Cox健康行为互动模式在冠状动脉搭桥术患者应激反应及康复结局中的实证研究

Empirical study of Cox interaction model of client health behavior in stress response and rehabilitation outcomes in patients undergoing coronary artery bypass graft

目的探究Cox健康行为互动模式(IMCHB)护理对冠状动脉搭桥术患者应激反应及康复结局的影响,以为护理人员降低此类患者应激反应、改善康复结局提供参考。方法采用类实验研究方法,应用便利抽样法选取2023年1—6月新疆医科大学第一附属医院心脏外科择期行冠状动脉搭桥术的62例患者作为研究对象。其中2023年1—3月收治的31例患者为对照组,采取常规护理措施;2023年4—6月收治的31例患者为干预组,在常规护理的基础上采取IMCHB护理。比较2组治疗前后的焦虑抑郁、生命质量、血流动力学指标及术后首次下床活动时间、排气排便时间、心包/纵隔引流管留置时间、ICU停留时间、总住院时间情况。结果2组最终各纳入31例。对照组男28例,女3例,年龄(57.42±7.38)岁;干预组男27例,女4例,年龄(56.29±7.29)岁。干预后干预组焦虑抑郁总分、SF-36总分分别为(16.87±4.83)、(78.32±13.41)分,对照组分别为(20.81±6.35)、(69.97±11.37)分,2组比较差异均有统计学意义(t=2.75、-2.65,均P<0.05)。体外循环结束即刻(T3),干预组患者平均动脉压为(85.55±8.46)mmHg(1 mmHg=0.133 kPa),高于对照组的(74.33±17.40)mmHg,心率减少为(77.72±10.97)次/min,低于对照组的(88.35±15.96)min;体外循环开始时(T2)、离开手术室时(T4),干预组患者心率为(69.50±10.94)、(81.11±10.22)次/min,低于对照组的(77.98±14.51)、(90.47±15.44)次/min,2组比较差异均有统计学意义(t值为-3.23~3.06,均P<0.05)。干预组术后首次下床活动时间、排气时间、心包/纵隔引流管留置时间、ICU停留时间、总住院时间为(7.48±2.83)、(3.06±0.99)、(6.52±2.39)、(5.35±3.20)、(28.90±5.63)d,均明显低于对照组的(12.81±4.84)、(4.55±1.65)、(8.87±3.30)、(12.74±7.31)、(35.94±8.82)d,2组比较差异均有统计学意义(t值为3.21~5.29,均P<0.05)。结论IMCHB护理的应用可以减轻冠状动脉搭桥术患者的焦虑抑郁情绪,提升生命质量,降低患者的应激反应,改善康复结局。

Objective To explore the impact of Cox interaction model of client health behavior(IMCHB)on stress response and rehabilitation outcome in patients undergoing coronary artery bypass graft,and to provide reference for caregivers to reduce stress response in such patients and improve rehabilitation outcomes.MethodsThis was a quasi-experimental study,and 62 surgical patients undergoing coronary artery bypass graft in the cardiac surgery department of the First Affiliated Hospital of Xinjiang Medical University were selected from January to June 2023.Among them,31 patients admitted from January to March 2023 were in the control group,and routine nursing measures were taken;31 patients admitted from April to June 2023 were in the intervention group with IMCHB nursing based on this routine nursing.The anxiety,depression,quality of life,hemodynamic indicators,postoperative activity time,evacuation time,pericardial/mediastinal drainage time,ICU stay length and total hospitalization length between the two groups were compared.ResultsThere were 31 cases were admitted in each group.There were 28 males and 3 females,aged(57.42±7.38)years old in the control group.There were 27 males and 4 females,aged(56.29±7.29)years old in the intervention group.After intervention,the total score of anxiety and depression and SF-36 in the intervention group were respectively(16.87±4.83)points and(78.32±13.41)points,and the control group were(20.81±6.35)points and(69.97±11.37)points,respectively,and the differences between the two groups were statistically significant(t=2.75,-2.65,both P<0.05).Immediately after completion of cardiopulmonary bypass(T3),the mean arterial pressure in the intervention group was(85.55±8.46)mmHg(1 mmHg=0.133 kPa),higher than(74.33±17.40)mmHg in the control group,heart rate was(77.72±10.97)times/min,lower than(88.35±15.96)times/min in the control group.At the beginning of cardiopulmonary bypass(T2),and when leaving the operation room(T4),the heart rate of patients in the intervention group was(69.50±10.94),(81.11±10.22)times/min,significantly lower than(77.98±14.51),(90.47±15.44)times/min in the control group,the differences were statistically significant(t values were-3.23 to 3.06,all P<0.05).In the intervention group,first ambulation,exhaust,pericardial/mediastinal drain retention,ICU stay,total hospitalization were(7.48±2.83),(3.06±0.99),(6.52±2.39),(5.35±3.20),(28.90±5.63)d,all were significantly lower than(12.81±4.84),(4.55±1.65),(8.87±3.30),(12.74±7.31),(35.94±8.82)d in the control group with statistical differences(t values were 3.21-5.29,all P<0.05).ConclusionsThe application of Cox health behavior interaction mode can reduce the anxiety and depression in coronary artery bypass graft patients,improve the quality of life,reduce the stress response of patients,and improve the rehabilitation outcomes.