施基于时机理论的延续性护理指导，比较2组患者出院后3、6个月后的抗凝药物服用依从性，国际标准化比值(INR)的达标情况以及并发症的发生情况。结果护理干预前，2组患者基本数据差异无统计学意义；护理干预后，观察组患者出院3个月后用药依从性评分(MMAS-8)为(7.42±0.87)分，明显高于对照组[(6.54±1.52)分，P=0.001]，出院6个月复查其用药依从性评分[(7.33±0.89)分]亦高于对照组[(6.39±1.49)分，P=0.001]；INR的达标率出院3个月后随访观察组明显高于对照组(P=0.009)，出院6个月后达标率观察组较高，但与对照组比较差异无统计学意义(P=0.075)；出院6个月后复查并发症的发生例数观察组(3例)低于对照组(9例)，但差异无统计学意义(P=0.065)。结论通过对房颤合并慢性心力衰竭患者实施基于时机理论的科学全面的延续性护理，可以明显提高患者的服药依从性，提高患者的INR达标率，减少并发症，预后好，具有较高的临床价值。
- 延续性护理 /
- 房颤 /
- 心力衰竭 /
- 抗凝
Abstract: Objective To explore the effect of continuous nursing intervention based on timing theory on the compliance of anticoagulant medication and anticoagulant effect in patients with atrial fibrillation and chronic heart failure. Methods A total of 100 patients with atrial fibrillation and chronic heart failure admitted to Hangzhou First People's Hospital from January 2019 to June 2019 were selected. The patients were randomly divided into observation group and control group with 50 cases each. The patients in the control group were provided with routine nursing and discharge guidance. The patients in the observation group were provided with continuous nursing guidance based on the timing theory on the basis of the control group. Compliance with anticoagulant medication after 3 and 6 months discharge, International normalized ration (INR) compliance and complications were compared between the two groups. Results Before the nursing intervention, no significant difference in basic data was found between the two groups. After the nursing intervention, the medication compliance score (MMAS-8) of the observation group was significantly higher (7.42±0.87) than that of the control group (6.54±1.52, P=0.001) 3 months after the patients were discharged from the hospital. Six months after discharge, the medication compliance score (7.33±0.89) was also higher than that of the control group (6.39±1.49, P=0.001). The INR compliance rate of the 3-month follow-up observation group after discharge was significantly higher than that of the control group (P=0.009). The compliance rate 6 months after discharge was higher in the observation group than in the control group, but the difference was not significant (P=0.075). The number of complications in the follow-up examination 6 months after discharge (3 cases) was lower than that in the control group (9 cases), but the difference was not significant (P=0.065). Conclusion Implementing scientific and comprehensive continuation nursing based on timing theory for patients with atrial fibrillation and chronic heart failure can significantly improve the patient's medication compliance, increase the patient's INR compliance rate and reduce complications, leading to a good prognosis. Thus, this intervention is worthy of clinical application and promotion.
- Continuous nursing /
- Atrial fibrillation /
- Heart failure /
- Anticoagulation

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表 1 2组房颤合并慢性心衰患者一般资料比较

Table 1. Comparison of general data of patients with atrial fibrillation complicated with chronic heart failure between two groups

组别	例数	性别(例)		年龄 (x±s, 岁)	文化程度(例)					病程 (x±s，年)	合并高血压(例)	合并冠心病(例)
组别	例数	男性	女性	年龄 (x±s, 岁)	文盲	小学	中学	中专/高中	大学	病程 (x±s，年)	合并高血压(例)	合并冠心病(例)
观察组	50	34	16	63.10±10.60	3	11	14	13	9	3.25±2.04	10	14
对照组	50	33	17	66.54±10.43	3	11	13	9	14	3.60±2.09	12	15
统计量		0.045^a		-1.636^b	1.864^a					-1.284^b	0.233^a	0.049^a
P值		0.832		0.105	0.761					0.205	0.629	0.826
注：^a为χ²值，^b为t值。

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表 2 2组房颤合并慢性心衰患者的服药依从性MMAS-8评分比较(x ±s，分)

Table 2. Comparison of medication compliance MMAS-8 score between two groups of patients with atrial fibrillation complicated with chronic heart failure

组别	例数	3个月	6个月	t值	P值
观察组	50	7.42±0.87	7.33±0.89	1.838	0.072
对照组	50	6.41±1.62	6.39±1.49	0.112	0.911
t值		3.851	3.666
P值		< 0.001	0.001

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表 3 2组房颤合并慢性心衰患者出院3、6个月后INR值监测情况比较(例)

Table 3. Comparison of INR values of patients with atrial fibrillation complicated with chronic heart failure in 2 groups 3 and 6 months after discharge

组别	例数	出院后3个月INR值			出院后6个月INR值
组别	例数	＜2.0	2.0~3.0	＞3.00	＜2.0	2.0~3.0	＞3.00
观察组	50	8	42	0	10	40	0
对照组	50	18	30	2	20	26	4
U值		2.580			1.778
P值		0.010			0.075

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表 4 2组房颤合并慢性心衰患者并发症发生率比较[例(%)]

Table 4. Comparison of complication rate between two groups of patients with atrial fibrillation complicated with chronic heart failure

组别	例数	牙龈出血	鼻腔出血	眼底出血	合计
观察组	50	2(4.0)	1(2.0)	0	3(6.0)
对照组	50	5(10.0)	2(4.0)	2(4.0)	9(18.0)
χ²值		0.614	< 0.001		3.409
P值		0.433	0.999	0.495^a	0.065
注：^a为采用Fisher精确检验。

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