基于KANO模型的护理干预在心脏起搏器植入者居家护理中的应用

吴秀华; 朱夏玲; 叶莉; 王莉丽

doi:10.16766/j.cnki.issn.1674-4152.003941

基于KANO模型的护理干预在心脏起搏器植入者居家护理中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003941

丽水市中心医院介入手术室，浙江丽水 323000

基金项目:

浙江省基础公益研究计划项目 LGF21H170001

丽水市科技计划项目 2023GYX30

详细信息

通讯作者:
朱夏玲，E-mail: yoyo060708@163.com

中图分类号: R473.54 R318.11
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- 文章访问数: 7
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-06-26
- 网络出版日期: 2025-05-14

Application of nursing intervention based on KANO model in home care of pacemaker implants

Interventional Surgery Room, Lishui Central Hospital, Lishui, Zhejiang 323000, China

摘要

摘要: 目的通过KANO模型需求分析，拟定和实施个性化护理方案，为临床护理工作开拓思路。方法选取2022年1月—2023年3月就诊于丽水市中心医院择期行心脏起搏器植入手术患者151例，采用随机数字表法分为对照组(76例)和KANO组(75例)，分别给予常规延续性护理干预、基于KANO模式的护理干预。最终各73例、74例入组，比较2组疾病相关知识掌握程度、遵医依从性、并发症发生率及生活质量评分。结果 KANO组护理后自身疾病知识、自我护理知识、起搏器具体知识及起搏器植入后使用知识知晓率分别为89.19%、87.84%、79.73%、85.14%，均高于对照组的64.38%、64.38%、57.53%、63.01%(P＜0.05)；KANO组遵医依从性评分中每日测量脉搏[(3.09±0.56)分]、按时服药[(3.01±0.47)分]、坚持锻炼[(2.88±0.45)分]、术后注意事项[(2.90±0.34)分]均高于对照组的(2.53±0.41)分、(2.44±0.36)分、(2.19±0.37)分、(2.23±0.46)分(P＜0.05)；KANO组并发症发生率(6.76% vs. 20.55%)低于对照组(χ²=5.946, P=0.015)；KANO组生活质量评分高于对照组(P＜0.05)。结论基于KANO模式的护理干预在提高心脏起搏器植入居家患者疾病相关知识掌握程度和遵医行为，减少并发症的发生，提高生活质量方面优势明显。
- 心脏起搏器 /
- 延续性护理 /
- KANO模型 /
- 依从性 /
- 并发症
Abstract: Objective To develop and implement personalized nursing plans through KANO model demand analysis, and to develop ideas for clinical nursing work. Methods A total of 151 patients who received pacemaker implantation surgery in Lishui Central Hospital from January 2022 to March 2023 were selected and divided into a control group (76 cases) and a KANO group (75 cases) by random number table method, and were given conventional continuous nursing intervention or nursing intervention based on KANO model, respectively. Finally, 73 and 74 cases were enrolled in each group, and the mastery of disease-related knowledge, compliance, complication rate, and quality of life score were compared between the two groups. Results The awareness rates of "self-disease knowledge, self-care knowledge, pacemaker specific knowledge, and pacemaker implantation knowledge" in the KANO group after nursing were 89.19%, 87.84%, 79.73%, and 85.14%, respectively, which were higher than 64.38%, 64.38%, 57.53%, and 63.01% in the control group (P < 0.05). Medical compliance score: daily pulse measurement [(3.09±0.56) points], regular medication [(3.01±0.47) points], exercise [(2.88±0.45) points], postoperative precautions [(2.90±0.34) points] in the KANO group were higher than (2.53±0.41) points, (2.44±0.36) points, (2.19±0.37) points, (2.23±0.46) points in control group (P < 0.05). The incidence of complications (6.76% vs. 20.55%) in the KANO group was lower than that of the control group (χ²=5.946, P=0.015). The quality of life score in the KANO group was higher than that of the control group (P < 0.05). Conclusion Nursing intervention based on the KANO model has obvious advantages in improving disease-related knowledge and compliance behavior of home patients with cardiac pacemaker implantation, reducing the occurrence of complications, and improving the quality of life.
- Cardiac pacemaker /
- Continuous care /
- KANO model /
- Compliance /
- Complication

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表 1 2组心脏起搏器植入患者资料比较

Table 1. Comparison of patients with pacemaker implantation between the two groups

项目	KANO组(n=74)	对照组(n=73)	统计量	P值
性别(男性/女性，例)	40/34	45/28	0.868^a	0.352
年龄(x±s，岁)	62.18±5.19	62.23±6.22	0.053^b	0.958
受教育年限(x±s，年)	8.23±1.14	8.09±1.11	0.754^b	0.452
BMI(x±s)	23.12±3.11	22.90±2.44	0.477^b	0.634
疾病诊断(例)			1.526^a	0.466
房室传导阻滞	35	41
血管迷走性晕厥	11	7
病态窦房结综合征	28	25
起搏器厂家(例)			0.363^a	0.547
美敦力	42	45
波科	32	28
起搏器类型(例)			0.087^a	0.958
单腔	15	15
双腔	50	48
三腔	9	10
注：^a为χ²值，^b为t值。

