认知行为干预联合综合心脏康复在急性失代偿性心力衰竭患者护理中的效果观察

Effect observation of cognitive behavioral intervention combined with comprehensive cardiac rehabilitation in the care of patients with acute decompensated heart failure

目的探讨认知行为干预联合综合心脏康复在急性失代偿性心力衰竭(ADHF)患者临床护理中的应用效果。方法选取2021年12月—2022年12月在医院诊治的ADHF患者118例,按照组间基本特征具有可比性的原则分为对照组和观察组各59例。对照组给予常规干预,观察组在对照组基础上给予认知行为干预联合综合心脏康复模式。比较两组干预前、干预3个月、干预6个月的自我效能、抑郁情绪、体能状况、运动耐力、认知功能、认知衰弱、生活质量,以及干预前、干预6个月纽约心脏协会分级(NYHA)心功能分级。结果双因素方差分析结果显示,两组患者干预3个月、6个月后自我效能感量表(GSES)评分、简易体能状况量表(SPPB)评分、6 min步行距离(6MWT)、简明精神状态检查表(MMSE)均随时间逐渐升高(P时间<0.05),并且各时点各项指标均以观察组患者高于对照组(P组间<0.05);而两组患者的汉密尔顿抑郁量表(HAMD-24)评分、Fried评分、堪萨斯城心肌病问卷(KCCQ-12)、明尼苏达心功能不全生命质量问卷(MLHFQ)均随时间逐渐降低(P时间<0.05),并且各时点各项指标均以观察组患者低于对照组(P组间<0.05)。干预6个月,两组患者的NYHA心功能分级均明显改善,但观察组患者的NYHA心功能分级优于对照组,差异有统计学意义(P<0.05)。结论认知行为干预联合综合心脏康复模式应用于ADHF患者,可有效提高患者的自我效能,缓解抑郁情绪,减轻认知衰弱,提高体能状况、运动耐力、认知功能以及生活质量。

Objective To investigate the application effect of cognitive behavioral intervention combined with comprehensive cardiac rehabilitation in the care of patients with acute decompensated heart failure(ADHF).Methods To select 118 ADHF patients diagnosed and treated in the hospital from December 2021 to December 2022,they were divided into a control group and an observation group of 59 cases each according to the principle of comparability of basic characteristics between groups.The control group was given conventional intervention,and the observation group was given cognitive behavioral intervention combined with a comprehensive cardiac rehabilitation model on the basis of the control group.The self-efficacy,depressed mood,physical status,exercise tolerance,cognitive function,cognitive frailty,quality of life,and New York Heart Association(NYHA)cardiac function classification before intervention and 6 months after intervention were compared between the two groups before intervention,3 months after intervention,and 6 months after intervention.Results The results of two-factor analysis of variance showed that the general selfefficacy scale(GSES)score,short physical performance battery(SPPB)score,6-minute walking distance(6MWT),and mini-mental state examination(MMSE)of the two groups of patients gradually increased over time after 3 months and 6 months of intervention(P<0.05),and all indicators at each time point were higher in the observation group than in the control group(P<0.05);while the Hamilton depression scale(HAMD-24)scores,Fried scores,Kansas city cardiomyopathy questionnaire(KCCQ-12)scores,and Minnesota living with heart failure questionnaire(MLHFQ)scores of the two groups of patients gradually decreased over time(P<0.05),and all indicators at each time point were lower in the observation group than in the control group(P<0.05).After 6 months of intervention,the NYHA cardiac function classification of patients in both groups improved significantly,the NYHA cardiac function classification of patients in observation group was better than that in the control group,,and the differences were statistically significant(P<0.05).Conclusion The application of cognitive behavioral intervention combined with comprehensive cardiac rehabilitation model in patients with ADHF can effectively improve patients'self-efficacy,relieve depression,reduce cognitive decline,and improve physical condition,exercise tolerance,cognitive function and quality of life.