教育与管理及效果评价模式对慢阻肺患者肺康复的有效性研究

Efficiency study on effectiveness evaluation model of education and management in pulmonary rehabilitation of patients with COPD

目的 构建教育与管理及效果评价于一体的模式应用于慢性阻塞性肺疾病（chronic obstructive pulmonary disease,简称慢阻肺）患者肺康复的效果.方法 对诊断为慢阻肺首次住院的患者,对照组60例由病房护士提供常规的健康教育和护理,实验组60例接受个案护士的健康教育、管理、效果评价模式的护理.收集两组患者的血气分析、慢阻肺症状和体征、并发症状/新出现的症状、居家环境、心理社交、家庭康复训练、健康行为等进行分析比较.结果 两组干预后动脉血氧分压、二氧化碳分压、血氧饱和度经t检验比较,实验组优于对照组,差异均有统计学意义（t=2.381,3.151,2.101;P＜0.05）.实验组患者对慢阻肺的危险因素、吸入治疗方法、康复锻炼方法、应对气喘突发的知晓程度与出院后症状加重程度呈负相关（r=-0.449,-0.308,-0.246,-0.484）,与出院后实施康复锻炼的行为呈正相关（r=0.36,0.694,0.712,0.266）.出院随访慢阻肺的症状和体征有无加重、有无并发症或新出现的症状、仍存在诱发因素、有无正常社交活动、有无进行家庭康复训练的指标,经x2检验比较,实验组患者的有利事件多于对照组,差异有统计学意义（x2=4.357,4.183,15.873,4.887,59.394;P＜0.05）.结论 教育与管理及效果评价于一体的模式应用于慢阻肺患者的肺康复是有效的.

Objective To establish the model of education and management with effectiveness evaluation,and to evaluate the effect of the model to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease （COPD）.Methods 120 COPD patients hospitalized for the first time were randomly divided into control group and experimental group.60 patients in control group were received regular health-education and cared by the ward nurses,60 patients in experimental group were received health education and management with effectiveness evaluation model by case management nurses.The two groups＇ data were collected,including blood gas analysis,symptoms and signs,concurrent and emerging symptoms,home environment,psychosocial,family rehabilitation and health behaviors.All the data were analyzed and compared.Results After comparative t-test,the arterial oxygen,carbon dioxide partial pressure and oxygen saturation of before and after intervention in the experimental group were better than those in the control group （t=2.381,t=3.151,t=2.101）,the difference was statistically significant （P ＜ 0.05）.The degree of awareness of risk factors for COPD,inhalation therapy,rehabilitation training methods,and dealing with unexpected of asthma were negatively correlated with the increased degree of symptoms after discharge in the experimental group （r=-0.449,r=--0.308,r=-0.246,r=-0.484）,and were positively correlated with the implementation of rehabilitation exercises after discharge （r=0.36,r=0.694,r=0.712,r=0.266）.The indicators of discharge follow-up in the experimental group were better than those in the control group.By x 2 test,the favorable events in the experimental group were more than those in the control group （x 2=4.357,x 2=4.183,x 2=15.873,x 2=4.887,x 2=59.394） and the difference was statistically significant （P ＜ 0.05）.Conclusion The application of the model of education and management with effectiveness evaluation in improving pulmonary rehabilitation of patients with COPD is obviously effective.