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表 2 2组心脏起搏器植入患者疾病相关知识掌握情况比较[例(%)]

Table 2. Comparison of disease-related knowledge mastery between two groups of patients with pacemaker implantatio [cases(%)]

组别	例数	自身疾病知识		自我护理知识		起搏器具体知识		起搏器植入后使用知识
组别	例数	护理前	护理后	护理前	护理后	护理前	护理后	护理前	护理后
KANO组	74	39(52.70)	66(89.19)^a	40(54.05)	65(87.84)^a	23(31.08)	59(79.73)^a	21(28.38)	63(85.14)^a
对照组	73	41(56.16)	47(64.38)	39(53.42)	47(64.38)	24(32.88)	42(57.53)^a	28(38.36)	46(63.01)^a
χ²值		0.178	34.571	0.006	20.091	0.055	30.091	1.646	25.431
P值		0.674	< 0.001	0.939	< 0.001	0.815	< 0.001	0.199	< 0.001
注：与同组护理前比较，^aP＜0.05。

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表 3 2组心脏起搏器植入患者遵医依从性评分比较(x±s，分)

Table 3. Comparison of compliance scores between two groups of patients with pacemaker implantation (x±s, points)

组别	例数	每日测量脉搏		按时服药		坚持锻炼		术后注意事项
组别	例数	护理前	护理后	护理前	护理后	护理前	护理后	护理前	护理后
KANO组	74	1.56±0.34	3.09±0.56^b	1.69±0.37	3.01±0.47^b	1.33±0.27	2.88±0.45^b	1.39±0.25	2.90±0.34^b
对照组	73	1.48±0.26	2.53±0.41^b	1.59±0.34	2.44±0.36^b	1.39±0.26	2.19±0.37^b	1.40±0.31	2.23±0.46^b
统计量		1.601^a	17.789^c	1.706^a	20.217^c	1.372^a	18.891^c	0.215^a	21.214^c
P值		0.112	< 0.001	0.090	< 0.001	0.172	< 0.001	0.830	< 0.001
注：^a为t值，^c为F值；与同组护理前比较，^bP＜0.05。

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表 4 2组心脏起搏器植入患者并发症发生率比较[例(%)]

Table 4. Comparison of complication rates in patients with pacemaker implantation in both groups [cases(%)]

组别	例数	起搏器综合征	心房颤动	囊袋感染	起搏器电极移位	肩关节活动受限	并发症发生
KANO组	74	2(2.70)	1(1.35)	2(2.70)	0	0	5(6.76)
对照组	73	5(6.85)	6(8.22)	3(4.11)	0	1(1.37)	15(20.55)
注：2组并发症发生率比较，χ²=5.946，P=0.015。

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表 5 2组心脏起搏器植入患者生活质量评分比较(x±s，分)

Table 5. Comparison of quality of life score of patients in two groups (x±s, points)

组别	例数	躯体功能	心理功能	社会	一般认识	总分
KANO组	74	42.34±4.10	43.99±5.11	36.11±5.21	39.15±4.51	163.59±11.21
对照组	73	35.09±5.69	33.21±4.77	31.48±4.16	33.14±4.28	132.92±15.33
t值		8.872	13.218	5.949	8.285	13.859
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

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参考文献(17)

