基于双心医学的经皮冠状动脉支架植入术后患者康复模式的构建及实施

doi:10.3761/j.issn.1672-9234.2019.03.003

摘要/Abstract

摘要：

目的构建基于双心医学经皮冠状动脉支架植入术后患者康复模式并探讨其应用效果。方法成立由多学科协作双心管理团队,以双心医学为基础构建经皮冠状动脉支架植入术后患者康复模式。便利选取2017年1月—12月入院且首次行经皮冠状动脉支架植入术后合并焦虑（和）或抑郁的患者为研究对象,2017年1月—6月的41例患者为对照组,2017年7月—12的44例患者为试验组。试验组采用以双心医学为基础构建的经皮冠状动脉支架植入术后患者康复模式,内容包括：认知重建、放松训练、药物干预、健康教育;对照组进行1次集体健康教育并给予院外电话随访指导,比较干预后两组患者焦虑、抑郁及心功能康复状况。结果干预后试验组焦虑和抑郁发生率与对照组比较差异有统计学意义（P<0.05）;干预后试验组N端前脑钠肽、左心室射血分数较干预前降低（P<0.05）;干预后试验组N端前脑钠肽、左心室射血分数与对照组比较差异有统计学意义（P<0.05）。结论基于双心医学构建的经皮冠状动脉支架植入术后患者康复模式,可改善患者的焦虑、抑郁及心功能康复状况。

关键词: 血管成形术, 气囊, 冠状动脉, 康复护理, 焦虑, 抑郁, 每搏输出量

Abstract:

Objective To establish a rehabilitation model for patients after percutaneous coronary stent implantation based on double heart medicine. Methods The multidisciplinary team was built up and the rehabilitation model for patients after percutaneous coronary stent implantation based on double heart medicine was developed. Patients with anxiety and/or depression who were admitted to the hospital from January to December 2017 and had undergone percutaneous coronary stent implantation were recruited through convenience sampling. Forty-one patients from January to June 2017 were in the control group. Forty-four patients from July to December of the year were in the experimental group. The rehabilitation model of percutaneous coronary stent implantation based on double heart medicine was used in the experimental group including：cognitive reconstruction,relaxation training,drug intervention,health education. Patients in the control group received group health education and given outpatient telephone follow-ups.The level of anxiety,depression and cardiac function were compared between the two groups. Results After intervention,the incidence of anxiety and depression in the experimental group was significantly different from that in the control group（P<0.05）. After intervention,the N-terminal forebrain natriuretic peptide and left ventricular ejection fraction in the experimental group were lower than those before intervention（P<0.05）. After intervention, the N-terminal forebrain natriuretic peptide and left ventricular ejection fraction in the experimental group were significantly different from those in the control group（P<0.05）. Conclusion The rehabilitation model of patients after percutaneous coronary stent implantation based on double heart medicine can improve the anxiety,depression and cardiac function of patients.

Key words: Angioplasty,Balloon,Coronary, Rehabilitation Nursing, Anxiety, Depression, Stroke Volume

黄峥,娄小平,郑晓,刘源. 基于双心医学的经皮冠状动脉支架植入术后患者康复模式的构建及实施[J]. 中华护理教育, 2019, 16(3): 178-182.

Zheng HUANG,Xiao-ping LOU,Xiao ZHENG,Yuan LIU. Construction and implementation of rehabilitation model for patients after percutaneous coronary stent implantation based on double heart medicine[J]. Chinese Journal of Nursing Education, 2019, 16(3): 178-182.

