以格林模式为框架的强化护理模式在冠心病不稳定型心绞痛患者中的实践研究

Intensive nursing mode based on Green model for patients with unstable angina pectoris of coronary heart disease

目的探究以格林模式为框架的强化护理模式在冠心病不稳定型心绞痛(UAP)患者中的应用价值。方法选取2020年4月至2022年1月无锡市第二人民医院心内科收治的118例冠心病UAP患者进行随机对照试验,随机数字表法分为强化组和对照组,各59例。强化组男32例,女27例,年龄(61.37±10.81)岁,实施以格林模式为框架的强化护理模式。对照组男34例,女25例,年龄(61.52±10.64)岁,实施常规护理模式。采用模糊综合评价法评价患者健康行为水平,采用简易应对方式问卷(SCSQ)评估患者应对方式,采用西雅图心绞痛问卷(SAQ)评估患者机体状态与生存质量,采用超声心动图观察患者左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)。采用t检验和χ^(2)检验。结果干预后,两组定期复查、戒烟戒酒、运动、饮食、遵医用药健康行为评分与总分均较干预前升高(均P<0.05),且强化组上述评分均高于对照组[(17.37±2.49)分(比16.42±2.34)分、(18.64±1.33)分比(17.58±1.27)分、(17.61±2.43)分比(16.75±2.19)分、(16.90±2.74)分比(15.71±2.46)分、(18.68±1.23)分比(17.46±1.14)分、(89.20±14.63)分比(83.92±14.19)分,t=2.136、4.427、2.019、2.482、5.588、1.990,均P<0.05]。干预后,两组患者积极应对方式评分均高于干预前(均P<0.05),消极应对方式评分均低于干预前(均P<0.05),且强化组积极应对方式评分高于对照组[(22.78±2.83)分比(19.54±2.44)分,t=6.660,P<0.05],消极应对方式评分低于对照组[(7.36±1.05)分比(9.81±1.17)分,t=11.971,P<0.05]。干预后,两组患者疾病认知程度、心绞痛稳定状态、心绞痛发作情况、躯体活动受限程度和满意度评分均高于干预前(均P<0.05),且强化组上述评分均高于对照组[(84.07±4.15)分比(73.42±5.23)分、(87.63±3.91)分比(75.71±4.57)分、(89.29±3.58)分比(72.86±5.62)分、(86.24±4.07)分比(77.53±4.65)分、(93.29±2.69)分比(87.93±4.36)分,t=12.253、15.223、18.939、10.826、8.036,均P<0.05]。强化组护理期间心血管不良事件发生率与再住院率均低于对照组[3.39%(2/59)比16.95%(10/59)、1.69%(1/59)比13.56%(8/59),χ^(2)=4.546、4.330,均P<0.05]。干预后,两组LVEF均高于干预前,LVEDD、LVESD均低于干预前(均P<0.05),且强化组LVEF高于对照组[(56.94±8.02)%比(51.42±7.56)%;t=3.847,P<0.05],LVEDD、LVESD低于对照组[(51.87±5.37)mm比(55.24±5.13)mm、(42.06±4.31)mm比(45.46±4.68)mm,t=3.486、4.105,均P<0.05]。结论以格林模式为框架的强化护理模式应用于冠心病UAP患者的护理中能更有效改善患者健康行为、应对方式、机体状态与生存质量,降低心血管不良事件发生率与再住院率,提升康复效果。

Objective To explore the value of intensive nursing mode based on the Green model for patients with unstable angina pectoris(UAP)of coronary heart disease.Methods One hundred and eighteen patients with UAP of coronary heart disease treated in Department of Cardiology,Wuxi Second People's Hospital from April 2020 to January 2022 were selected for the random control trial.They were divided into an enhancement group and a control group by the random number table method,with 59 cases in each group.There were 32 males and 27 females in the enhancement group;they were(61.37±10.81)years old.There were 34 males and 25 females in the control group;they were(61.52±10.64)years old.The enhancement group implemented the intensive nursing mode based on the Green model.The control group implemented the routine nursing mode.The fuzzy comprehensive evaluation method was used to evaluate their health behavior level;the Simple Coping Style Questionnaire(SCSQ)was used to evaluate their coping style;the Seattle Angina Questionnaire(SAQ)was used to evaluate their body status and quality of life;echocardiography was used to observe their left ventricular ejection fractions(LVEF),left ventricular end diastolic diameters(LVEDD),and left ventricular end systolic diameters(LVESD).t andχ^(2)tests were applied.Results After the intervention,the scores of taking reexamination regularly,quitting smoking and drinking,exercise,diet,and medication compliance and total score of health behaviors were higher than those before the intervention in the two groups(all P<0.05);the above scores of the enhancement group were higher than those of the control group[(17.37±2.49)vs.(16.42±2.34),(18.64±1.33)vs.(17.58±1.27),(17.61±2.43)vs.(16.75±2.19),(16.90±2.74)vs.(15.71±2.46),(18.68±1.23)vs.(17.46±1.14),and(89.20±14.63)vs.(83.92±14.19);t=2.136,4.427,2.019,2.482,5.588,and 1.990;all P<0.05].After the intervention,the scores of positive coping style in the two groups were higher than those before the intervention(both P<0.05),while the scores of negative coping style were lower than those before the intervention(both P<0.05);the score of positive coping style in the enhancement group was higher than that in the control group[(22.78±2.83)vs.(19.54±2.44);t=6.660,P<0.05],while the score of negative coping style was lower than that in the control group[(7.36±1.05)vs.(9.81±1.17);t=11.971,P<0.05].After the intervention,the scores of disease cognition,stable state of angina pectoris,angina pectoris attack,physical activity limitation,and satisfaction in the two groups were higher than those before the intervention(all P<0.05);the above scores of the enhancement group were higher than those of the control group[(84.07±4.15)vs.(73.42±5.23),(87.63±3.91)vs.(75.71±4.57),(89.29±3.58)vs.(72.86±5.62),(86.24±4.07)vs.(77.53±4.65),and(93.29±2.69)vs.(87.93±4.36);t=12.253,15.223,18.939,10.826,and 8.036;all P<0.05].The incidence of cardiovascular adverse events during nursing period and rehospitalization rate in the enhancement group were lower than those in the control group[3.39%(2/59)vs.16.95%(10/59)and 1.69%(1/59)vs.13.56%(8/59);χ^(2)=4.546 and 4.330,both P<0.05].After the intervention,the LVEF's in the two groups were higher than those before the intervention,and the LVEDD's and LVESD's were lower than those before the intervention(all P<0.05);the LVEF of the enhancement group was higher than that of the control group[(56.94±8.02)%vs.(51.42±7.56)%;t=3.847,P<0.05],and the LVEDD and LVESD were lower than those of the control group[(51.87±5.37)mm vs.(55.24±5.13)mm and(42.06±4.31)mm vs.(45.46±4.68)mm;t=3.486 and 4.105,both P<0.05].Conclusion Intensive nursing mode based on Green model for patients with UAP of coronary heart disease can more effectively improve their health behaviors,coping style,body state,and quality of life,reduce the incidence of cardiovascular adverse events and rehospitalization rate,and improve the rehabilitation effect.