基于跨理论模型的护理管理对吻合器痔上黏膜环切术后混合痔患者疼痛、心理和康复质量的影响

Effect of nursing management based on cross th eoretical model on pain,psychology,and rehabilitation quality of patients with mixed hemorrhoids after procedure for prolapse and hemorrhoids

目的 探讨基于跨理论模型的护理管理对混合痔患者采用吻合器痔上黏膜环切术(PPH)后疼痛、心理及康复质量的影响。方法 前瞻性纳入2019年1月至2022年12月安徽省亳州市人民医院采用PPH进行治疗的混合痔患者120例。采用随机数字法将其分为对照组和观察组,各60例。对照组采用常规专科护理,观察组应用基于跨理论模型的护理管理。比较两组术后12、24 h和48 h视觉模拟评分法(VAS)评分,比较两组术前,术后3、7 d的焦虑自评量表(SAS)和抑郁自评表(SDS),康复质量(术后首次排尿时间和持续时间、首次排便时间和持续时间、肛门创缘水肿和便血评分及便秘发生率)。结果 整体分析发现:两组VAS评分组间、时间点比较差异均有统计学意义(P<0.05)。进一步两两比较,组内比较:两组术后24、48 h的VAS评分低于术后12 h,术后48 h的VAS评分低于术后24 h,差异有统计学意义(P<0.05);组间比较,观察组术后12、24、48 h的VAS评分均低于对照组,差异有统计学意义(P<0.05)。整体分析发现:两组SAS、SDS评分组间、时间点及交互作用比较,差异均有统计学意义(P<0.05)。进一步两两比较,组内比较:术后3、7 d的SAS、SDS评分低于术前,术后7 d的SAS、SDS评分低于术后3 d,差异有统计学意义(P<0.05);组间比较,观察组术后3、7 d的SAS、SDS评分均低于对照组,差异有统计学意义(P<0.05)。观察组首次排尿时间和持续时间、首次排便时间和持续时间短于对照组,水肿和便血评分低于对照组,便秘发生率低于对照组,差异有统计学意义(P<0.05)。结论 基于跨理论模型的护理管理能够进一步减轻混合痔患者PPH术后的疼痛体验,降低焦虑和抑郁风险,改善康复质量,是一种新型优质护理模式,值得推广应用。

Objective To explore effect of nursing management based on cross theoretical model on pain,psychology,and rehabilitation quality of patients after procedure for prolapse and hemorrhoids(PPH) in mixed hemorrhoids patients.Methods A total of 120 patients with mixed hemorrhoids treated with PPH in Bozhou People's Hospital,Anhui Province from January 2019 to December 2022 were prospectively included.They were divided into control group and observation group by random number table method,with 60 cases in each group.The control group received routine specialized nursing,and the observation group received nursing management based on cross theoretical model.Visual analogue scale(VAS)scores at 12,24 h,and 48 h after surgery,self-rating anxiety scale(SAS) and self-rating depression scale(SDS) before surgery at 3 and 7 days after surgery were compared between the two groups.The quality of rehabilitation,including the time and duration of first urination,the time and duration of first defecation,the score of traumatic anal edema and blood stool,and the incidence of constipation were compared between the two groups.Results Overall analysis showed that there were significant differences in VAS scores between groups and at time points between the two groups(P <0.05).Further pound-wise comparison,intra-group comparison:24 and 48 h after surgery,VAS scores of the two groups were lower than those 12 h after surgery,48 h after surgery VAS scores were lower than 24 h,the differences were statistically significant(P<0.05).The scores of VAS 12,24 h and 48 h after surgery in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The overall analysis showed that there were statistically significant differences in SAS and SDS scores among groups,time points,and interactions between the two groups(P<0.05).Further pairwise comparison,intra-group comparison:SAS and SDS scores 3 and 7 d after surgery were lower than those before surgery,and SAS and SDS scores 7 d after surgery were lower than that 3 d after surgery,the differences were statistically significant(P<0.05).The scores of SAS and SDS in the observation group were lower than those in the control group at 3 and 7 d after operation,and the difference was statistically significant(P<0.05).The first urination time and duration,the first defecation time and duration in the observation group were shorter than those in the control group,the scores of edema and blood stool were lower than those in the control group,and the incidence of constipation was lower than that in the control group,and the differences were statistically significant(P<0.05).Conclusion Nursing management based on the cross theoretical model can further reduce the pain experience after mixed hemorrhoid PPH,reduce the risk of anxiety and depression,and improve the quality of rehabilitation,which is a new high-quality nursing model,worthy of promotion and application.