基于知信行理论护理干预对NTM肺病患者呼吸康复排痰依从性的影响

Effect of nursing intervention based on the knowledge-attitude-practice theory on the expectoration compliance of respiratory rehabilitation in patients with NTM lung disease

目的探讨基于知信行理论的护理干预对非结核分枝杆菌(NTM)肺病合并支气管扩张患者呼吸康复排痰依从性及生活质量的影响。方法选取2022年3月至2023年6月广州市胸科医院非结核分枝杆菌病诊疗中心内一科收治的98例NTM肺病合并支气管扩张、伴有胸闷气促患者进行随机对照试验,采用随机数字表法将患者分为观察组(49例)与对照组(49例)。对照组男17例,女32例,年龄(61.08±13.23)岁,中位年龄62.0岁。观察组男19例,女30例,年龄(59.65±11.29)岁,中位年龄62.0岁。两组均指导进行呼吸康复排痰训练,对照组采用常规护理,观察组在对照组的基础上采用知信行理论护理干预。两组均干预1周。比较两组患者干预前、出院1周、出院1个月呼吸康复排痰知信行水平(自行设计的NTM合并支气管扩张患者呼吸康复排痰知信行现状调查问卷)、呼吸康复排痰依从性(呼吸康复排痰依从性量表)和生活质量[中文版莱斯特咳嗽问卷(LCQ-MC)]。采用独立样本t检验、配对t检验、χ^(2)检验。结果观察组出院1周、出院1个月呼吸康复排痰知信行水平均高于对照组(均P<0.05);观察组出院1周、出院1个月呼吸康复排痰依从性[(3.12±0.53)分、(2.76±0.52)分]均高于对照组[(2.90±0.51)分、(2.27±0.45)分](均P<0.05);观察组出院1周、出院1个月LCQ-MC生理维度[(5.00±0.97)分、(5.00±1.03)分]、心理维度[(5.35±1.01)分、(5.22±1.08)分]、社会维度评分[(5.31±1.02)分、(5.20±0.98)分]、LCQ-MC总分[(15.66±2.42)分、(15.42±2.31)分]均高于对照组[(4.52±1.18)分、(4.27±1.13)分;(4.70±1.11)分、(4.65±1.08)分;(4.58±1.15)分、(4.56±1.20)分;(13.80±2.68)分、(13.49±2.64)分](均P<0.05)。结论基于知信行理论的护理干预能有效提高NTM肺病合并支气管扩张患者的呼吸康复排痰依从性及舒适度,改善患者的生活质量。

Objective To explore the effects of nursing knowledge-attitude-practice(KAP)theory on the expectoration compliance of respiratory rehabilitation and quality of life in patients with nontuberculous mycobacterium(NTM)lung disease complicated with bronchiectasis.Methods A randomized controlled trial was conducted on 98 patients with NTM lung disease combined with bronchiectasis,chest tightness,and shortness of breath admitted to the non-tuberculous Mycobacteriosis Diagnosis and Treatment Center of Guangzhou Chest Hospital from March 2022 to June 2023.The patients were divided into an observation group(49 cases)and a control group(49 cases)by the random number table method.In the control group,there were 17 males and 32 females,aged(61.08±13.23)years,with a median age of 62.0 years old.In the observation group,there were 19 males and 30 females,aged(59.65±11.29)years,with a median age of 62.0 years old.Both groups were instructed to undergo respiratory rehabilitation expectoration training.The control group was given routine nursing,and the observation group was given nursing intervention based on the KAP theory based on routine nursing.Both groups were treated for 1 week.The KAP level of respiratory rehabilitation expectoration(self-designed questionnaire on the KAP status quo of respiratory rehabilitation expectoration in NTM patients with bronchiectasis),expectoration compliance of respiratory rehabilitation(respiratory rehabilitation expectoration compliance scale),and quality of life[Leicester Cough Questionnaire in Mandarin-Chinese(LCQ-MC)]were compared between the two groups before intervention,1 week and 1 month after discharge.Independent sample t test,paired t test,andχ^(2) test were used.Results The KAP level of respiratory rehabilitation expectoration in the observation group was higher than that in the control group 1 week and 1 month after discharge(both P<0.05).The expectoration compliance of respiratory rehabilitation 1 week and 1 month after discharge in the observation group[(3.12±0.53)points and(2.76±0.52)points]were higher than those in the control group[(2.90±0.51)points and(2.27±0.45)points](both P<0.05).The scores of physiological dimension[(5.00±0.97)points and(5.00±1.03)points],psychological dimension[(5.35±1.01)points and(5.22±1.08)points],and social dimension[(5.31±1.02)points and(5.20±0.98)points]and total score of the LCQ-MC[(15.66±2.42)points and(15.42±2.31)points]in the observation group 1 week and 1 month after discharge were higher than those in the control group[(4.52±1.18)points,(4.27±1.13)points,(4.70±1.11)points,(4.65±1.08)points,(4.58±1.15)points,(4.56±1.20)points,(13.80±2.68)points,and(13.49±2.64)points](all P<0.05).Conclusion Nursing intervention based on the KAP theory can effectively improve the expectoration compliance of respiratory rehabilitation in patients with NTM lung disease complicated with bronchiectasis,and improve the patients'comfort and quality of life.