经皮冠状动脉介入治疗术后患者结构化教育方案的构建及应用

doi:10.3761/j.issn.1672-9234.2023.04.002

摘要/Abstract

摘要：

目的构建经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）术后患者结构化教育方案，探讨其在患者自我管理中的应用效果。方法通过文献回顾、半结构式访谈和德尔菲法，构建PCI术后患者结构化教育方案。采用便利抽样法，选取2021年1月—4月在某三级甲等医院心内科行PCI术的115例患者为研究对象。对照组（57例）患者接受常规健康教育，试验组（58例）患者接受结构化教育，采用冠心病自我管理行为量表于干预前、出院后3个月、出院后6个月对两组患者进行调查。结果 2轮专家函询专家积极系数分别为94%、100%，权威系数分别为0.907、0.910，协调系数分别为0.245、0.313（均P<0.001）。构建的结构化教育方案包括7个教育模块、78项教育目标和58项教育内容。干预后，两组自我管理行为量表得分组间与时间存在交互效应（F=114.573，P<0.001）；经简单效应分析显示，出院后3个月、出院后6个月，试验组自我管理行为得分均高于对照组（P<0.05）。结论构建的PCI术后患者结构化教育方案科学可靠，具有实用性。实施结构化教育能有效提高PCI术后患者的自我管理水平。

关键词: 血管成形术, 气囊, 冠状动脉, 健康教育, 病人, 自我护理, 结构化教育

Abstract:

Objective To construct a structured education program for patients after percutaneous coronary intervention（PCI），and to explore the effect of the structured education program in the self-management of patients. Methods Through literature review，semi-structured interview and Delphi technique，we constructed a structured education program for patients after PCI. A total of 115 patients who received PCI in the cardiology department of a tertiary A level hospital from January to April 2021 were selected by convienient sampling. Patients in the control group（n=57） received conventional health education and those in the treatment group（n=58） accepted structured education. The Coronary artery disease Self-Management Behavioral Scale was used to investigate patients in both groups before intervention，3 months and 6 months after discharge. Results The positive coefficient of experts of the two rounds of expert correspondence inquiry was 94% and 100%，the authority coefficient was 0.907 and 0.910 respectively，and the Kendall’s coordination coefficient was 0.245 and 0.313 respectively（all P<0.001）. The structured education program consists of 7 modules，78 pieces of objectives and 58 contents. In the application of the scheme，there was an interaction effect between groups and time for the total score of self-management in the two groups（F=114.573，P<0.001）. The simple effects analysis showed that the scores of self-management behavior in the treatment group were higher than those in the control group at 3 and 6 months after discharge（P<0.05）. Conclusion The constructed structured education program for patients after PCI is scientific，reliable and practical. Structured education can significantly improve self-management for coronary heart disease in patients after PCI.

Key words: Angioplasty, Balloon, Coronary, Health Education, Patients, Self Care, Structured education

王立艳, 黄霞, 卢晓虹, 贾培培, 王斌, 曹丽华. 经皮冠状动脉介入治疗术后患者结构化教育方案的构建及应用[J]. 中华护理教育, 2023, 20(4): 395-402.

WANG Liyan, HUANG Xia, LU Xiaohong, JIA Peipei, WANG Bin, CAO Lihua. Construction and application of structured education program for patients after percutaneous coronary intervention[J]. Chinese Journal of Nursing Education, 2023, 20(4): 395-402.

