过渡期护理模式在中重度慢性阻塞性肺疾病患者中的应用效果

Application Effect of Transitional Care Model in Patients with Moderate or Severe Chronic Obstructive Pulmonary Disease

目的分析过渡期护理模式(TCM)在中重度慢性阻塞性肺疾病(COPD)患者中的应用效果。方法选取2016年1月—2017年6月上海市肺科医院收治的中重度COPD患者120例,采用随机数字表法分为对照组和研究组,每组60例。对照组患者给予常规护理及健康宣教,研究组患者在对照组基础上给予TCM。比较两组患者出院前2 d和出院后6个月自我护理行为调查问卷(ESCA)评分、肺通气功能指标、动脉血气分析指标及出院后6个月内再住院率。结果出院前2 d两组患者满足一般性自理需求的行为维度评分、满足健康偏离性自理需求的行为维度评分、ESCA总分比较,差异无统计学意义(P>0.05);出院后6个月研究组患者满足一般性自理需求的行为维度评分、满足健康偏离性自理需求的行为维度评分、ESCA总分高于对照组(P<0.05)。出院前2 d两组患者肺活量(VC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)比较,差异无统计学意义(P>0.05);出院后6个月研究组患者VC、FEV1大于对照组,FEV1/FVC高于对照组(P<0.05)。出院前2 d两组患者动脉血氧分压(Pa O2),动脉血二氧化碳分压(Pa CO2)比较,差异无统计学意义(P>0.05);出院后6个月研究组患者Pa O2高于对照组,Pa CO2低于对照组(P<0.05)。研究组患者出院后6个月内再住院率低于对照组(P<0.05)。结论 TCM在中重度COPD患者中的应用效果良好,可有效提高出院后自我护理能力,改善患者出院后肺通气功能及动脉血气分析指标,有利于降低再住院率。

Objective To analyze the application effect of Transitional Care Model in patients with moderate or severe chronic obstructive pulmonary disease. Methods A total of 120 patients with moderate or severe chronic obstructive pulmonary disease were selected in Shanghai Pulmonary Hospital from January 2016 to June 2017,and they were divided into control group and research group according to random number table,each of 60 cases. Patients in control group received routine nursing care and health education,while patients in research group received Transitional Care Model based on that of control group. ESCA score,index of pulmonary ventilation function and arterial blood-gas analysis results 2 days before discharge and 6 months after discharge,and re-hospitalization rate within 6 months after discharge were compared between the two groups. Results No statistically significant differences of behavior dimension for general self-care demand score,behavior dimension for deflected self-care demand score or total ESCA score was found between the two groups 2 days before discharge（P〈0.05）,while behavior dimension for general self-care demand score,behavior dimension for deflected self-care demand score and total ESCA score in research group were statistically significantly higher than those in control group 6 months after discharge（P〈0.05）. No statistically significant differences of VC,FEV1 or FEV1/FVC was found between the two groups 2 days before discharge（P〈0.05）,while VC and FEV1 in research group were statistically significantly larger than that in control group,FEV1/FVC in research group were statistically significantly higher than that in control group 6 months after discharge（P〈0.05）. No statistically significant differences of PaO2 or PaCO2 was found between the two groups 2 days before discharge（P〈0.05）;6 months after discharge,PaO2 in research group was statistically significantly higher than that in control group,while PaCO2 in research group was statistically significantly lower than that in control group（P〈0.05）. Re-hospitalization rate in research group was statistically significantly lower than that in control group within 6 months after discharge. Conclusion Transitional Care Model has good application effect in patients with moderate or severe chronic obstructive pulmonary disease,can effectively improve the post-discharge self-care ability and pulmonary ventilation function,adjust the arterial blood-gas analysis index and reduce re-hospitalization rate.