PCI围术期舒适护理对冠心病患者心理状态及预后的影响  

Effect of perioperative comfortable nursing on psychological stress and prognosis in patients with percutaneous coronary intervention

作　　者：马士容[1] 

机构地区：[1]重庆三峡中心医院心血管内科,404000

出　　处：《中华全科医学》2015年第11期1866-1868,共3页Chinese Journal of General Practice

摘　　要：目的 通过对比研究,探讨冠心病介入治疗（PCI）围术期心理结合行为护理的舒适护理对患者心理状态及预后的影响。方法 以2009年1月—2012年12月在重庆三峡中心医院就诊的240例拟行PCI患者为研究对象,将所有患者随机分为对照组和护理干预组。对照组按常规护理方法进行;护理干预组进行常规护理的同时,给予心理护理结合行动护理相结合的舒适护理干预措施。对患者焦虑自评量表（SAS）和抑郁自评量表（SDS）评估进行术前1天在护理前和拔动脉鞘管后12 h进行,与此同时,检测血清促肾上腺皮质激素（ACTH）、血浆皮质醇（Cor）、血糖及血C反应蛋白（CRP）。随访一年内不良血管事件（MACE）。结果 对照组术后的SDS评分、SAS评分、ACTH、Cor和CRP均比术前显著升高（P〈0.01）,护理干预组术后SDS评分、ACTH、Cor和CRP均比术前显著升高（P〈0.01）,但护理干预组术后SDS评分、ACTH及Cor均比对照组术后的降低（P〈0.05）。护理干预组12个月总MACE比对照组减少（χ2=11.06,P〈0.05）。经Logistic多因素回归分析围术期抑郁是影响PCI术后12个月MACE的独立影响因素（OR=1.556,95.0%CI：1.07~2.28,P=0.024）,护理干预是负影响PCI术后12个月MACE的独立影响因素（OR=0.113,95.0%CI：0.02~0.83,P=0.032）,护理干预是减少PCI术后12个月MACE的影响因素。结论 由于PCI围术期易引起患者抑郁的心理应激反应升高,而抑郁是PCI术后MACE的独立影响因素,舒适护理干预可使负性心理反应大大降低,并减少术后一年总MACE,对PCI围术期能起到很好的护理作用,值得推广采用。Objective To explore the effect of comfortable nursing combined with behavior and psychological care on the psychological status and prognosis in patients with percutaneous coronary intervention （PCI）. Methods A total of 240 patients scheduled for PCI in our hospital from January 2009 to December 2009 were enrolled and randomly divided into control group and intervention group. The control group received the conventional nursing method, while the comfortable nursing combined with behavior and psychological care was performed in the intervention group besides the conventional care. The anxiety self-assessment scale（SAS） and depression self-rating scale（SDS） evaluation were performed one day before PCI and 12 hours after arterial sheath removal. The levels of serum SCTH, Cur and blood glucose and CRP were tested. The major adverse cardiovascular events（MACE） were observed in the one year follow-up. Results After PCI, the scores of SDS and SAS and the levels of ACTH, Cor and CRP increased significantly both in the control group and the intervention group（ P 〈 0.01 ）, but the SDS score ,ACTH and Cor levels in the intervention group were lower than those in the control group（ P 〈 0.05 ）. The total MACE in the 12 months after PCI was lower in the intervention group as compared with the control group （ ehi-square = 11.6, P 〈 0.05 ）. Logistic muhifaetor regression analysis showed that The perioperative depression was the independent impact factor for MACE after PCI within 12 months（ OR = 1. 556 95.0% CI： 1.07 - 2.28 ,P =0.024） ,and the nursing intervention is the negative independent impact factor for MACE after PCI within 12 months （OR = 0.113 ,95. 0% CI：0. 02 -0.83, P = 0.032 ）, the nursing intervention the influence factors for reducing the MACE within 12 months after PCI. Conclusion The perioperative psychological stress can lead to the depression in patients with PCI, and raise the risks of MACE within 12 months after PCI. The comfortable nursing intervention combined ps

关 键 词：冠心病介入治疗 舒适护理 冠心病 心理应激 

分 类 号：R473.54[医药卫生—护理学] R541.4[医药卫生—临床医学]