冠心病心脾两虚失眠症患者症状体验的质性研究

A qualitative study of experience symptoms on insomnia patients with heart-spleen deficiency in coronary heart disease

目的对冠心病心脾两虚患者进行访谈,以期为医护人员全面掌握冠心病心脾两虚失眠症患者的症状提供依据,并对患者进行科学性的症状管理,促进患者心脏康复。方法采用现象学研究法,对18例冠心病心脾两虚失眠症患者进行半结构式访谈,运用Colaizzi 7步分析法对访谈资料进行分析。分别从冠心病心脾两虚失眠症患者症状感知、症状评估、症状反应3方面分析。症状感知(perception)包括3个主题:躯体症状感知(神疲乏力;冠心病相关症状包括胸闷心慌,气促气短,心悸健忘,头晕头痛,肢体麻木,头身困重,腰膝酸软,耳鸣,畏寒肢冷;疼痛,胸痛;以及夜尿频繁)、心理症状感知(紧张焦虑抑郁,情绪遗留现象)、社会适应改变。症状评估(evaluation):包括2个主题:分为主观、客观两方面。客观原因(包括疾病因素,工作性质、生活环境、突发生活事件等)。主观原因(包括性格因素、电子产品使用、睡眠认知)。症状反应(response):包括3个主题:身体与行为(身体与用药行为、身体与饮食行为、身体与运动、身体与中医护理技术);心理与行为;社会文化与行为。结果冠心病心脾两虚失眠症患者在症状体验方面有多种表现及诸多影响因素,但多数患者担心西药的不良反应,不愿意采取西药治疗失眠,在中药汤剂的服用上存在难坚持性,愿意尝试中医中药以及中医护理技术等方式促进睡眠。结论医护人员可以进行中医护理技术方案,并对冠心病心脾两虚患者症状进行有效的干预,以改善冠心病患者的双心健康,并提高患者自我管理能力。

Objective To interview patients with heart and spleen deficiency of coronary heart disease,in order to provide medical staff with a comprehensive grasp of the symptoms of insomnia patients with heart and spleen deficiency of coronary heart disease,and to carry out scientific symptom management for patients,to promote patients'cardiac rehabilitation.Methods Semi-structured interviews were conducted on 18 patients with insomnia of heart and spleen deficiency in coronary heart disease by phenomenological method.Colaizzi 7-step analysis method was used to analyze the interview data.The symptom perception,symptom assessment and symptom response of insomnia patients with heart and spleen deficiency in coronary heart disease were analyzed.Perception consists of 3 themes:somatic symptom perception(fatigue;CHD related symptoms include chest tightness and palpitation,shortness of breath,palpitation and forgetfulness,dizziness and headache,limb numbness,heavy head and body sleepiness,waist and knee tenderness,tinnitus,fear of cold limb cold;pain,chest pain;frequent nocturia),psychological symptom perception(tension,anxiety,depression,emotional legacy phenomenon),social adaptation changes.The symptom evaluation includes two themes:objective reasons(including disease factors,work nature,living environment,sudden life events,etc.)and subjective reasons(including personality factors,use of electronic products,and sleep cognition).Symptom response includes three themes:body and behavior(body and medication behavior,body and diet behavior,body and exercise,body and TCM nursing technology),psychology and behavior,and social culture and behavior.Results Patients with insomnia in CHD have a variety of manifestations and many influencing factors,but most of the patients are worried about the adverse reactions of western medicine,unwilling to take western medicine to treat insomnia,willing to try TCM and traditional Chinese nursing technology,and other ways to promote sleep.Conclusions Medical staff can carry out traditional Chinese medicine nursing technical plan,and effectively intervene the symptoms of patients with heart and spleen deficiency of coronary heart disease,so as to improve the double-heart health of patients with coronary heart disease,and improve patients self-management ability.