图/表 2

参考文献 19

[1]	陆再英, 钟南山 . 内科学[M]. 北京: 人民卫生出版社, 2008.
[2]	王瑾, 李妹芳, 朱海萍 . 双心医学模式在护理老年冠心病患者中的应用研究[J]. 心血管康复医学杂志, 2018,27(5):507-511.
[3]	Saran RK, Puri A, Agarwal M . Depression and the heart[J]. India Heart J, 2012,64(4):397-401. doi: 10.1016/j.ihj.2012.06.004
[4]	Oldroyd JC, Cyril S, Wijayatilaka BS , et al. Evaluating the impact of depression anxiety and autonomic function on health related quality of life,vocational functioning and health care utilization in acute coronary syndrome patient:the advent study protocol[J]. BMC Cardiovasc Disord, 2013,13:103. doi: 10.1186/1471-2261-13-103
[5]	Kroenke K, Spitzer RL, Williams JBW . The PHQ-9:validity of a brief depression severity measure[J]. J Gen Intern Med, 2001,16(9):606-613. doi: 10.1046/j.1525-1497.2001.016009606.x
[6]	Spitzer RL, Kroenke K, Williams JB . A Brief Measure for Assessing generalized anxiety disorder:the GAD-7[J]. Arch Intern Med, 2006,166(10):1092-1097. doi: 10.1001/archinte.166.10.1092
[7]	陈灝珠, 王吉耀 . 实用内科学[M]. 北京: 人民卫生出版社, 2013.
[8]	毛慧子, 田洪阳, 陶贵周 . 双心医学诊疗模式对冠心病合并焦虑抑郁患者的疗效[J]. 锦州医科大学学报, 2018,39(3):37-40,47.
[9]	郑婷, 石玉芝, 张宁 , 等. 病人健康问卷-9在卒中抑郁患者中的信度和效度研究[J]. 北京医学, 2013,35(5):352-356.
[10]	王艳娇, 蒋涛 . 临床护理用患者健康问卷抑郁量表与汉密尔顿抑郁量表的一致性研究[J]. 齐齐哈尔医学院学报, 2018,39(17):2055-2056.
[11]	孙振晓, 孙宇新, 于相芬 . 广泛性焦虑量表在颈椎病患者焦虑情绪评估的信度和效度研究[J]. 临床精神医学杂志, 2017,27(4):250-252.
[12]	程冬兰, 梁国强, 邹彩琼 . 健康教育联合心理疏导对冠心病伴焦虑抑郁患者心理状态的影响[J]. 齐齐哈尔医学院学报, 2016,37(29):3718-3719.
[13]	王新歌, 樊少磊, 张守梅 , 等. 认知行为干预对维持性血液透析患者负性情绪的影响[J]. 中华护理杂志, 2013,48(8):744-746. doi: 10.3761/j.issn.0254-1769.2013.08.024
[14]	李海燕, 蓝玲 . 基于冥想训练的护理干预改善体检者不良情绪及满意度的效果观察[J]. 全科护理, 2018,16(29):3636-3637.
[15]	王梅, 王翠, 张淑美 , 等. 健康教育在消化内科伴抑郁焦虑患者中的应用[J]. 齐鲁护理杂志, 2018,24(17):122-123.
[16]	钟美容, 胡明, 麦超 , 等. 认知行为干预对冠心病介入治疗患者心身康复的影响[J]. 中华现代护理杂志, 2010,16(28):3390-3391. doi: 10.3760/cma.j.issn.1674-2907.2010.28.014
[17]	王婷, 陆萍静, 柳晓 , 等. 冠心病患者心脏康复护理研究进展[J]. 护理学杂志, 2015,30(21):106-109. doi: 10.3870/j.issn.1001-4152.2015.21.106
[18]	朱渊, 刘晓芯, 陈娟 , 等. 放松训练对肺癌患者围手术期康复的效果[J]. 中华护理杂志, 2013,48(5):465-467. doi: 10.3761/j.issn.0254-1769.2013.05.028
[19]	杜若飞, 王盼盼, 田丽 , 等. 冠心病患者心脏康复依从性的研究进展[J]. 中华护理杂志, 2017,52(10):1246-1251.

项目	类别	试验组（n=44）	对照组（n=41）	χ²值	P 值
抑郁	有	20（45.5）	33（80.5）	11.097	0.001
	无	24（54.5）	8（19.5）
焦虑	有	15（34.1）	30（73.2）	13.010	<0.001
项目	无	29（65.9）	11（26.8）	χ²值	P 值

项目	试验组（n=44）		对照组（n=41）		t₁值	P₁值	t₂值	P₂值	t₃值	P₃值
项目	干预前	干预后	干预前	干预后	t₁值	P₁值	t₂值	P₂值	t₃值	P₃值
N端前脑钠肽（pg/ml）	486.77±161.19	279.43±84.25	515.05±103.16	495.03±67.23	7.562	<0.001	1.010	0.316	13.016	<0.001
左心室射血分数（%）	56.14±5.83	68.23±5.87	54.59±3.85	55.37±7.40	9.695	<0.001	0.599	0.551	8.909	<0.001