PCI术后患者自我管理行为及影响因素现状调查分析
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摘要
目的调查分析经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者自我管理行为的状况及其影响因素。方法采取问卷调查法对2016年5月至10月首都医科大学附属北京友谊医院收治的83例PCI术后患者进行调查,收集并分析患者生活习惯、依从性及相关知识了解等资料。结果 PCI术后患者不良嗜好管理方面,戒烟行为管理完成度较高,达到90.3%,总是能够遵从饮食限盐、限制饮酒、限制脂肪和胆固醇摄入建议的患者分别为54.2%、77.1%、50.6%;各项症状管理总是能够做到的患者为13.2%～24.1%,各项疾病知识管理各项能总是做到的患者为10.8%～15.6%;患者情绪认知管理现状目前较良好,能够总是从事喜欢的休闲娱乐的患者占66.2%;PCI术后患者的急救管理处于中下水平,随身携带急救药物这一项,经常及总是携带的患者仅达到56.5%,但是66.1%的患者经常及总是认为一旦疾病发作,能够识别并正确自救;在日常行为及治疗依从性方面,能够经常或总是定期复查并按处方服药的患者超过95%,能够经常或总是合理搭配营养饮食的患者不足90%。结论 PCI术后患者在吸烟问题上能够很好地自我管理,饮食、饮酒等方面的管理完成率较低,但仍然高于情绪认知管理、疾病知识管理等。应重视出院后的延伸护理,根据患者的自我管理能力实施个体化、精准的评估,采用符合教育对象实际需求的具体措施,加强对患者持续监测的力度和时间。
Objective To investigate the patient's condition after percutaneous coronary intervention(PCI) and to understand the patient's self-management behavior and its influencing factors. Method A questionnaire survey was conducted to investigate 83 patients with postoperative PCI who were admitted to Beijing Friendship Hospital affiliated to Capital Medical University from May to October 2016. Data on patient habits, compliance and related knowledge were collected and analyzed. Result In the management of bad habits of patients after PCI, the complete degree of quit smoking behavior was 90.3%. The patients who could always follow the advice of dietary salt limit, drinking restriction, fat and cholesterol intake restriction were 54.2%,77.1% and 50.6%. The number of patients who could always manage the symptoms was 13.2%and 24.1%. The patients who could always manage the disease knowledge were 10.8%and 15.6%patients. The current situation of patientsundefined emotional cognition management is relatively good. The patients who can always engage in the leisure and entertainment that they like are 66.2% patients. The first aid management of patients after PCI is at the middle and lower level. The number of patients who carry first aid drugs with them is only 56.5%, but 66.1% of patients often and always think that once the disease breaks out, be able to identify and correct self-help; in terms of daily behavior and therapeutic compliance, more than 95% patients were regularly or always treated with regular reexamination and prescriptive medication, and fewer than 90% patients were able to regularly or always reasonably match a nutritious diet. Conclusion Patients after PCI can have good self-management on smoking, but the completion rate of management in diet, drinking and other aspects is lower, but still higher than emotional cognitive management, disease knowledge management and so on. To pay attention to the extended nursing care after discharge, to implement individualized and accurate evaluation according to self-management ability, to meet the actual needs of the educational objects, to strengthen the intensity and time of continuous monitoring of patients.
Objective To investigate the patient's condition after percutaneous coronary intervention(PCI) and to understand the patient's self-management behavior and its influencing factors. Method A questionnaire survey was conducted to investigate 83 patients with postoperative PCI who were admitted to Beijing Friendship Hospital affiliated to Capital Medical University from May to October 2016. Data on patient habits, compliance and related knowledge were collected and analyzed. Result In the management of bad habits of patients after PCI, the complete degree of quit smoking behavior was 90.3%. The patients who could always follow the advice of dietary salt limit, drinking restriction, fat and cholesterol intake restriction were 54.2%,77.1% and 50.6%. The number of patients who could always manage the symptoms was 13.2%and 24.1%. The patients who could always manage the disease knowledge were 10.8%and 15.6%patients. The current situation of patientsundefined emotional cognition management is relatively good. The patients who can always engage in the leisure and entertainment that they like are 66.2% patients. The first aid management of patients after PCI is at the middle and lower level. The number of patients who carry first aid drugs with them is only 56.5%, but 66.1% of patients often and always think that once the disease breaks out, be able to identify and correct self-help; in terms of daily behavior and therapeutic compliance, more than 95% patients were regularly or always treated with regular reexamination and prescriptive medication, and fewer than 90% patients were able to regularly or always reasonably match a nutritious diet. Conclusion Patients after PCI can have good self-management on smoking, but the completion rate of management in diet, drinking and other aspects is lower, but still higher than emotional cognitive management, disease knowledge management and so on. To pay attention to the extended nursing care after discharge, to implement individualized and accurate evaluation according to self-management ability, to meet the actual needs of the educational objects, to strengthen the intensity and time of continuous monitoring of patients.