[1]	ABRAMOCHKIN D V, KUZMIN V S, MATCHKOV V, et al. The snake heart pacemaker is localized near the sinoatrial valve[J]. J Exp Biol, 2021, 224(16): jeb242778. DOI: 10.1242/jeb.242778.
[2]	DEALMEIDA M C. Heinrich Ewald Hering ' s discovery of the heart pacemaker: Hering, Tawara and Aschoff ' s search for its morphological basis, the sinoatrial node, and why they failed[J]. Anat Sci Int, 2023, 98(4): 482-492. doi: 10.1007/s12565-023-00711-z
[3]	TABATA H, OKADA A, KOBAYASHI H, et al. "Alpha"-looped broken pacemaker lead inside the heart[J]. Circ J, 2020, 85(1): 77. DOI: 10.1253/circj.CJ-20-0680.
[4]	谷元静, 史婷奇, 郭赛男, 等. 基于Kano模型的临床护士对护理机器人应用场景需求调查[J]. 护理学杂志, 2023, 38(11): 53-58. GU Y J, SHI T Q, GUO S N, et al. Investigation of clinical nurses'needs for nursing robot application scenarios based on Kano model[J]. Journal of Nursing Science, 2023, 38(11): 53-58.
[5]	黄运芳. 基于KANO模式的人文关怀服务对精神分裂症患者康复功能、服药依从性及生活质量的影响[J]. 中国医药科学, 2023, 13(17): 148-151. HUANG Y F. The impact of humanistic care services based on the KANO model on the rehabilitation function, medication compliance, and quality of life of patients with schizophrenia[J]. China Medicine And Pharmacy, 2023, 13(17): 148-151.
[6]	陈灝珠, 林果为, 王吉耀, 等. 实用内科学[M]. 16版. 北京: 人民卫生出版社, 2021: 89-94. CHEN H Z, LIN G W, WANG J Y, et al. Practical Internal Medicine[M]. 16th edition. Beijing: People ' s Medical Publishing House, 2021: 89-94.
[7]	张代民, 郭涛, 李淑敏. 起搏器患者生存质量量表的编制及信效度分析[J]. 中国临床康复, 2002, 6(23): 3490-3491. ZHANG D M, GUO T, LI S M. Development and evaluation of a quality of life instrument for patients with pacemaker[J]. Chinese Journal of Clinical Rehabilitation, 2002, 6(23): 3490-3491.
[8]	冯锦梅, 许艳. 个性化护理模式在永久性心脏起搏器植入术患者围手术期的应用效果[J]. 贵州医药, 2023, 47(8): 1331-1332. FENG J M, XU Y. Application of personalized nursing model in perioperative period of patients with permanent cardiac pacemaker implantation[J]. Guizhou Medical Journal, 2023, 47(8): 1331-1332.
[9]	刘晟, 左静. 永久性心脏起搏器植入术后康复运动的研究进展[J]. 广西医学, 2022, 44(18): 2163-2166. LIU S, ZUO J. Research progress on rehabilitation exercise after permanent pacemaker implantation[J]. Guangxi Medical Journal, 2022, 44(18): 2163-2166.
[10]	李娜. 基于健康信念模式的健康教育对永久性心脏起搏器植入术患者自我效能感及心理状态的影响[J]. 临床与病理杂志, 2021, 41(6): 1369-1375. LI N. Effect of health education based on health belief model on self-efficacy and psychological state of patients undergoing permanent pacemaker implantation[J]. Journal of Clinical and Pathological Research, 2021, 41(6): 1369-1375.
[11]	马子林, 马文妮, 马懿, 等. 基于Kano模型的心房颤动射频消融术患者健康教育需求调查分析[J]. 昆明医科大学学报, 2024, 45(2): 170-176. MA Z L, MA W N, MA Y, et al. Investigation and analysis of health education needs of patients undergoing radiofrequency ablation of atrial fibrillation based on kano model[J]. Journal of Kunming Medical University, 2024, 45(2): 170-176.
[12]	MONTENEGRO J F, CONTRERAS P A, SÁENZ F. Hybridization of the KANO model and business model canvas: aeronautical and metalworking industry in Bogota, Colombia[J]. Heliyon, 2021, 7(10): e08097. DOI: 10.1016/j.heliyon.2021.
[13]	张琪, 胡君君, 金薇. 基于KANO模型改进胸外科住院患者护理服务的效果观察[J]. 护理实践与研究, 2022, 19(16): 2492-2495. ZHANG Q, HU J J, JIN W. Effect observation of improving nursing service based on Kano model for inpatients in thoracic surgery[J]. Nursing Practice and Research, 2022, 19(16): 2492-2495.
[14]	马嘉兴. 延续护理对心脏起搏器植入术后患者生活质量的影响分析[J]. 中西医结合心血管病电子杂志, 2021, 9(5): 103-105. MA J X. Effect of transitional care on the quality of life in the patients with an implanted cardiac pacemaker[J]. Electronic journal of cardiovascular diseases in Integrative Chinese and Western Medicine, 2021, 9(5): 103-105.
[15]	黄小琴, 吕东来, 周丽梅. 基于微信平台的延续护理在使用PICC的消化道肿瘤患者中的应用[J]. 中华全科医学, 2021, 19(8): 1419-1422. doi: 10.16766/j.cnki.issn.1674-4152.002075 HUANG X Q, LYU D L, ZHOU L M. Observation on the application effect of continuing care based on WeChat platform in patients with gastrointestinal tumors using PICC[J]. Chinese Journal of General Practice, 2021, 19(8): 1419-1422. doi: 10.16766/j.cnki.issn.1674-4152.002075
[16]	王珊珊, 郭文静, 赵苏莉, 等. KANO模式的干预方案在血液透析护理中的应用[J]. 齐鲁护理杂志, 2023, 29(24): 149-152. WANG S S, GUO W J, ZHAO S L, et al. Application of KANO model in hemodialysis care[J]. Journal of Qilu Nursing, 2023, 29(24): 149-152.
[17]	白井双, 王颖, 蔡立柏, 等. 基于智慧云随访平台的远程居家管理模式在老年心脏起搏器植入患者中的应用[J]. 中华现代护理杂志, 2021, 27(8): 988-993. BAI J S, WANG Y, CAI L B, et al. Application of remote home management model based on smart cloud follow-up platform in elderly patients with pacemakers[J]. Chinese Journal of Modern Nursing, 2021, 27(8): 988-993.