多学科协作联合华生关怀干预冠状动脉粥样硬化性心脏病介入术患者的价值

詹健; 左强; 刘芝修; 周桂香; 王亚婷

doi:10.16766/j.cnki.issn.1674-4152.003652

多学科协作联合华生关怀干预冠状动脉粥样硬化性心脏病介入术患者的价值

doi: 10.16766/j.cnki.issn.1674-4152.003652

1.
安徽中医药大学第一附属医院介入中心，安徽合肥 230031
2.
安徽中医药大学第一附属医院心内科

基金项目:

国家自然科学基金青年科学基金项目 82305186

详细信息

通讯作者:
左强，E-mail：zqys779@ahtcm.edu.cn

中图分类号: R541.4 R473.54
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出版历程
- 收稿日期: 2024-04-12
- 网络出版日期: 2024-11-19

The value of multidisciplinary collaboration combined with Watson care intervention on cardiac function, perceived burden and complications in patients undergoing interventional coronary heart disease

1.
Interventional Center, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui 230031, China

摘要

摘要: 目的研究多科学协作干预结合华生关怀理论在冠状动脉粥样硬化性心脏病(冠心病)介入手术中的护理效果，为临床护理工作提供参考。方法研究对象为2021年3月—2023年3月在安徽中医药大学第一附属医院介入中心手术室行介入手术的冠心病患者204例，以随机数字表法分为对照组(102例，采用常规围手术期护理干预)及观察组(102例，在对照组基础上采用多学科协作干预结合华生关怀理论干预)，比较2组患者干预前后的心功能指标、遵医行为、自我感受负担、生活质量，统计并发症发生率，运用SPSS 22.0统计学软件进行统计学分析。结果 (1) 干预3个月后，2组患者左心室射血分数、每搏心输出量、完全遵医占比、生活质量评分均升高，且观察组高于对照组(P＜0.05)，左心室舒张末内径、自我感受负担评分均降低，且观察组低于对照组(P＜0.05)；(2)观察组患者并发症发生率(3.92%)低于对照组(12.75%，χ²=5.198，P=0.023)。结论多学科协作干预结合华生关怀理论可改善冠心病患者介入手术后的心功能，同时提高其遵医行为及生活质量，减轻其自我感受负担，减少并发症的发生。
- 多学科协作干预 /
- 华生关怀理论 /
- 冠状动脉粥样硬化性心脏病 /
- 介入手术
Abstract: Objective To study the nursing effect of multi-science collaborative intervention combined with Watson care theory in interventional operation for coronary atherosclerotic heart disease (CAD), and provide guidance for clinical nursing. Methods The study subjects were 204 patients with coronary heart disease who underwent interventional surgery in the First Affiliated Hospital of Anhui University of Chinese Medicine from March 2021 to March 2023, who were divided into the control group (n=102, routine nursing intervention) and the observation group (n=102, multidisciplinary collaborative intervention combined with Watson Care theory intervention on the basis of the control group) by random number table method. The cardiac function indexes, compliance behavior, self-perceived burden scale, and quality of life were compared before and after intervention between the two groups, and the incidence of complications was recorded. SPSS 22.0 software was used for statistical analysis. Results (1) After 3 months of intervention, left ventricular ejection fraction, cardiac output per stroke, proportion of complete compliance, and quality of life score of the two groups were increased, and the observation group was higher than the control group (P < 0.05), the left ventricular end-diastolic diameter and self-perceived burden score were decreased, and the observation group was lower than the control group (P < 0.05). (2) The complication rate of the observation group (3.92%) was lower than that of the control group (12.75%, χ²=5.198, P=0.023). Conclusion Multidisciplinary collaborative intervention combined with Watson care theory can improve the heart function of patients with coronary heart disease after interventional surgery, improve their compliance behavior and quality of life, reduce their self-perceived burden, and reduce the occurrence of complications.
- Multidisciplinary collaborative intervention /
- Watson care theory /
- Coronary heart disease /
- Interventional surgery

