预立医疗照护计划在老年呼吸慢病终末期患者及其家属中的应用

Pre-planned medical care schemes for elderly patients with end-stage chronic respiratory diseases and their family members

目的预立医疗照护计划在老年呼吸慢病终末期患者及其家属中的应用。方法对2018年10月至2019年12月本院收治的80例老年呼吸慢病终末期患者实施预立医疗照护计划干预,比较干预前后患者的生存质量、患者家属的心理应激以及患者对维持生命治疗的态度和临终治疗护理意愿。结果除身体不适和食物关注外,干预后患者的生存质量总分及其整体生存质量、负面情绪、疏离感、存在困扰、医护关注、社会支持、生活价值等维度较干预前高,前后比较,差异具有统计学意义(均P<0.05)。干预后患者家属的心理应激状态总分及其维度(心理痛苦、生活扰乱程度、负性情感)评分均低于干预前,前后比较,差异具有统计学意义(均P<0.001)。干预后患者对心肺复苏、人工辅助呼吸的接受率较干预前降低(均P<0.05)。干预前患者临终照护意愿以延续生命为主;干预后以减轻痛苦为主,前后比较,差异具有统计学意义(P<0.05)。结论预立照护计划可提高老年呼吸慢病终末期患者的生存质量,从而减轻患者家属的心理应激反应,引导患者理性对待维持生命治疗和表达临终治疗护理意愿。

Objective To explore the significance of pre-planned medical care schemes for elderly patients with end-stage chronic respiratory diseases.Methods The pre-planned medical care schemes were used for the intervention in the care to 80 elderly patients hospitalized in our hospital during October 2018 to December 2019.Comparisons were done between pre-and post-intervention in view of the patient's life quality,their family's mental stress,their attitude to life-sustaining treatment and will on end-stage care.Results After intervention,the total score of life quality was significantly higher than before intervention(P<0.05),and so it was with the respective score of the dimensions like overall living quality,negative emotions,sense of alienation,living disturbance,care attention,social support and life value(P<0.05).The total score of mental stress after intervention was significantly lower than that before intervention(P<0.001),and so it was with the scores of its dimensions like mental pain,life disturbance and negative emotions(P<0.001).The acceptance rate of cardiopulmonary resuscitation and artificially aided breathing was significantly lower than that before intervention(P<0.05).Before intervention,the will on hospice care was to sustain life as long as possible,and after intervention it was to reduce pain,with a significant difference between pre-and post-intervention(P<0.05).Conclusions The pre-planned care schemes are effective in the improvement of quality of life of elderly patients with end-stage chronic respiratory diseases as well as the reduction of their mental stress.It can help them to rationally treat the therapy of life sustaining and express their wills on hospice care.