改进护理干预对全穿刺技术治疗腹主动脉瘤患者健康教育及应激反应的影响

Effect of improved nursing intervention on health education and perioperative stress response in patients with abdominal aortic aneurysm undergoing TPEVAR

目的探讨改进护理干预对全穿刺技术治疗腹主动脉瘤(TPEVAR)患者健康教育及围术期应激反应的影响。方法选取2013年1月至2016年1月间首都医科大学附属北京朝阳医院收治的行TPEVAR手术治疗的56例腹主动脉瘤患者,采用随机数字表法分为观察组和对照组,每组28例。患者均接受TPEVAR治疗后,对照组患者采用普通护理,观察组患者采用改进护理干预,并接受相应的健康教育。比较两组患者术后指标、Barthel自理指数和Kolcaba评分情况,统计健康教育满意度,测定患者术后去甲肾上腺素、肾上腺素和C反应蛋白水平。结果观察组患者术后卧床时间和住院时间分别为(1.36±0.25)d和(4.76±0.67)d,均显著短于对照组患者的(2.79±0.43)d和(6.68±0.53)d,差异均有统计学意义(均P<0.05)。观察组患者术后Barthel自理指数和Kolcaba评分分别为(77.41±1.25)分和(89.42±1.42)分,均显著高于对照组患者的(61.57±0.94)分和(70.24±1.26)分,差异均有统计学意义(均P<0.05)。观察组患者健康教育满意度为92.9%,显著高于对照组的75.0%,差异有统计学意义(P<0.05)。对照组患者去甲肾上腺素、肾上腺素和C反应蛋白水平分别为(178.34±25.35)pmol/L、(164.20±23.57)pmol/L和(96.73±12.46)ng/L,均显著高于观察组患者的(142.57±18.43)pmol/L、(103.44±12.46)pmol/L和(48.52±8.35)ng/L,差异均有统计学意义(均P<0.05)。结论改进护理干预可有效提高全穿刺技术治疗腹主动脉瘤患者术后生活自理能力和舒适度,提高健康教育满意度,降低应激反应,值得临床推广。

Objective To investigate the effect of improved nursing intervention on health education and perioperative stress response in patients with abdominal aortic aneurysm treated with total percutaneous endovascular aneurysm repair（ TPEVAR）. Methods Fifty-six patients with abdominal aortic aneurysm undergoing TPEVARat Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2013 to January 2016 were selected and randomly divided into an observation group and a control group using a random number table with 28 patients in each group. After TPEVAR,patients in the experimental group received the modified nursing intervention and received the corresponding health education and patients in the control group received general nursing. The postoperative indicators,Barthel self-care index and Kolcaba score were compared between the two groups. Patients＇ satisfaction with health education was recorded. The levels of norepinephrine,epinephrine and C reactive protein were measured. Results The bed time and hospital stay was（ 1. 36 ± 0. 25）d and（ 4. 76 ± 0. 67） d respectively which were significantly shorter than（ 2. 79 ± 0. 43） d and（ 6. 68 ±0. 53） d of the control group（ all P〈0. 05）. Barthel＇s index and Kolcaba score were 77. 41 ± 1. 25 and89. 42 ± 1. 42 respectively for the observation group which were significantly higher than 61. 57 ± 0. 94 and70. 24 ± 1. 26 respectively of the control group（ all P〈0. 05）. The rate of satisfaction with health education was 92. 9% for the observation group which was significantly higher than 75. 0% of the control group（ P〈0. 05）. The level of norepinephrine,epinephrine and C reactive protein was（ 178. 34 ± 25. 35） pmol/L,（ 164. 20 ± 23. 57） pmol/L and（ 96. 73 ± 12. 46） ng/L respectively for the observation group which was significantly lower than（ 142. 57 ± 18. 43） pmol/L,（ 103. 44 ± 12. 46） pmol/L and（ 48. 52 ± 8. 35） ng/L of the control group（ all P〈0. 05）. Conclusion Improved nursing intervention can effectively improve the patients＇ self-care ability,comfort and satisfaction with health education and reduce stress response in patients with abdominal aortic aneurysm undergoing TPEVAR. It is worthy of clinical application.