聚焦解决模式在冠脉搭桥手术患者呼吸功能训练中的应用

Clinical Study of Focused Solution Approach on Respiratory Function Training of Patients Undergoing Coronary Artery Bypass Grafting

目的探讨聚焦解决模式(solution focused approach,SFA)对冠脉搭桥手术(CABG)患者呼吸功能训练的影响。方法选取111例CABG患者,观察组55例采用SFA对患者在围术期的呼吸功能进行干预训练;对照组56例按照常规健康教育模式对患者进行呼吸功能的训练。比较2组手术前后呼吸功能锻炼知识掌握情况、医学应对方式、呼吸功能锻炼的依从性、咳嗽方式的掌握、术前术后潮气量、术后咳嗽时疼痛程度的评分和肺部并发症。结果观察组在呼吸功能锻炼知识(29.73±8.23)、医学应对方式面对(6.14±3.63)得分,术前(9.62±0.87)和术后(7.93±0.26)的呼吸功能锻炼依从性得分,手术前潮气量得分第1天(519.39±17.39)、术后第3天(398.80±11.95)、术后第7天(508.70±10.50),均高于对照组的(14.86±4.64)、(3.02±3.30)、(8.02±0.08)、(7.50±0.85)、(480.84±11.04)、(369.80±12.95)及(469.50±12.07);观察组回避得分(-3.93±2.97)、屈服得分(-1.91±2.69),低于对照组的(-1.39±2.49)和(-0.38±2.69),差异有统计学意义(P<0.01或<0.001);观察组在术前咳嗽方式的掌握情况均好于对照组,差异有统计学意义(P<0.05);观察组手术后第4～7天的连续测量显示观察组疼痛评分第4天(2.27±0.52)、第5天(1.64±0.98)、第6天(1.07±0.99)和第7天(0.36±0.75),均低于对照组的(3.09±2.47)、(1.98±1.24)、(1.77±0.76)和(0.89±1.00),差异有统计学意义(P<0.05或<0.01);观察组术后并发症发生率3.6%,低于对照组的19.6%,差异有统计学意义(P<0.05)。结论 SFA提高了CABG患者呼吸功能锻炼的依从性,引导患者转变医学应对方式,提高了CABG患者对自我呼吸功能管理的积极性,使患者的呼吸功能知识和咳嗽技巧的掌握情况得到提高,从而减轻患者术后咳嗽的疼痛和术后肺部并发症。以SFA为基础的呼吸功能训练研究是一种较可行、有效的干预方式,可以作为临床心脏外科呼吸功能锻炼领域中一种新的健康教育应用方式。

Objective To investigate the effect of Solution Focused Approach (SFA) on respiratory function training in patients undergoing coronary artery bypass grafting (CABG).Methods A total of 111 patients with CABG were selected by questionnaire and quantitative data collection.The patients were divided into intervention group (n =55) in one area and the control group (n =56) in another area.The respiratory function training was carried out through SFA in the intervention group and using the routine health education model in the control group during the perioperative period.The knowledge of respiratory function training,medical coping style,compliance of respiratory function exercise,mastery of cough mode,preoperative and postoperative tidal volume,postoperative cough pain score and pulmonary complications were used as evaluation indexes.Results Compared with the control group [(14.86±4.64),(3.02 ± 3.30),(-1.39±2.49),(-0.38±2.69),(8.02± 0.08),(7.50± 0.85),(480.84±11.04),(369.8±12.95),(469.5±12.07)],the knowledge of respiratory function training (29.73± 8.23);medical coping style including latitude score of face (6.14± 3.63),avoidance (-3.93±2.97) and yield (-1.91±2.69);preoperative (9.62±0.87) and postoperative (7.93±0.26) compliance of respiratory function exercise,tidal Volume Score of the first day before operation (519.39±17.39),the third postoperative day (398.8±11.95) and the 7th postoperative day (508.7±10.50) of the observation group was significant higher respectively (P <0.05 or <0.001).The preoperative mastery of cough mode in the observation group was better than that of the control group (effective cough: P < 0.05;cough with incision: P <0.05);while postoperative cough pain score in the fourth day (2.27±0.52),in the fifth day (1.64± 0.98),in the sixth day (1.07± 0.99),in the 7th day (0.36±0.75) in the observation group was significant lower than that of the control group [(3.09± 2.47),(1.98± 1.24),(1.77± 0.76),(0.89±1.00)](P <0.05 or <0.01).The incidence of postoperative complications in the observation group was 3.6%,which was lower than 19.6% in the control group.The difference was statistically significant (P <0.05).Conclusion The SFA health education model improved the compliance of patients with CABG on respiratory function training,guided the patients to change the medical coping style,improved the initiative of self respiratory function management for the patients with CABG,improved the patient’s knowledge of respiratory function training and coughing skills,so as to reduce the patient’s suffering postoperative cough pain and postoperative pulmonary complications.The study of respiratory function training based on SFA is a more feasible and effective way of intervention.It could be used as a new way of health education in the field of respiratory function training in clinical cardiac surgery.