预立医疗照护计划对慢性心力衰竭患者疲乏症状和情绪状态的影响

Effects of advance care planning on fatigue symptom and psychological condition among patients with chronic heart failure

目的探讨预立医疗照护计划在慢性心力衰竭患者中的应用价值, 为预立医疗照护计划临床实践的开展提供参考。方法选择2017年10月至2019年11月阜外华中心血管病医院收治的62例慢性心力衰竭患者作为研究对象, 其中2017年10月至2018年10月入组的31例患者作为对照组, 2018年11月至2019年11月入组的31例患者作为试验组。对照组给予常规护理, 试验组在常规护理基础上实施预立医疗照护计划。干预前和干预3周后, 采用多维疲劳量表(MFI-20)和90项症状自评量表(SCL-90)评估2组患者疲乏症状和情绪状态。结果 2组患者干预前MFI-20、SCL-90评分比较差异无统计学意义(P >0.05)。干预3周后, 试验组患者MFI-20中脑力疲乏得分和总分分别为(8.23 ± 2.77)、(51.00 ± 5.03)分, 低于对照组的(10.23 ± 2.58)、(54.06 ± 5.50)分, 差异有统计学意义(t = 2.94、2.29, 均P<0.05)。干预3周后, 试验组患者SCL-90中躯体化、强迫症状、抑郁、焦虑、恐怖因子得分及总分分别为(1.28 ± 0.14)、(1.43 ± 0.09)、(1.19 ± 0.12)、(1.13 ± 0.08)、 (1.33 ± 0.07)、(121.00 ± 3.68)分, 低于对照组的(1.82 ± 0.44)、(1.73 ± 0.58)、(1.69 ± 0.12)、(1.78 ± 0.13)、(1.39 ± 0.10)、(144.69 ± 9.09)分, 差异有统计学意义(t值为2.76 ~ 23.06, 均P<0.05)。结论预立医疗照护计划能有效缓解慢性心力衰竭患者疲乏症状, 改善其情绪状态。

Objective To investigate the application value of advance care planning among patients with chronic heart failure,so as to provide reference for the clinical practice of advance care planning.Methods A total of 62 chronic heart failure patients from October 2017 to November 2019 in Fuwai Central China Cardiovascular Hospital were assigned to control group and experimental group according to the enrolled time,with 31 cases in each group.The patients in the control group from October 2017 to October 2018 recieved routine nursing,the experimental group from November 2018 to November 2019 carried out advance care planning based on the routine care.Before and after 3 weeks of intervention,the fatigue symptom and psychological condition were assessed by the Multidimensional Fatigue Inventory(MFI-20)and Symptom Checklist 90(SCL-90),respectively.Results There was no significant difference in the score of MFI-20 and SCL-90 before intervention between the two groups(P>0.05).After 3 weeks of intervention,the mental fatigue scores and total scores in MFI-20 were(8.23±2.77),(51.00±5.03)points in the experimental group,significantly lower than those in the control group(10.23±2.58),(54.06±5.50)points,the differences were statistically significant(t=2.94,2.29,all P<0.05).After 3 weeks of intervention,the somatization,obsessive symptoms,depression,anxiety,hostility scores and total score of SCL-90 were(1.28±0.14),(1.43±0.09),(1.19±0.12),(1.13±0.08),(1.33±0.07),(121.00±3.68)points in the experimental group,significantly lower than those in the control group(1.82±0.44),(1.73±0.58),(1.69±0.12),(1.78±0.13),(1.39±0.10),(144.69±9.09)points,the differences were statistically significant(t values were 2.76-23.06,all P<0.05).Conclusions Advance care planning can effectively alleviate fatigue symptom and improve psychological condition of patients with chronic heart failure.