基于个案管理的延伸护理干预...层术后患者中的应用效果分析_李瞳.pdf

黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2主动脉夹层（AD）属于较为严重的心血管疾病，在确诊后需及时采取有效治疗措施1。目前，开胸手术为临基于个案管理的延伸护理干预模式在主动脉夹层术后患者中的应用效果分析李瞳郑州大学第二附属医院心血管外科，河南郑州450052摘要目的：探讨基于个案管理的延伸护理干预模式在主动脉夹层（AD）术后患者中的应用效果。方法：回顾性分析2018年4月2020年5月郑州大学第二附属医院收治的236例AD术后患者的临床资料，按入院先后顺序分为对照组和观察组，每组各118例。对照组采用常规护理，观察组采用基于个案管理的延伸护理干预模式，均连续干预3个月。比较两组患者干预前、干预3个月时自我护理能力自我护理能力测定量表（ESCA）评分、心理状态焦虑自评量表（SAS）和抑郁自评量表（SDS）评分，记录并对比两组患者并发症发生情况和护理满意度。结果：干预前，两组患者ESCA量表各维度评分比较，差异无统计学意义（t=1.189、1.185、1.077、0.799，P0.05）；干预后，两组患者ESCA量表各维度评分均高于干预前，且观察组高于对照组，差异有统计学意义（t=9.556、17.567、12.450、15.560，P0.05）。干预前，两组患者SAS、SDS评分比较，差异无统计学意义（t=1.101、0.038，P0.05）；干预后，两组患者SAS、SDS评分均降低，且观察组低于对照组，差异有统计学意义（t=13.800、12.734，P0.05）。两组患者并发症发生情况比较，观察组并发症发生率低于对照组，差异有统计学意义（2=4.159，P0.05）。两组患者护理满意度比较，观察组护理满意度高于对照组，差异有统计学意义（2=3.989，P0.05）。结论：基于个案管理的延伸护理干预模式可提高AD术后患者自我护理能力，减轻患者消极情绪，降低并发症发生率，提升患者护理满意度。关键词主动脉夹层；延伸护理；个案管理；自我护理能力；消极情绪；并发症doi10.3969/j.issn.1004-5775.2023.02.031学科分类代码320.71中图分类号R473.5文献标识码BAnalysis of the Effect of the Extended Nursing Intervention Model Based on Case Management in Patients After Aortic Dissection Operation/LI Tong/Department of Cardiovascular Surgery,The Second Affiliated Hospital of ZhengzhouUniversity,Zhengzhou,Henan,450052,ChinaAbstract Objective:To explore the application effect of the extended nursing intervention model based on case management in patients after aortic dissection(AD).Methods:The clinical data of 236 postoperative AD patients admitted to the hospital from April2018 to May 2020 were retrospectively analyzed,and they were divided into control group and observation group according to theorder of admission,with 118 cases in each group.The control group was given routine nursing care,and the observation group wasgiven the extended nursing intervention mode based on case management,both of which were continuously intervened for 3 months.The scores of self-care ability(Self-care Ability Assessment ESCA score)and psychological state(Self-rating Anxiety ScaleSAS and Self-rating Depression Scale SDS)were compared between the two groups before the intervention and at 3 months afterthe intervention.The incidence of complications and nursing satisfaction of the two groups of patients were recorded and compared.Results:Before intervention,there was no statistically significant difference in ESCA scale scores between the two groups(t=1.189,1.185,1.077,0.799,P0.05).After the intervention,the ESCA scale scores of the two groups were higher than those before the intervention,and the observation group was higher than the control group,the differences were statistically significant(t=9.556,17.567,12.450,15.560,P0.05).Before intervention,there was no statistically significant difference in SAS and SDS scores between the two groups(t=1.101,0.038,P0.05).After the intervention,the SAS and SDS scores of the two groups were decreased,and the observation group was lower than the control group,and the difference was statistically significant(t=13.800,12.734,P0.05).The incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(2=4.159,P0.05).The nursing satisfaction of the observation group was higher than that of the controlgroup,and the difference was statistically significant(2=3.989,P0.05).Conclusion:The extended nursing intervention modelbased on case management can improve the self-care ability of patients after AD surgery,reduce the negative emotions of patients,reduce the incidence of complications,and improve the nursing satisfaction of patients.Keywords Aortic dissection;Extended nursing;Case management;Self-care ability;Negative emotions;Complications232黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2床治疗AD患者的主要方案，能够切除内膜撕裂口，降低主动脉破裂的发生风险。但AD患者术后恢复时间较长，加之患者术后自我护理能力低下，存在较多的并发症发生风险，影响患者术后恢复。而常规的术后护理仅可提高住院期间的患者自护行为，却无法将工作项目延伸至院外，且常缺乏针对性，需积极探究更合理的术后干预措施。个案管理是一种持续性个体化管理模式，能够最大限度地优化护理质量；而在此基础上展开延伸护理干预可对出院患者提供连续性的医疗服务，可有效促进疾病的康复2。鉴于此，本研究旨在探究基于个案管理的延伸护理干预模式在AD术后患者中的应用效果，现将结果报告如下。1资料与方法1.1一般资料回顾性分析2018年4月2020年5月郑州大学第二附属医院收治的236例AD术后患者的临床资料，按入院先后顺序分为对照组和观察组，每组各118例。对照组中男71例，女47例；年龄4371岁，平均年龄（54.532.61）岁；主动脉夹层DeBakey分型：型95例，型23例；文化程度为初中及以下26例，高中59例，专科及以上33例。观察组中男 76 例，女 42 例；年龄 4168 岁，平均年龄（54.492.57）岁；主动脉夹层DeBakey分型：型98例，型20例；文化程度为初中及以下24例，高中60例，专科及以上34例。纳入标准：（1）AD 诊断符合 内科学（第8版）3相关标准。（2）认知能力良好。（3）开胸手术治疗。（4）患者自愿参与研究。排除标准：（1）合并其他恶性肿瘤。（2）伴全身性感染疾病。（3）严重精神系统疾病。（4）合并肝肾等重大脏器功能衰弱。两组患者一般资料具有可比性（P0.05）。本研究经样本医院医学伦理委员会审核批准。1.2方法对照组采用常规术后护理。由责任护士评估患者相关风险，并进行相应的健康教育，结合患者恢复情况鼓励患者早日下地活动；在患者出院时再次进行健康宣教，让患者其及家属意识到规范用药、合理饮食、康复运动的重要性，叮嘱患者定期返院复查。观察组采用基于个案管理的延伸护理干预。（1）成立个案管理组。由1名责任护士、1名专科医生、1名护理组长与2名护士组成个案管理组，且均接受2周专业培训考核后入组；评估术后患者心功能分级、生活自理能力等，依据评估结果，制定完整性护理方案。（2）方案实施。提前建立微信平台，在患者出院时邀请其与家属进微信群，关注官方微信号，告知患者术后存在疑虑可在群内咨询沟通，鼓励患者主动分享自护经验；每隔7 d进行1次电话随访，了解患者术后恢复情况，指导患者养成记录血压与体温的习惯，指导患者服用钙离子拮抗剂，维持理想的血压；若体温异常升高应及时加强抗感染治疗；每周邀请专家进行线上视频讲座，鼓励群内患者积极参与，并在教育讲座结束后安排有奖竞答；每天上午9：00在微信平台发布术后自我护理相关文章，如自护方法、术后并发症预防措施等；嘱咐家属给予患者足够的陪伴，监督其戒除烟酒，养成良好的生活习惯；每周六主动与患者沟通，鼓励患者讲述目前存在的问题，并给予针对性的