引文
[1]李科,刘俊明,黄文军,等.急性心肌梗死患者经皮冠状动脉介入治疗术后早期心室重构及心功能变化相关研究[J].中华实用诊断与治疗杂志,2012,26(7):656-658.
[2]楼娟,黄鸣,谭莉,等.心脏康复综合管理对改善PCI术后患者生活质量的影响[J].医学理论与实践,2016,(18):3274-3276.
[3]丁飙,许燕玲,彭易,等.首次行经皮冠状动脉支架植入术后患者自我管理能力现状及影响因素的调查[J].中华现代护理杂志,2015,21(16):1867-1871.
[4]刘鹏飞,王宜芝,孙玉梅,等.腹膜透析患者自我管理行为与自我效能的相关性分析[J].中华护理杂志,2006,41(7):615-617.
[5]赵月元,张爱华.冠心病介入治疗患者自我管理行为与焦虑抑郁及生存质量的相关性[J].护理学杂志,2016,31(5):8-11.
[6]郑淑梅,杨秀兰,吕烨辉,等.延续性自我管理教育在冠心病介入治疗患者心脏康复中的应用[J].中华护理杂志,2012,47(4):297-300.
[7]庄杜敏.肾移植出院受者自我管理现状及影响因素的研究[D].福州:福建医科大学,2007.
[8]Yusuf S,Hawken S,Ounpuu S,et al.Effect of potentialy modifiable risk factors associated with myocardial infarction in 52countries(the INTERHEART study):case-control study[J].Lancet,2004,364(9438):937-952.
[9]Janssen V,Gucht VD,Dusseldorp E,et al.Lifestyle modification programmes for patients with coronary heart disease:a systematic review and meta-analysis of randomized controlled trials[J].Eur JPre Cardiol,2013,20(4):620-640.
[10]刘浩然.电话随访对PCI术后患者自我管理的效果研究[D].石家庄:河北医科大学,2016.
[11]谢博钦,徐丽华.冠心病患者自我管理行为现状及其预测因子分析[J].解放军护理杂志,2011,28(3B):3-7.
[12]胡亚妮,林平,张金丽,等.经皮冠状动脉支架植入术后患者自我管理行为及其影响因素[J].中华护理杂志,2012,47(2):167-169.
[13]周彤.护理干预对冠脉介入术后患者自我管理水平和生存质量影响研究[D].济南:山东大学,2016.
[14]冯梅,蒋文慧.个性化健康教育与随访对PCI术后AMI患者危险因素的影响[J].护理学杂志,2012,27(7):83-86.
[15]杨静.焦点解决模式对中青年冠心病患者自我管理行为的干预效果研究[D].合肥:安徽医科大学,2013.
[16]刘书英,姜慧哲.影响冠心病患者自我护理能力的因素及对策[J].中国误诊学杂志,2012,12(6):1453.
[17]林琳,易琦峰,李颖,等.冠心病患者自我管理水平及影响因素分析[J].齐鲁护理杂志,2014,20(14):1-4.
[18]胡亚妮,林平,赵振娟.经皮冠状动脉介入术后患者自我管理知识及其行为的相关性[J].解放军护理杂志,2011,28(21):12-15.
[19]胡亚妮.经皮冠状动脉介入术后患者自我管理知识水平调查研究[J].护理学报,2012,19(1A):12-15.
[20]曹松海,赵庆华,张光惠.冠状动脉支架植入术后患者应对方式社会支持与生存质量的相关研究[J].中国行为医学科学,2007,16(3):211-213.
[21]王家美,张慧玲,王蓓.冠心病患者自我管理的研究与进展[J].上海护理,2014,14(6):62-64.
[22]Loring K.Self-management education[J].Med Care,2003,41(6):699-701.
[23]吕珊珊.心脏瓣膜置换术后患者自我管理行为及影响因素[D].济南:山东大学,2016.
[24]刘雪,王艳梅.老年高血压病人用药依从性及其影响因素的研究进展[J].全科护理,2011,9(1):253-254.
[25]侯新华,赵香芝,郭春明,等.冠心病患者治疗依从性与社会支持的调查分析[J].护理研究,2009,23(6):496-497.
