多学科团队基于行动研究方法降低心血管介入迷走神经反射的效果

Multidisciplinary team action based approach to reduce vagal reflex in cardiovascular intervention

目的:探讨多学科团队基于行动研究方法降低心血管介入迷走神经反射的效果。方法:按照干预方式不同将1500例心血管介入治疗患者分为对照组与观察组,每组各750例;对照组给予常规护理管理,观察组在对照组的基础上组建多学科团队,采用行动研究方法管理;比较两组患者手术前后迷走神经反射发生情况,并比较两组不同时刻心率(HR)、收缩压(SBP)、平均动脉压(MAP)及手术前后血清超氧化物歧化酶(SOD)、丙二醛(MDA)水平。出院前1 d采用问卷的形式评估两组患者护理满意度。结果:观察组患者术前、术中、术后迷走神经反射发生率均低于对照组,差异均有统计学意义(2.93%vs.5.07%,P<0.05)。时间与干预方式在心率(HR)、收缩压(SBP)、平均动脉压(MAP)上均存在交互作用(P<0.05),且时间、干预方式在HR、SBP、MAP上的主效应具有统计学意义(P<0.05)。观察组在穿刺中(T1时刻)、穿刺后(T2时刻)、压迫包扎前(T3时刻)的HR、SBP、MAP均低于对照组(P<0.05)。术后1 d,两组SOD水平均低于术前,但观察组高于对照组(P<0.05);两组MDA水平均高于术前,但观察组低于对照组(P<0.05)。护理满意度调查结果显示,观察组患者健康教育、服务态度、护理主动性、关爱与沟通各维度评分及总评分均高于对照组(P<0.05)。结论:多学科团队基于行动研究方法有利于降低心血管介入患者迷走神经反射发生风险,提升患者护理满意度,值得在临床中推广应用。

Objective:To investigate the effect of multidisciplinary team action research on reducing vagal reflex of cardiovascular intervention.Methods:A total of 1500 patients who received cardiovascular interventional therapy were selected as the research objects,and they were divided into control group and observation group according to the intervention methods,with 750 patients in each group.The control group received routine nursing management,and the observation group established a multidisciplinary team based on the control group and adopted action research management.The incidence of vagus nerve reflex before,during and after operation was compared between the two groups.The heart rate(HR),systolic blood pressure(SBP),mean arterial pressure(MAP)and the levels of serum superoxide dismutase(SOD)and malondialdehyde(MDA)before and after operation were compared between the two groups at different times.The nursing satisfaction of the two groups was evaluated by questionnaire.Results:The incidence of vagal reflex in the observation group was lower than that in the control group before,during and after surgery,and the total incidence of vagal reflex between the two groups was statistically significant(2.93%vs.5.07%,P<0.05).There was interaction between time and intervention mode on heart rate(HR),systolic blood pressure(SBP)and mean arterial pressure(MAP)(P<0.05),and the main effects of time and intervention mode on HR,SBP and MAP were significant(P<0.05).HR,SBP and MAP in the observation group were lower than those in the control group during puncture(time T1),after puncture(time T2)and before compression and bandaging(time T3).On the first day after operation,the level of SOD in both groups was lower than that before operation,and the observation group was higher than the control group(P<0.05).The level of MDA in both groups was higher than that before operation,and the observation group was lower than the control group(P<0.05).The nursing satisfaction survey results showed that health education,service attitude,nursing initiative,care and communication dimension scores and total scores of patients in the observation group were higher than those in the control group(P<0.05).Conclusion:Multidisciplinary team-based action research is beneficial to reduce the risk of vagal reflex in patients with cardiovascular intervention and improve patient care satisfaction,which is worth promoting in clinical application.