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表 1 2组冠心病患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with coronary heart disease

组别	例数	性别(例)		年龄 (x±s，岁)	空腹血糖 (x±s，mmol/L)	总胆固醇 (x±s，mmol/L)	甘油三酯 (x±s，mmol/L)	低密度脂蛋白胆固醇 (x±s，mmol/L)
组别	例数	男性	女性	年龄 (x±s，岁)	空腹血糖 (x±s，mmol/L)	总胆固醇 (x±s，mmol/L)	甘油三酯 (x±s，mmol/L)	低密度脂蛋白胆固醇 (x±s，mmol/L)
观察组	102	52	50	63.89±4.26	8.32±0.43	6.21±0.69	3.22±0.51	4.12±0.49
对照组	102	54	48	64.42±4.18	8.24±0.47	6.09±0.74	3.13±0.54	4.01±0.53
统计量		0.079^a		0.897^b	1.268^b	1.198^b	1.224^b	1.539^b
P值		0.779		0.371	0.206	0.232	0.223	0.125

组别	例数	高密度脂蛋白胆固醇 (x±s，mmol/L)		血肌酐 (x±s，mmol/L)		收缩压 (x±s，mmHg)	舒张压 (x±s，mmHg)	血管病变支数 (x±s，支)
观察组	102	1.46±0.52		87.43±5.69		126.87±9.86	78.93±5.78	2.51±0.44
对照组	102	1.54±0.56		86.62±5.74		125.53±9.94	77.89±5.83	2.42±0.46
统计量		1.057^b		1.012^b		0.967^b	1.279^b	1.428^b
P值		0.292		0.313		0.335	0.202	0.155
注：^a为χ²值，^b为t值。1 mmHg=0.133 kPa。

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表 2 2组冠心病患者心功能指标比较(x±s)

Table 2. Comparison of cardiac function indexes between the two groups of patients with coronary heart disease (x±s)

组别	例数	LVEF(%)		SV(mL)		LVEDD(mm)
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
观察组	102	38.02±1.72	47.38±1.58^b	40.13±2.04	45.56±2.17^b	52.03±1.78	46.48±1.54^b
对照组	102	37.71±1.81	46.74±1.62^b	39.87±2.12	44.65±2.24^b	51.76±1.84	47.29±1.43^b
统计量		1.254^a	3.012^c	0.893^a	3.331^c	1.065^a	4.073^c
P值		0.211	0.005	0.373	0.004	0.288	＜0.001
注：^a为t值，^c为F值。与干预前比较，^bP＜0.05。

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表 3 2组冠心病患者遵医行为比较[例(%)]

Table 3. Comparison of compliance behaviors between the two groups of patients with coronary heart disease [cases(%)]

组别	例数	干预前			干预3个月
组别	例数	完全遵医	不完全遵医	完全不遵医	完全遵医	不完全遵医	完全不遵医
观察组	102	12(11.76)	74(72.55)	16(15.69)	62(60.78)	36(35.29)	4(3.92)
对照组	102	10(9.80)	68(66.67)	24(23.53)	34(33.33)	58(56.86)	10(9.80)
Z值			1.310			3.960
P值			0.191			＜0.001

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表 4 2组冠心病患者自我感受负担比较(x±s，分)

Table 4. Comparison of patients ' perceived burden between the two groups of patients with coronary heart disease (x±s, points)

组别	例数	身体负担		情感负担		经济负担
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
观察组	102	11.02±1.12	7.43±1.36^b	18.26±2.37	11.57±2.17^b	7.38±1.09	4.42±0.63^b
对照组	102	10.86±1.24	8.14±1.28^b	17.87±2.52	12.42±2.04^b	7.21±1.15	4.78±0.74^b
统计量		0.967^a	4.272^c	1.139^a	3.256^c	1.084^a	3.927^c
P值		0.335	＜0.001	0.256	0.004	0.280	＜0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

