聚焦解决护理模式联合心脏康复对慢性心力衰竭患者的效果分析

Analysis of the effect of solution-focused nursing approach combined with cardiac rehabilitation in patients with chronic heart failure

目的 研究聚焦解决护理模式联合心脏康复对慢性心力衰竭患者的效果。方法 76例慢性心力衰竭患者,随机分为对照组和观察组,每组38例。对照组患者给予常规干预,观察组患者在对照组基础上给予聚焦解决护理模式联合心脏康复干预。比较两组患者入组时、干预结束后的自我效能感、自我管理能力、临床相关生化指标、心功能相关指标、生活质量及心血管不良事件发生情况。结果 干预结束后,两组患者一般自我效能感量表(GSES)评分和自我管理能力评分均高于本组入组时,且观察组患者GSES评分(28.63±5.05)分、自我管理能力评分(85.95±8.54)分明显高于对照组的(23.54±4.26)、(73.76±7.11)分,差异具有统计学意义(P<0.05)。干预结束后,两组患者的心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、N-末端脑钠肽前体(NT-proBNP)水平均较本组入组时下降,且观察组患者cTnI(0.16±0.02)ng/ml、CK-MB(8.51±0.92)U/L、NT-proBNP(117.21±16.48)pg/ml均低于对照组的(0.32±0.04)ng/ml、(14.19±2.00)U/L、(150.65±23.79)pg/ml,差异具有统计学意义(P<0.05)。干预结束后,两组患者左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)小于本组入组时,心脏指数(CI)、每搏输出量(SV)、左心室射血分数(LVEF)高于本组入组时, 6 min步行距离(6MWT)长于本组入组时,且观察组患者LVEDD(46.62±2.66)mm、LVESD(31.76±1.69)mm小于对照组的(54.23±3.10)、(41.16±2.07)mm, CI(3.04±0.45)L/(min·m2)、SV(67.40±7.14)ml、LVEF(52.96±6.45)%高于对照组的(2.69±0.40)L/(min·m2)、(56.65±6.37)ml、(47.52±5.75)%, 6MWT(532.74±48.72)m长于对照组的(405.94±41.65)m,差异具有统计学意义(P<0.05)。观察组患者心血管不良事件发生率为2.63%,低于对照组的21.05%,差异具有统计学意义(P<0.05)。干预结束后,两组患者心理情绪、体力限制、疾病状况、社会关系评分及总分均低于本组入组时,且观察组患者低于对照组,差异具有统计学意义(P<0.05)。结论 对慢性心力衰竭患者实施聚焦解决护理模式联合心脏康复干预有利于提高其自我效能与自我管理能力,能够较好地改善心力衰竭症状、心功能以及生活质量,还可减少心血管不良事件的发生。

Objective To study the effect of solution-focused nursing approach combined with cardiac rehabilitation in patients with chronic heart failure. Methods A total of 76 patients with chronic heart failure were randomly divided into control group and observation group, with 38 patients in each group. Patients in the control group received conventional intervention, while patients in the observation group received solutionfocused nursing approach combined with cardiac rehabilitation on the basis of the control group. Both groups were compared in terms of self-efficacy, self-management ability, clinical related biochemical indicators, cardiac function related indicators, quality of life at the time of enrollment and the end of intervention, and occurrence of adverse cardiovascular events. Results At the end of the intervention, the general self-efficacy scale(GSES) scores and self-management ability scores of patients in both groups were higher than those at the time of enrollment in this group;the GSES score(28.63±5.05) points and self-management ability score(85.95±8.54) points of patients in the observation group were significantly higher than(23.54±4.26) and(73.76±7.11) points in the control group;the differences were statistically significant(P<0.05). At the end of the intervention, the levels of cardiac troponin I(cTnI), creatine kinase isoenzyme(CK-MB), and N-terminal probrain natriuretic peptide(NT-proBNP) were decreased in both groups compared to those at the time of enrollment;the observation group had cTnI of(0.16±0.02) ng/ml, CK-MB of(8.51±0.92) U/L, and NT-proBNP of(117.21±16.48) pg/ml, which were lower than(0.32±0.04) ng/ml,(14.19±2.00) U/L, and(150.65±23.79) pg/ml in the control group;the differences were statistically significant(P<0.05). At the end of the intervention, the left ventricular end-diastolic diameter(LVEDD) and left ventricular end-systolic diameter(LVESD) of patients in both groups were less than those at the time of enrollment in this group, and the cardiac index(CI), stroke volume(SV),and left ventricular ejection fraction(LVEF) were higher than those at the time of enrollment in this group, and the 6-min walk test(6MWT) was longer than that at the time of enrollment in this group;the LVEDD(46.62±2.66) mm and LVESD(31.76±1.69) mm in the observation group were less than(54.23±3.10) and(41.16±2.07) mm in the control group;the CI(3.04±0.45) L/(min·m2), SV(67.40±7.14) ml, LVEF(52.96±6.45)% in the observation group were higher than(2.69±0.40) L/(min·m2),(56.65±6.37) ml,(47.52±5.75) % in the control group;the 6MWT(532.74±48.72) m in the observation group was longer than(405.94±41.65) m in the control group;the differences were statistically significant(P<0.05). The incidence of cardiovascular adverse events in the observation group was 2.63%, which was lower than 21.05% in the control group, and the difference was statistically significant(P<0.05). At the end of the intervention, the psycho-emotional, physical limitation, disease status, social relationship scores and total scores of patients in both groups were lower than those at the time of enrollment in this group, and the patients in the observation group were lower than those in the control group, and the difference was statistically significant(P<0.05). Conclusion The implementation of solution-focused nursing approach combined with cardiac rehabilitation intervention for patients with chronic heart failure is beneficial to improve their self-efficacy and self-management ability, better improve heart failure symptoms, cardiac function and quality of life, and reduce the occurrence of adverse cardiovascular events.