[26]薛小慧.冠脉支架置入术后患者自我管理现状与影响因素分析[D].杭州:浙江大学,2016.
[27]黄菲菲,赵秋利,郭美宜.成年人健康自我管理能力现状及影响因素的调查[J].中华护理杂志,2011,46(7):701.
[28]戴俊明,卫志华,张蓓燕,等.社区高血压病人的药物利用与依从性关系分析[J].高血压杂志,2001,9(1):65-71.
[29]Albert NM.Improving medication adherence in chronic cardiovascular disease[J].Crit Care Nurse,2008,28(5):54-64.
[30]程红,裴咏桢.稳定型心绞痛病人156例服药依从性调查[J].中国医药指南,2007,5(12):663.
[31]漆红梅,王霞.授权教育对冠心病患者自我管理行为及自我效能感影响的研究[J].中国实用护理杂志,2013,29(25):62-66.
[32]王明飞,肖晓兰.某城区635例院前死亡病例分析和院前急救探讨[J].中国病案,2014,15(6):33-35.
[33]顾亚琴,陈黎.临床路径式管理在高血压自我管理中的效果评价[J].中国全科医学,2011,14(8):2558-2560.
[34]张文娴,平付敏,智华.延伸护理服务对提高冠心病患者自我管理能力的调查研究[J].河北医药,2015,37(23):3670-3671.
[35]刘梅讯,彭贵海,孔燕.延续护理对冠心病PCI术后康复患者的影响[J].海南医学,2016,27(16):2749-2752.
[36]董延丽.延续性护理对冠脉介入术后患者自我管理、自我效能和生活质量的影响[D].济南:山东大学,2015.
[37]谢燕.冠心病患者自我管理现状及社区护理需求调查[J].齐鲁护理杂志,2010,16(11):58-60.
[38]Kang Y,Yang IS,KimN.Correlates of health behaviors in patients with coronaryarterydisease[J].Asian Nurs Res,2010,4(1):45-55.
[39]高润霖.冠心病介入治疗的新进展:解读我国更新的经皮冠状动脉介入治疗指南[J].中华心血管病杂志,2009,37(1):2-3.
[40]Lorig K,Ritter PL,Plant K,et al.The South Australia health chronic disease self-management Internet trial[J].Health Edue Behav,2013,40(23):67-77.
[41]The National Council On Ageing.Challenges and success in implementing Chronic Disease Self-management Program(CDSMP)--final report[R].NCOA,2004.35-40.
[42]殷白丁.针对性健康教育对社区冠心病患者自我管理及生活质量的影响[J].中国煤炭工业医学杂志,2015,18(3):462-464.
[2]楼娟,黄鸣,谭莉,等.心脏康复综合管理对改善PCI术后患者生活质量的影响[J].医学理论与实践,2016,(18):3274-3276.
[3]丁飙,许燕玲,彭易,等.首次行经皮冠状动脉支架植入术后患者自我管理能力现状及影响因素的调查[J].中华现代护理杂志,2015,21(16):1867-1871.
[4]刘鹏飞,王宜芝,孙玉梅,等.腹膜透析患者自我管理行为与自我效能的相关性分析[J].中华护理杂志,2006,41(7):615-617.
[5]赵月元,张爱华.冠心病介入治疗患者自我管理行为与焦虑抑郁及生存质量的相关性[J].护理学杂志,2016,31(5):8-11.
[6]郑淑梅,杨秀兰,吕烨辉,等.延续性自我管理教育在冠心病介入治疗患者心脏康复中的应用[J].中华护理杂志,2012,47(4):297-300.
[7]庄杜敏.肾移植出院受者自我管理现状及影响因素的研究[D].福州:福建医科大学,2007.
[8]Yusuf S,Hawken S,Ounpuu S,et al.Effect of potentialy modifiable risk factors associated with myocardial infarction in 52countries(the INTERHEART study):case-control study[J].Lancet,2004,364(9438):937-952.
[9]Janssen V,Gucht VD,Dusseldorp E,et al.Lifestyle modification programmes for patients with coronary heart disease:a systematic review and meta-analysis of randomized controlled trials[J].Eur JPre Cardiol,2013,20(4):620-640.
[10]刘浩然.电话随访对PCI术后患者自我管理的效果研究[D].石家庄:河北医科大学,2016.
[11]谢博钦,徐丽华.冠心病患者自我管理行为现状及其预测因子分析[J].解放军护理杂志,2011,28(3B):3-7.
[12]胡亚妮,林平,张金丽,等.经皮冠状动脉支架植入术后患者自我管理行为及其影响因素[J].中华护理杂志,2012,47(2):167-169.