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表 5 2组冠心病患者生活质量比较(x±s，分)

Table 5. Comparison of quality of life between the two groups of patients with coronary heart disease (x±s, points)

组别	例数	体力		一般生活		病情		医疗状况		工作状况		社会心理状况
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	干预前	干预3个月	干预前	干预3个月
观察组	102	51.37±4.62	80.63±4.34^b	9.16±1.08	12.69±1.43^b	14.08±2.09	19.56±2.19^b	3.38±0.55	4.59±0.34^b	4.79±0.51	7.53±0.48^b	13.94±1.48	19.36±2.25^b
对照组	102	50.88±4.78	78.79±4.53^b	8.97±1.12	11.98±1.61^b	13.76±2.13	18.43±2.34^b	3.29±0.61	4.43±0.42^b	4.68±0.56	7.32±0.54^b	13.62±1.52	18.24±2.37^b
统计量		0.744^a	3.332^c	1.233^a	3.621^c	1.083^a	4.038^c	1.107^a	3.151^c	1.467^a	3.069^c	1.523^a	3.826^c
P值		0.458	0.003	0.219	0.001	0.280	0.001	0.270	0.003	0.144	0.004	0.129	0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

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表 6 2组患者并发症发生率比较[例(%)]

Table 6. Comparison of complication rates between the two groups [cases(%)]

组别	例数	心律失常	心肌梗死	心绞痛	血栓形成	总发生
观察组	102	2(1.96)	0	2(1.96)	0	4(3.92)^a
对照组	102	3(2.94)	2(1.96)	3(2.94)	5(4.90)	13(12.75)
注：与对照组比较，χ²=5.198, ^aP=0.023。

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参考文献(21)

