HFEMA联合认知行为干预在心因性过度换气综合征患者中的应用

The application of HFMEA combined with cognitive behavioral intervention in relieving discomfort symptoms of patients with psychogenic hyperventilation syndrome

目的探讨医疗失效模式与效应分析(HFEMA)联合认知行为干预在缓解心因性过度换气综合征患者临床症状及预防复发中的应用效果。方法2017年1月至2018年12月收治的393例心因性过度换气综合征患者为研究对象。其中2017年1月至2017年12月的222例为对照组,2018年1月至2018年12月的171例为观察组。对照组按原急诊处置流程进行干预,观察组给予HFMEA联合认知行为干预改进后新流程进行干预,比较2组患者的不适症状缓解情况、心理应激程度的调整状况及1年内的复发情况。结果2组患者在30 min内、4 h内和24 h内症状累计缓解率比较,差异有统计学意义(χ^2值分别为9.58、31.687和21.394,P<0.01)。观察组1年内的复发率为4.06%,对照组为27.93%,2组患者复发率比较,差异有统计学意义(χ^2值为37.91,P<0.01)。不同时间测量2组患者焦虑自评量表(SAS)和抑郁自评量表(SDS)评分,2组较干预前均有降低,且观察组的SAS和SDS评分低于对照组,2组差异有统计学意义(P<0.01)。结论HFEMA联合认知行为干预的模式,优化了心因性过度换气综合征患者的救治流程、提升护理质量,也使患者切实受益,迅速缓解了症状、调节了心理应激的程度、减少了复发率,值得推广。

Objective To investigate the application effects of healthcare failure mode and effect analysis(HFMEA)combined with cognitive behavioral intervention in relieving clinical symptoms of patients with psychogenic hyperventilation syndrome and in preventing recurrence.Methods A total of 393 patients with psychogenic hyperventilation syndrome who were admitted and treated in our hospital from January 2017 to December 2018 were enrolled in the study,of whom,the 222 patients who were admitted and treated in our hospital from January 2017 to December 2017 were enrolled as control group,and the other 171 patients who were admitted and treated in our hospital from January 2018 to December 2018 were enrolled as observation group.The patients in control group were intervened according to the primary emergency treatment process,however,the patients in observation group were intervened by the new improvement process of the HFMEA combined with cognitive behavioral therapy.The relief staus of discomfort symptoms,the adjustment of psychological stress degree and the recurrence rate within one year were observed and compared between the two groups.Results There were significant differences in remission rates of clinical symptome within 30m,4h,24h between the two groups(P<0.01).The relapse rate within 1 year in observation group was 4.06%,which was significantly lower than that(27.93%)in control group(P<0.01).After intervention,the scores of self-rating anxiety scale(SAS)and self-rating depression scale(SDS)in both groups were significantly decreased,moreover,which in observation group were significantly lower than those in control group(P<0.01).Conclusion The pattern of HFMEA combined with cognitive behavioral intervention can optimize the treatment process for the patients with psychogenic hyperventilation syndrome,improve the nursing quality,which can quickly alleviate the symptoms,regulate the degree of psychological stress and reduce the recurrence rate,therefor,which is worth of promotion in clinical practice.