图/表 2

参考文献 24

[1]	中国心血管健康与疾病报告编写组, 胡盛寿. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6):521-545.
[2]	中国心血管病风险评估和管理指南编写联合委员会. 中国心血管病风险评估和管理指南[J]. 中国循环杂志, 2019, 34(1):4-28.
[3]	中华医学会心血管病学分会介入心脏病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会, 中华心血管病杂志编辑委员会. 中国经皮冠状动脉介入治疗指南(2016)[J]. 中华心血管病杂志, 2016, 44(5):382-400.
[4]	陈纪言, 陈韵岱, 韩雅玲, 等. 经皮冠状动脉介入治疗术后运动康复专家共识[J]. 中国介入心脏病学杂志, 2016, 24(7):361-369.
	Chen JY, Chen YD, Han YL, et al. Expert consensus on exercise rehabilitation after percutaneous coronary intervention[J]. Chin J Interv Cardiol, 2016, 24(7):361-369.
[5]	Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis:what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014[J]. Eur Heart J, 2015, 36(47):3320-3331. doi: 10.1093/eurheartj/ehv511
[6]	Rezende PC, Hueb W, Garzillo CL, et al. Ten-year outcomes of patients randomized to surgery,angioplasty,or medical treatment for stable multivessel coronary disease:effect of age in the Medicine,Angioplasty,or Surgery Study II trial[J]. J Thorac Cardiovasc Surg, 2013, 146(5):1105-1112. doi: 10.1016/j.jtcvs.2012.08.015 pmid: 22944095
[7]	Saeidzadeh S, Darvishpoor Kakhki A,Abed Saeedi J. Factors associated with self-care agency in patients after percutaneous coronary intervention[J]. J Clin Nurs, 2016, 25(21/22):3311-3316. doi: 10.1111/jocn.13396
[8]	林雪琴, 黄文娟. 经皮冠状动脉介入治疗后患者自我管理行为及其与不良心血管事件发生的相关性分析[J]. 实用预防医学, 2018, 25(9):1113-1116.
	Lin XQ, Huang WJ. Self-management behavior of patients after percutaneous coronary intervention and its correlation with adverse cardiovascular events[J]. Pract Prev Med, 2018, 25(9):1113-1116.
[9]	乔秋萍, 徐娟娟, 杨巧芳, 等. 居家护理平台在冠心病患者经皮冠状动脉介入治疗术后自我管理中的应用[J]. 中国护理管理, 2020, 20(8):1178-1182.
	Qiao QP, Xu JJ, Yang QF, et al. Application of Homecare Platform to self-management after Percutaneous Coronary Intervention for patients with Coronary Heart Disease[J]. Chin Nurs Manag, 2020, 20(8):1178-1182.
[10]	王楠楠, 赵秋利, 信博, 等. 经皮冠状动脉介入治疗患者自我管理轨迹的质性研究[J]. 中华现代护理杂志, 2021, 27(14):20-23.
	Wang NN, Zhao QL, Xin B, et al. Qualitative study on the self-management trajectory of patients undergoing percutaneous coronary intervention[J]. Chin J Mod Nurs, 2021, 27(14):20-23.
[11]	楼娟, 黄鸣, 陈兰英, 等. 专科护士主导的个体化延续护理对经皮冠状动脉介入治疗患者自我管理能力的影响[J]. 重庆医学, 2020, 49(5):758-761.
	Lou J, Huang M, Chen LY, et al. Effect of individualized continuous nursing led by specialied nurses on patients’ self-management ability of patients undergoing percutaneous coronary intervention[J]. Chongqing Med, 2020, 49(5):758-761.
[12]	顾芳臣, 林征, 尚星辰, 等. 结构化教育在慢性病自我管理中的应用研究进展[J]. 护理研究, 2019, 33(19):3361-3365.
	Gu FC, Lin Z, Shang XC, et al. Research progress on application of structured education in self-management of chronic diseases[J]. Chin Nurs Res, 2019, 33(19):3361-3365.
[13]	Hawkes CP, Willi SM, Murphy KM. A structured 1-year education program for children with newly diagnosed type 1 diabetes improves early glycemic control[J]. Pediatr Diabetes, 2019, 20(4):460-467. doi: 10.1111/pedi.12849 pmid: 30932293
[14]	Cui X, Zhou X, Ma LL, et al. A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure:a randomized and controlled trial in China[J]. Rural Remote Health, 2019, 19(2):5270.
[15]	栗江霞, 崔永菁, 李娟, 等. 结构化教育在脑卒中病人自我管理中的应用[J]. 护理研究, 2021, 35(10):1843-1846.
	Li JX, Cui YJ, Li J, et al. Application of structured education in self-management of stroke patients[J]. Chin Nurs Res, 2021, 35(10):1843-1846.
[16]	蒋新军, 刘叶灵, 罗丹, 等. 结构化教育在糖尿病患者中的应用进展[J]. 中华护理教育, 2019, 16(12):897-901.
	Jiang XJ, Liu YL, Luo D, et al. Structured education in patients with diabetes:a literature review[J]. Chin J Nurs Educ, 2019, 16(12):897-901.
[17]	卢学萍, 黄霞, 贾培培, 等. 经皮冠状动脉介入治疗患者延续护理质量评价指标体系的构建[J]. 中华护理杂志, 2021, 56(1):73-79. doi: 10.3761/j.issn.0254-1769.2021.01.012
	Lu XP, Huang X, Jia PP, et al. Construction of an evaluation index system for hospital-community linkage continued nursing quality after percutaneous coronary intervention[J]. Chin J Nurs, 2021, 56(1):73-79. doi: 10.3761/j.issn.0254-1769.2021.01.012
[18]	张梦倩, 李晓敏, 梁明明, 等. 小组赋权干预对冠心病介入治疗术后患者自我损耗的影响[J]. 中华护理教育, 2020, 17(11):970-974.
	Zhang MQ, Li XM, Liang MM, et al. The influence of group empowerment intervention on self-depletion of patients with coronary heart disease after percutaneous coronary intervention[J]. Chin J Nurs Educ, 2020, 17(11):970-974.
[19]	任洪艳. 冠心病自我管理量表开发及健康教育研究[D]. 重庆: 重庆医科大学, 2009.
	Ren HY. Development of coronary heart disease self-management scale and research on health education[D]. Chongqing: Chongqing Medical University, 2009.
[20]	中国康复医学会心血管病专业委员会, 胡大一. 中国心脏康复与二级预防指南2018精要[J]. 中华内科杂志, 2018, 57(11):802-810.
[21]	吴佳奇, 曹小翠, 陈洁红, 等. 冠心病患者运动康复参与现状及其影响因素研究进展[J]. 中国护理管理, 2021, 21(8):1245-1249.
	Wu JQ, Cao XC, Chen JH, et al. Participation in exercise rehabilitation of patients with coronary heart disease and the influencing factors[J]. Chin Nurs Manag, 2021(8):1245-1249.
[22]	Jiang WH, Feng M, Gao CY, et al. Effect of a nurse-led individualized self-management program for Chinese patients with acute myocardial infarction undergoing percutaneous coronary intervention[J]. Eur J Cardiovasc Nurs, 2020, 19(4):320-329. doi: 10.1177/1474515119889197
[23]	Mani H, Chudasama Y, Hadjiconstantinou M, et al. Structured education programme for women with polycystic ovary syndrome:a randomised controlled trial[J]. Endocr Connect, 2018, 7(1):26-35. doi: 10.1530/EC-17-0274
[24]	阙静, 赵娜, 户相访, 等. 冠心病PCI术后患者自我管理的研究进展[J]. 中华现代护理杂志, 2017, 23(13):1814-1816.
	Que J, Zhao N, Hu XF, et al. Research progress of self-management of coronary heart disease patients after PCI[J]. Chin J Mod Nurs, 2017, 23(13):1814-1816.