[1]	TIAN Y, DENG P, LI B, et al. Treatment models of cardiac rehabilitation in patients with coronary heart disease and related factors affecting patient compliance[J]. Rev Cardiovasc Med, 2019, 20(1): 27-33. doi: 10.31083/j.rcm.2019.01.53
[2]	CYBULSKA B, KŁOSIEWICZ-LATOSZEK L. Landmark studies in coronary heart disease epidemiology. The Framingham heart study after 70 years and the seven countries study after 60 years[J]. Kardiol Pol, 2019, 77(2): 173-180. doi: 10.5603/KP.a2019.0017
[3]	NICHOLS S, MCGREGOR G, BRECKON J, et al. Current insights into exercise-based cardiac rehabilitation in patients with coronary heart disease and chronic heart failure[J]. Int J Sports Med, 2020, 42(1): 19-26.
[4]	SONG Y X, REN C, LIU P, et al. Effect of smartphone-based telemonitored exercise rehabilitation among patients with coronary heart disease[J]. J Cardiovasc Transl Res, 2019, 13(4): 659-667.
[5]	AL-LAMEE R K, NOWBAR A N, FRANCIS D P. Percutaneous coronary intervention for stable coronary artery disease[J]. Heart, 2018, 105(1): 11-19.
[6]	张丹凤. 医院-社区-家庭三元联动护理模式在冠心病经皮冠状动脉介入术后居家护理中的应用[J]. 山西医药杂志, 2021, 50(2): 297-299. doi: 10.3969/j.issn.0253-9926.2021.02.053 ZHANG D F. Application of hospital-community-family triple linkage nursing model in home nursing after percutaneous coronary intervention for coronary heart disease[J]. Shanxi Medical Journal, 2021, 50(2): 297-299. doi: 10.3969/j.issn.0253-9926.2021.02.053
[7]	汪旭丽, 唐川君, 吝洁. 基于华生关怀理论的护理风险干预在无痛胃镜检查中的应用研究[J]. 河北医药, 2021, 43(15): 2384-2387. doi: 10.3969/j.issn.1002-7386.2021.15.035 WANG X L, TANG C J, LIN J. Application of nursing risk intervention based on Watson's caring theory in painless gastroscopy[J]. Hebei Medical Journal, 2021, 43(15): 2384-2387. doi: 10.3969/j.issn.1002-7386.2021.15.035
[8]	张琼, 苗素琴. 基于多学科团队协作模式的路径管理在麻醉科手术病人转运中的应用[J]. 蚌埠医学院学报, 2019, 44(2): 253-256. ZHANG Q, MIAO S Q. Application of path management based on multidisciplinary team collaboration in the transit of patients treated with anesthesia operation[J]. Journal of Bengbu Medical College, 2019, 44(2): 253-256.
[9]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 稳定性冠心病基层诊疗指南(2020年)[J]. 中华全科医师杂志, 2021, 20(3): 265-273. doi: 10.3760/cma.j.cn114798-20210120-00079 Chinese Medical Association, Journal of Chinese Medical Association, Chinese Medical Association Branch of General Practice, et al. Guideline for primary care of stable coronary artery disease (2020)[J]. Chinese Journal of General Practitioners, 2021, 20(3): 265-273. doi: 10.3760/cma.j.cn114798-20210120-00079
[10]	赵志勇, 王惠琴, 吴清美, 等. 延续照护在急诊经皮冠状动脉介入术后患者居家康复中的效果研究[J]. 中华护理杂志, 2019, 54(3): 428-433. ZHAO Z Y, WANG H Q, WU Q M, et al. The effects of joint model of continuous care and family doctor on in-home rehabilitation of acute myocardial infarction patients after emergency percutaneous coronary intervention[J]. Chinese Journal of Nursing, 2019, 54(3): 428-433.
[11]	刘志新, 刘琼, 王静. 循证-情志护理模式对老年高血压合并冠心病病人心理状态及治疗依从性的影响[J]. 护理研究, 2023, 37(9): 1682-1685. LIU Z X, LIU Q, WANG J. Influence of evidence-based emotional nursing mode on mental state and treatment compliance in elderly patients with hypertension complicated with coronary heart disease[J]. Chinese Nursing Research, 2023, 37(9): 1682-1685.
[12]	郭晶晶, 袁河新, 张丹锋. 基于IMPACT模式的临床干预在冠心病患者中的应用及对预后的影响[J]. 中国循证心血管医学杂志, 2023, 15(1): 106-108, 113. doi: 10.3969/j.issn.1674-4055.2023.01.23 GUO J J, YUAN H X, ZHANG D F. Application of clinical intervention based on IMPACT mode and its influence on prognosis in patients with coronary heart disease[J]. Chinese Journal of Evidence-Bases Cardiovascular Medicine, 2023, 15(1): 106-108, 113. doi: 10.3969/j.issn.1674-4055.2023.01.23
