叙事医学联合抗阻训练对慢性心力衰竭患者心理健康及心功能的影响

Effect of narrative nursing combined with resistance training on mental health and cardiac function in patients with chronic heart failure

目的观察叙事医学联合抗阻训练对慢性心力衰竭(CHF)患者心理健康及心功能的影响,探讨CHF患者的康复方案。方法使用前瞻性随机对照试验的方法,选取2019年3月至2021年2月收治的112例CHF患者,以随机数字表法平均分为观察组和对照组,每组56例。对照组实施抗组训练,同时接受常规护理干预,观察组加用叙事医学干预,2组均以12个月为评价终点。观察指标包括心理指标[焦虑自评量表(SAS)、心理弹性量表(CD-RISC)],运动依从性,心功能[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)]。结果入组112例CHF患者,随访期间观察组和对照组分别剔除4例和2例,最终观察组52例,对照组54例患者完成研究。完成干预后,2组患者在SAS评分均降低,CD-RISC评分均升高,观察组评分相比对照组得到显著改善,差异有统计学意义(P<0.05)。观察组依从性86.54%,高于对照组68.52%,差异有统计学意义(P<0.05)。完成干预后,2组LVEF均上升,LVEDD、LVESD均减少,观察组LVEDD、LVESD相比对照组得到显著改善,差异有统计学意义(P<0.05);但2组干预后LVEF比较,差异无统计学意义(P>0.05)。结论CHF患者接受叙事医学联合抗阻训练用于CHF患者中能够通过减少焦虑,改善心理健康的途径,提高患者运动依从性,促进心功能改善。

Objective To observe the effect of narrative nursing combined with resistance training on mental health and cardiac function of patients with chronic heart failure(CHF),and to explore the rehabilitation plan for CHF patients.Methods Using a prospective randomized controlled trial method,totally 112 CHF patients who received diagnosis and treatment in our hospital from March 2019 to February 2021 were enrolled as research objects.The patients were randomly assigned into the observation group(n=56)and the control group(n=56).All patients were managed by routine nursing and resistance training,and the patients in the observation group were additionally treated narrative nursing.The evaluation end point of both groups was 12 months.The observation indicators included psychological indicators such as Self-rating Anxiety Scale(SAS)and Connor-Davidson resilience scale(CD-RISC),exercise compliance,cardiac function such as left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)were inclued as comparisons between groups.Results A total of 112 CHF patients were enrolled in the study.During the follow-up period,four patients in the observation group and 2 patients in the control group were excluded.Finally,fifty-two patients in the observation group and 54 patients in the control group completed the study.After intervention,SAS scores decreased while the CD-RISC score increased in both groups.The significantly lower SAS score and significantly higher CD-RISC score were detected in the observation group compared with the control group(both P<0.05).The compliance of the observation group was significantly higher than that in the control group(86.54%vs 68.52%,P<0.05).After intervention,significantly increased LVEF and significantly decreased LVEDD and LVESD were found in both groups.LVEDD and LVESD in the observation group were significant decreased than those in the control group(P<0.05),but difference was not significant in LVEF between the two groups after intervention(P>0.05).Conclusion Narrative nursing combined with resistance training for CHF patients can improve the exercise compliance by reducing anxiety and improving mental health,so as to improve exercise tolerance and cardiac function.