结构式心理护理对经皮冠脉介入治疗患者疾病不确定感及心血管不良事件的影响

Effects of structural psychological nursing on sense of uncertainty and adverse cardiovascular events in patients with PCI

目的 探讨结构式心理护理对经皮冠脉介入治疗患者疾病不确定感及心血管不良事件的影响.方法 选取心内科病房2015年6月—2016年5月收治的拟择期经皮冠脉介入治疗的98例患者作为研究对象,按随机数字表法分为对照组和观察组,每组49例.对照组采取冠脉介入术常规护理,观察组在进行常规护理的基础上实施结构式心理护理.评价PCI术前、术后心境状态,术前1 d和术后1 d不确定感及术后至出院3个月内两组患者心血管不良事件的发生率.结果 护理后观察组患者的心境状态优于对照组患者;PCI术前1 d观察组患者与对照组患者的不明确性评分、复杂性评分和疾病不确定感总分差异均无统计学意义（P〉0.05）;术后1 d观察组患者不明确性评分、复杂性评分和疾病不确定感总分分别为（35.63±5.96）、（21.26±3.01）、（56.89±5.84）分,与对照组比较差异均有统计学有意义（t值分别为4.635、3.265、4.012;P〈0.01）.术后3个月,血管迷走反射和穿刺部位血肿发生率两组比较差异均有统计学意义（P〈0.05）,心肌梗死和心绞痛发生率比较差异无统计学意义（P〉0.05）.结论 结构式心理护理可降低经皮冠脉介入治疗患者的不确定感和心血管不良事件的发生率.

Objective To investigate the effects of the structural psychological nursing on the sense of uncertainty and adverse cardiovascular events （ACE） in patients with PCI.Methods Totals of 98 PCI patients who admitted to the Cardiology Department of Affiliated Hospital of Binzhou Medical College from June 2015 to May 2016 were selected into the study. The participants were divided into the control group （n=49） and the intervention group （n=49） according to a random number table. Based on the routine nursing care, the intervention group received an additional structural psychological care. To compare the state of pre operative mood and postoperative mood, the sense of uncertainty one day before and after PCI, and the incidence of ACE three months after PCI between the two groups.Results Patients in the intervention group had a better state of mood after the intervention compared with the control group. The sense of uncertainty was similar before the operation （P〉0.05） but was significantly different between the two groups after the operation （t=4.635, 3.265, 4.012;P〈0.01）. In the intervention group, the scores of undefined diagnosis, complexity, and sense of uncertainty to the disease was （35.63±5.96）, （21.26±3.01） and （56.89±5.84）. After three months, the vasovagal reflectivity and incidence of hematoma on the puncture site had significant differences between the two groups （P〈0.05）, but had limited difference in the incidence of myocardial infarction or angina recurrence rate （P〉0.05）.Conclusions The structural psychological nursing can effectively prevent the sense of uncertainty and adverse cardiovascular events in patients with PCI.