[13]	中华医学会心血管病学分会流行病学组, 中国医师协会心血管内科医师分会, 中国老年学学会心脑血管病专业委员会. 糖代谢异常与动脉粥样硬化性心血管疾病临床诊断和治疗指南[J]. 中华心血管病杂志, 2015, 43(6): 488-506. doi: 10.3760/cma.j.issn.0253-3758.2015.06.008 Epidemiology Group, Society of Cardiology, Chinese Medical Association, Branch of Cardiovascular Physicians, Chinese Medical Doctor Association, Cardio-cerebrovascular disease Professional Committee of Chinese Gerontology Society. Guidelines for the clinical diagnosis and treatment of abnormal glucose metabolism and atherosclerotic cardiovascular disease[J]. Chinese Journal of Cardiology, 2015, 43(6): 488-506. doi: 10.3760/cma.j.issn.0253-3758.2015.06.008
[14]	严海琳, 杨锦林, 马洪升. 冠状动脉粥样硬化性心脏病合并消化道出血的研究进展[J]. 华西医学, 2020, 35(6): 745-749. YAN H L, YANG J L, MA H S. Research progress of coronary heart disease with gastrointestinal bleeding[J]. West China Medical Journal, 2020, 35(6): 745-749.
[15]	张飒然, 易敏, 陶花. 延续照护在农村地区PCI术后冠心病患者中的应用价值[J]. 中华全科医学, 2019, 17(7): 1237-1240. doi: 10.16766/j.cnki.issn.1674-4152.000910 ZHANG S R, YI M, TAO H. Application of continuous care in patients with coronary heart disease after PCI in rural areas[J]. Chinese Journal of General Practice, 2019, 17(7): 1237-1240. doi: 10.16766/j.cnki.issn.1674-4152.000910
[16]	郑梅, 邹芸, 严雪娇, 等. 基于问题导向的护理干预对冠心病PCI术后患者自我管理能力及康复效果的影响[J]. 中国实用护理杂志, 2022, 38(18): 1361-1367. doi: 10.3760/cma.j.cn211501-20211202-03314 ZHENG M, ZOU Y, YAN X J, et al. Influence of problem-oriented nursing intervention on self-management ability and rehabilitation effect of patients with coronary heart disease after PCI[J]. Chinese Journal of Practical Nursing, 2022, 38(18): 1361-1367. doi: 10.3760/cma.j.cn211501-20211202-03314
[17]	连春雁, 马辉, 安静, 等. 以自我管理为导向的5A护理模式对冠心病经皮冠状动脉介入术后患者自我管理行为和早期康复的影响[J]. 临床与病理杂志, 2023, 43(2): 379-387. LIAN C Y, MA H, AN J, et al. Effect of self-management-oriented 5A nursing mode on self-management behavior and early rehabilitation of patients with coronary heart disease after percutaneous coronary intervention[J]. Journal of Clinical and Pathological Research, 2023, 43(2): 379-387.
[18]	金秀, 李屏, 曹宏玲. 全程护理模式对冠心病合并糖尿病患者PCI术后生活质量及心血管不良事件的影响[J]. 海南医学, 2019, 30(5): 675-677. doi: 10.3969/j.issn.1003-6350.2019.05.038 JIN X, LI P, CAO H L. Effects of whole-course nursing mode on quality of life and cardiovascular adverse events after PCI in patients with coronary heart disease complicated with diabetes mellitus[J]. Hainan Medical Journal, 2019, 30(5): 675-677. doi: 10.3969/j.issn.1003-6350.2019.05.038
[19]	郑宇娟, 赵华, 王晓云, 等. 冠心病患者经皮冠状动脉介入治疗术后运动恐惧现状及影响因素分析[J]. 山西医药杂志, 2022, 51(6): 611-614. doi: 10.3969/j.issn.0253-9926.2022.06.003 ZHENG Y J, ZHAO H, WANG X Y, et al. Current situation and influencing factors of kinesiophobia in patients with coronary heart disease after PCI[J]. Shanxi Medical Journal, 2022, 51(6): 611-614. doi: 10.3969/j.issn.0253-9926.2022.06.003
[20]	王光益, 王玉龙, 朱晓龙, 等. 个体化康复运动训练干预对冠心病PCI术后病人糖脂代谢、心功能、生活质量的影响[J]. 中西医结合心脑血管病杂志, 2020, 18(13): 2094-2097. doi: 10.12102/j.issn.1672-1349.2020.13.019 WANG G Y, WANG Y L, ZHU X L, et al. Effects of individualized rehabilitation exercise training on glucose and lipid metabolism, heart function and quality of life in patients with coronary heart disease after PCI[J]. Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease, 2020, 18(13): 2094-2097. doi: 10.12102/j.issn.1672-1349.2020.13.019
[21]	金晶, 何萍. 格林护理模型在经皮冠状动脉介入术后冠心病患者中的应用效果[J]. 贵州医药, 2023, 47(1): 137-138. JIN J, HE P. Application effect of Green's nursing model in patients with coronary heart disease after percutaneous coronary intervention[J]. Guizhou Medical Journal, 2023, 47(1): 137-138.