以家庭为单位的护理在COPD稳定期患者自我管理中的应用

A family-based intervention on self-management of stable paitents with Chronic Obstructive Pulmonary Disease

目的:本研究采用以家庭为单位的护理干预模式,对COPD稳定期的患者实施肺康复,评价康复的临床效果。方法:随机选取合肥市第一人民医院呼吸内科2017年12月至2018年6月收治的COPD患者,采用随机数字表法将其分成对照组与实验组。对照组给予常规护理干预,实验组在此基础上,将患者家庭成员纳入康复计划中,出院后进行跟踪访视。出院前和出院6个月对患者行6分钟步行实验(6 Minute Walking Distance,6MWD)、呼吸困难评分(manufacturing Management Research Center,mMRC)和Borg主观疲劳程度量表(Borg)、COPD评估测试(COPD Assessment Test,CAT)和ADL。结果:实验组出院前和出院6个月的6MWD[(332.64±40.53)m vs(350.72±48.88)m]、mMRC[(2.33±0.86)分vs(1.14±0.83)分]、Brog[(2.42±1.03)分vs(1.19±1.17)分]、CAT[(20.17±4.29)分vs(16.27±4.87)分]和ADL[(87.50±10.99)分vs(94.31±7.19)分]比较,出院6个月较出院前有所改善,差异有统计学意义(P<0.05)。对照组出院前和出院6个月的6MWD[(331.36±60.94)分vs(340.86±72.59)分]、mMRC[(2.47±0.91)分vs(1.94±1.04)分]、Brog[(2.72±0.95)分vs(2.32±1.12)分]、CAT[(19.94±3.16)分vs(17.39±4.05)分]和ADL[(80.56±16.25)分vs(83.47±16.68)分]比较,出院6个月较出院前有所改善,差异有统计学意义(P<0.05)。实验组和对照组干预前后各评价指标差值比较分别为6MWD是[(18.06±15.96)m vs(9.50±18.52)m]、mMRC是[(1.19±0.58)分vs-(0.53±0.61)分]、Brog是[(2.72±0.95)分vs-(0.40±0.68)分]、CAT是[-(3.89±2.73)分vs-(2.56±1.80)分]和ADL是[(6.81±7.67)分vs(2.92±6.02)分],实验组差值高于对照组,差异有统计学意义(P<0.05)。结论:以家庭为单位的护理干预模式能有效提高COPD患者的自我管理能力,改善患者呼吸困难程度,提高其生活自理能力,增强活动耐力。

Objective:To explore the effects of a family-based intervention on self-management of stable patients with Chronic Obstructive Pulmonary Disease(COPD).Methods:Patients with COPD in the Respiratory Department of Hefei First People’s Hospital from December 2017 to June 2018 were selected and randomly divided into the control group and the experimental group using the table of random digit.Routine care was given to the patients in the control group.Besides routine care,family members of the patients in the experimental group were invited to join in the rehabilitation plan and follow-up visits after discharge.The outcomes we evaluated included 6-Minute Walking Distance(6 MWD),dyspnea score(manufacturing Management Research Center,mMRC)and subjective fatigue scale(Borg),quality of life(CAT questionnaire),and daily self-care ability score(ADL).Results:For patients in the experimental group,the 6 MWD[(332.64±40.53)m vs(350.72±48.88)m],mMRC[(2.33±0.86)vs(1.14±0.83)],Brog[(2.42±1.03)vs(1.19±1.17)],CAT[(20.17±4.29)vs(16.27±4.87)]and ADL[(87.50±10.99)vs(94.31±7.19)]were all significantly improved before discharge and 6 months after discharge(P<0.05).The similar effects were also observed in the control group with 6 MWD[(331.36±60.94)m vs(340.86±72.59)m],mMRC[(2.47±0.91)vs(1.94±1.04)],Brog[(2.72±0.95)vs(2.32±1.12)],CAT[(19.94±3.16)vs(17.39±4.05)]and ADL[(80.56±16.25)vs(83.47±16.68)]all improved before discharge and 6 months after discharge(P<0.05).The 6 MWD[(18.06±15.96)m vs(9.50±18.52)m],mMRC[(1.19±0.58)vs-(0.53±0.61)],Brog[(2.72±0.95)vs-(0.40±0.68)],CAT[-(3.89±2.73)vs-(2.56±1.80)],and ADL[(6.81±7.67)vs(2.92±6.02)]between the two groups were significantly different with better outcomes found in the experimental group(P<0.05).Conclusion:The family-based intervention can effectively improve the self-management ability of patients with COPD,improve the degree of dyspnea,improve their self-care abilities,and enhance their endurance of activity.