基于认知行为疗法的自我管理教育在心脏机械瓣膜置换术后患者中的应用效果

Application of self-management education based on cognitive behavioral therapy in patients after mechanical heart valve replacement

目的探讨基于认知行为疗法的自我管理教育在心脏机械瓣膜置换术(MHVR)后患者中的应用效果。方法选择2018年7月至2020年7月江苏省人民医院心脏大血管外科93例MHVR后患者为研究对象,采用随机数字表法将其分为对照组46例、试验组47例。对照组给予常规自我管理教育,试验组联合应用基于认知行为疗法的自我管理教育。两组均干预6个月,比较两组疾病不确定感、自我管理能力、并发症。结果干预后,两组疾病不明确性、不一致性、复杂性、不可预测性及疾病不确定感总分均低于干预前,且试验组低于对照组,差异有统计学意义(P<0.05);两组症状管理、治疗依从性管理、日常生活管理、情绪管理、信息管理、自我效能管理、自我管理能力总分均高于干预前,且试验组症状管理、日常生活管理、情绪管理、信息管理、自我效能管理、自我管理能力总分高于对照组,差异有统计学意义(P<0.05);试验组术后并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论认知行为疗法有助于缓解MHVR患者疾病不确定感,促进自我管理能力的养成,减少术后并发症的发生。

Objective To explore the application effect of self-management education based on cognitive behavioral therapy in patients after mechanical heart valve replacement(MHVR).Methods A total of 93 MHVR patients in the Department of Cardiac Great Vascular Surgery Ward,Jiangsu Provincial People’s Hospital from July 2018 to July 2020 were selected as the study subjects,and they were divided into control group 46 cases and experimental group 47 cases by random number table method.The control group received conventional self-management education,and the experimental group received self-management education based on cognitive behavioral therapy.After six months of intervention,disease uncertainty,self-management ability and complications were compared between the two groups.Results After intervention,the scores disease of uncertainty,inconsistency,complexity,unpredictability and disease uncertainty total score in two groups were lower than those before intervention,and the experimental group was lower than the control group,and the differences were statistically significant(P<0.05);the scores of symptom management,treatment compliance management,daily life management,emotion management,information management,self-efficacy management and self-management ability total score of the two groups were higher than those before intervention,and the scores of symptom management,daily life management,emotion management,information management,self-efficacy management and self-management ability of the experimental group were higher than those of the control group,and the differences were statistically significant(P<0.05);the total incidence of postoperative complications in experimental group was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion Cognitive behavioral therapy is helpful to alleviate the uncertainty of MHVR patients,promote the cultivation of self-management ability and reduce the incidence of postoperative complications.