[13]周彤.护理干预对冠脉介入术后患者自我管理水平和生存质量影响研究[D].济南:山东大学,2016.
[14]冯梅,蒋文慧.个性化健康教育与随访对PCI术后AMI患者危险因素的影响[J].护理学杂志,2012,27(7):83-86.
[15]杨静.焦点解决模式对中青年冠心病患者自我管理行为的干预效果研究[D].合肥:安徽医科大学,2013.
[16]刘书英,姜慧哲.影响冠心病患者自我护理能力的因素及对策[J].中国误诊学杂志,2012,12(6):1453.
[17]林琳,易琦峰,李颖,等.冠心病患者自我管理水平及影响因素分析[J].齐鲁护理杂志,2014,20(14):1-4.
[18]胡亚妮,林平,赵振娟.经皮冠状动脉介入术后患者自我管理知识及其行为的相关性[J].解放军护理杂志,2011,28(21):12-15.
[19]胡亚妮.经皮冠状动脉介入术后患者自我管理知识水平调查研究[J].护理学报,2012,19(1A):12-15.
[20]曹松海,赵庆华,张光惠.冠状动脉支架植入术后患者应对方式社会支持与生存质量的相关研究[J].中国行为医学科学,2007,16(3):211-213.
[21]王家美,张慧玲,王蓓.冠心病患者自我管理的研究与进展[J].上海护理,2014,14(6):62-64.
[22]Loring K.Self-management education[J].Med Care,2003,41(6):699-701.
[23]吕珊珊.心脏瓣膜置换术后患者自我管理行为及影响因素[D].济南:山东大学,2016.
[24]刘雪,王艳梅.老年高血压病人用药依从性及其影响因素的研究进展[J].全科护理,2011,9(1):253-254.
[25]侯新华,赵香芝,郭春明,等.冠心病患者治疗依从性与社会支持的调查分析[J].护理研究,2009,23(6):496-497.
[26]薛小慧.冠脉支架置入术后患者自我管理现状与影响因素分析[D].杭州:浙江大学,2016.
[27]黄菲菲,赵秋利,郭美宜.成年人健康自我管理能力现状及影响因素的调查[J].中华护理杂志,2011,46(7):701.
[28]戴俊明,卫志华,张蓓燕,等.社区高血压病人的药物利用与依从性关系分析[J].高血压杂志,2001,9(1):65-71.
[29]Albert NM.Improving medication adherence in chronic cardiovascular disease[J].Crit Care Nurse,2008,28(5):54-64.
[30]程红,裴咏桢.稳定型心绞痛病人156例服药依从性调查[J].中国医药指南,2007,5(12):663.
[31]漆红梅,王霞.授权教育对冠心病患者自我管理行为及自我效能感影响的研究[J].中国实用护理杂志,2013,29(25):62-66.
[32]王明飞,肖晓兰.某城区635例院前死亡病例分析和院前急救探讨[J].中国病案,2014,15(6):33-35.
[33]顾亚琴,陈黎.临床路径式管理在高血压自我管理中的效果评价[J].中国全科医学,2011,14(8):2558-2560.
[34]张文娴,平付敏,智华.延伸护理服务对提高冠心病患者自我管理能力的调查研究[J].河北医药,2015,37(23):3670-3671.
[35]刘梅讯,彭贵海,孔燕.延续护理对冠心病PCI术后康复患者的影响[J].海南医学,2016,27(16):2749-2752.
[36]董延丽.延续性护理对冠脉介入术后患者自我管理、自我效能和生活质量的影响[D].济南:山东大学,2015.
[37]谢燕.冠心病患者自我管理现状及社区护理需求调查[J].齐鲁护理杂志,2010,16(11):58-60.
[38]Kang Y,Yang IS,KimN.Correlates of health behaviors in patients with coronaryarterydisease[J].Asian Nurs Res,2010,4(1):45-55.
[39]高润霖.冠心病介入治疗的新进展:解读我国更新的经皮冠状动脉介入治疗指南[J].中华心血管病杂志,2009,37(1):2-3.
[40]Lorig K,Ritter PL,Plant K,et al.The South Australia health chronic disease self-management Internet trial[J].Health Edue Behav,2013,40(23):67-77.
[41]The National Council On Ageing.Challenges and success in implementing Chronic Disease Self-management Program(CDSMP)--final report[R].NCOA,2004.35-40.
[42]殷白丁.针对性健康教育对社区冠心病患者自我管理及生活质量的影响[J].中国煤炭工业医学杂志,2015,18(3):462-464.