叙事医学模式下患者参与式决策干预在心脏瓣膜置换术中的应用研究  

Application of Patient Participatory Decision Intervention in Heart Valve Replacement Surgery Under Narrative Medicine Model

作　　者：吴玉丽[1] WU Yuli(Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院,泉州362000

出　　处：《中国医药指南》2024年第3期180-183,共4页Guide of China Medicine

摘　　要：目的 探讨叙事医学模式下患者参与式决策干预在心脏瓣膜置换术中的应用效果。方法 选取2020年9月至2022年2月于福建省泉州市第一医院接受心脏瓣膜置换手术的84例心脏瓣膜患者为研究对象,按照随机数字表法分为对照组与研究组,每组各42例。对照组采取心脏瓣膜置换术常规护理模式,研究组在对照组的护理模式基础上实施叙事医学模式下患者参与式决策方案的干预,观察两组患者的术后恢复情况(首次排气时间、首次排便时间)及住院时间和不良事件发生率(低心排出量综合征发生率、肾功能衰竭发生率、感染发生率、心律失常发生率、脑栓塞发生率)差异,术前1 d和术后7 d各评估1次两组患者的生存质量[世界卫生组织生存质量测定量表(WHOQOL-100)]和心理状况[自我效能感量表(GSES)、心理弹性量表(Rs-14)]。结果 研究组的住院时间和不良事件总发生率低于对照组,差异有统计学意义(P <0.05)。两组的首次排气、排便时间和各项不良事件发生率差异无统计学差异(P> 0.05)。术前1 d,两组的WHOQOL-100评分、GSES评分和Rs-14评分差异无统计学意义(P> 0.05),术后7 d,研究组的WHOQOL-100评分、GSES评分和Rs-14评分均高于对照组,差异有统计学意义(P <0.05)。结论 在心脏瓣膜置换手术常规护理中,实施叙事医学模式下患者参与式决策干预,有助于改善患者心理状态,减少术后不良事件发生风险,从而促进患者术后恢复,对改善术后生存质量有积极意义。Objective The purpose of this study is to explore the application effect of patient participatory decision-making intervention in heart valve replacement surgery under the narrative medicine model.Methods 84 patients with heart valves who underwent heart valve replacement surgery at the First Hospital of Quanzhou City,Fujian Province from September 2020 to February 2022 were selected as the study subjects.They were randomly divided into a control group and a study group using a random number table method,with 42 patients in each group.The control group adopted a routine nursing model for heart valve replacement surgery,while the study group implemented patient participatory decisionmaking interventions under the narrative medicine model based on the nursing model of the control group.The postoperative recovery(first exhaust time,first defecation time),hospitalization time,and incidence of adverse events(low cardiac output syndrome incidence,renal failure incidence,infection incidence,arrhythmia incidence,and cerebral embolism incidence)of the two groups of patients were observed.The quality of life(World Health Organization Quality of Life Scale(WHO QOL-100))and psychological status(Self Efficacy Scale(GSES)and Psychological Resilience Scale(Rs-14))of the two groups of patients were evaluated 1 day before surgery and 7 days after surgery,respectively.Results The length of hospital stay and total incidence of adverse events in the study group were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference(P>0.05)in the first exhaust,defecation time,and incidence of various adverse events between the two groups.On the 1st day before surgery,there was no statistically significant difference in the WHOQOL-100 score,GSES score,and Rs-14 score between the two groups(P>0.05).On the 7th day after surgery,the WHOQOL-100 score,GSES score,and Rs-14 score in the study group were higher than those in the control group,and the difference was

关 键 词：叙事医学 参与式决策 心脏瓣膜置换术 护理 

分 类 号：R473.6[医药卫生—护理学]