访视护理干预对冠心病病人睡眠状况和急性心脏事件发生率的影响

Effect of visiting nursing intervention on the sleep state and incidence of acute cardiac events in patients with CHD

目的:探讨访视护理干预对冠心病病人睡眠状况和急性心脏事件(ACE)发生率的影响。方法:选择100例冠心病病人为研究对象,将其随机分为干预组和对照组,各50例。对照组病人在出院时给予常规健康教育和指导,干预组病人在出院后1年内接受访视护理干预,定期对他们的认知、心理及行为方式进行护理干预。观察记录2组病人在出院后1年内的睡眠状况及ACE发生情况、再住院率和病死率。结果:出院后3个月、6个月和12个月,干预组睡眠状况评分均明显低于对照组(P<0.01);干预组病人睡眠状况评分出院前后各时间点比较差异有统计学意义(P<0.01),出院后3个月、6个月和12个月均明显低于出院当天、1个月和2个月(P<0.01),出院6个月和12个月均低于出院3个月(P<0.05和P<0.01);而对照组病人出院前后各时间点睡眠状况评分比较差异无统计学意义(P>0.05)。干预组病人的ACE发生率和再住院率均较对照组明显降低(P<0.01),而2组病死率比较差异无统计学意义(P>0.05)。出院1年之内,2组病人出现ACE均包含心源性猝死、急性心力衰竭、不稳定性心绞痛、ST段抬高心肌梗死、非ST段抬高心肌梗死、心律失常6种疾病,对其进行分类记录比较,2组病人ACE构成差异无统计学意义(P>0.05)。结论:访视护理干预有助于培养冠心病病人积极健康的心态,促进良好生活方式的形成,改善睡眠状况、降低ACE发生率及再住院率。

Objective： To investigate the effects of visiting nursing intervention on the sleep state and incidence of acute cardiac events（ ACE） in patients with coronary heart disease（ CHD）. Methods： A total of 100 patients with CHD were randomly divided into the control group and intervention group（ 50 cases each group）. The control group was nursed with conventional discharge guidance,and the interventional group were nursed with visiting nursing intervention within 1 year after discharge,the cognition,psychology and behavior of patients were regularly nursed. The sleep state,incidence of ACE,rehospitalization rate and fatality rate in two groups were observed within 1 year after discharge. Results： The scores of self rating scale of sleep（ SRSS） in intervention group after 3,6 and 12 months of discharge were significantly lower than that in control group（ P〈 0. 01）. In intervention group,the difference of the sleep quality between before and after discharge was statistically significant（ P 〈0. 01）,which after 3,6 and 12 months of discharge was significantly lower than that on the day of discharge and after 1 and 2 months of discharge,and which after 6 and 12 months of discharge was lower than that after 3 months of discharge（ P 〈0. 01 and P〈 0. 05）. The difference of the sleep quality in control group between before and after discharge was not statistical significance（ P〉 0. 05）. Compared with the control group,the incidence rate of ACE and rehospitalization rate in interventional group significantly decreased（ P〈 0. 01）,and the difference of fatality rate between two groups was not statistically significant（ P 〉0. 05）. Within 1 year of discharge,the incidence of ACE,which included cardiac sudden death,acute heart failure,unstable angina pectoris,st-segment elevation myocardial infarction,non-st segment elevation myocardial infarction and arrhythmia,was recorded,and the difference of composition of ACE between two groups was not statistically significant（ P 〉0. 05）.Conclusions： Visiting nursing intervention can contribute to culture the positive and healthy mentality in patients with CHD,promote the formation of good life interview,improve sleep and reduce the incidence of ACE.