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全程个体化健康教育的自我护理在慢性心力衰竭患者中的应用及其影响因素。

Application of self-care based on full-course individualized health education in patients with chronic heart failure and its influencing factors.

作者信息

Sun Jing, Zhang Zhi-Wei, Ma Yue-Xian, Liu Wei, Wang Chun-Ying

机构信息

Department of Nursing, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar 161000, Heilongjiang Province, China.

Department of Cardiovascular, the Second Affiliated Hospital of Qiqihar Medical University, Qiqihar 161000, Heilongjiang Province, China.

出版信息

World J Clin Cases. 2019 Aug 26;7(16):2165-2175. doi: 10.12998/wjcc.v7.i16.2165.

Abstract

BACKGROUND

The treatment of heart failure not only needs to relieve the clinical symptoms and improve the quality of life for patients but also needs to select scientific and reasonable ways to prevent or delay the progression of the disease, thus reducing the mortality and hospitalization rate. Although the previous regimen can effectively relieve symptoms in the early stage of treatment, long-term use may cause adverse events, such as arrhythmia, and even increase mortality. Therefore, conventional treatment cannot meet the actual health needs of patients, and scientific nursing intervention is very necessary.

AIM

To investigate the application of self-care based on full-course individualized health education (FCIHE) and its influencing factors in patients with chronic heart failure (CHF).

METHODS

We enrolled CHF patients who were admitted to our center between September 2015 and June 2016 and divided them into an intervention group ( = 50) and control group ( = 50) using a random number table. Routine nursing care was applied to the control group, and FCIHE was offered to the intervention group. The self-care behavior, 6-min walking distance (6MWD), and 36-item short form health survey (SF-36) scores were compared between the two groups. The influencing factors of the self-care were also analyzed.

RESULTS

The 6MWD was not significantly different between the two groups at admission ( > 0.05); however, at 3 and 6 mo after discharge, 6MWD was significantly increased, and it was significantly longer in the intervention group ( < 0.05). The scores for self-care behavior showed no significant difference at admission between the two groups ( > 0.05); however, at 3 and 6 mo after discharge, the total scores for self-care maintenance, management, confidence, and behavior of the intervention group were significantly higher than those of the control group ( < 0.05). There were no significant differences in the SF-36 scores at admission ( > 0.05); however, at 3 mo and 6 mo after discharge, the scores for all eight subscales, including physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role-limitations due to emotional problems, and mental health, were significantly higher in the intervention group ( < 0.05). As shown by logistic regression analysis, the influencing factors of self-care mainly included age, cardiac function class, and education background (odds ratio > 1; all < 0.05).

CONCLUSION

FCIHE improved self-care behavior and cardiac function in CHF patients. Age, cardiac function, and education level affected the implementation of self-care among CHF patients.

摘要

背景

心力衰竭的治疗不仅需要缓解患者的临床症状、提高生活质量,还需要选择科学合理的方法来预防或延缓疾病进展,从而降低死亡率和住院率。尽管先前的治疗方案在治疗早期能有效缓解症状,但长期使用可能会引发不良事件,如心律失常,甚至增加死亡率。因此,传统治疗无法满足患者的实际健康需求,科学的护理干预非常必要。

目的

探讨基于全程个体化健康教育(FCIHE)的自我护理在慢性心力衰竭(CHF)患者中的应用及其影响因素。

方法

选取2015年9月至2016年6月在本中心住院的CHF患者,采用随机数字表法将其分为干预组(n = 50)和对照组(n = 50)。对照组给予常规护理,干预组给予FCIHE。比较两组患者的自我护理行为、6分钟步行距离(6MWD)及36项简短健康调查(SF - 36)评分,并分析自我护理的影响因素。

结果

两组患者入院时6MWD差异无统计学意义(P > 0.05);但出院后3个月和6个月,6MWD均显著增加,且干预组更长(P < 0.05)。两组患者入院时自我护理行为评分差异无统计学意义(P > 0.05);但出院后3个月和6个月,干预组自我护理维持、管理、信心及行为的总分显著高于对照组(P < 0.05)。两组患者入院时SF - 36评分差异无统计学意义(P > 0.05);但出院后3个月和6个月,干预组包括生理功能、因身体问题所致角色受限、身体疼痛、总体健康感知、活力、社会功能、因情绪问题所致角色受限及心理健康在内的所有8个分量表评分均显著更高(P < 0.05)。Logistic回归分析显示,自我护理的影响因素主要包括年龄、心功能分级及教育背景(比值比>1;均P < 0.05)。

结论

FCIHE改善了CHF患者的自我护理行为和心功能。年龄、心功能及教育水平影响CHF患者自我护理的实施。

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