中药足浴加穴位贴敷配合认知领悟疗法对重症脓毒血症连续性血液净化患者心理状态、生命质量的影响

The effects of traditional Chinese medicine foot bath and acupoint application combined with cognitive comprehend therapy on the psychological status and quality of life of patients with severe sepsis undergoing continuous blood purification

目的 探讨重症脓毒血症连续性血液净化干预中中药足浴加穴位贴敷配合认知领悟疗法对患者心理状态、生命质量的影响。方法 回顾性选取重症脓毒血症连续性血液净化患者68例,依据干预方法不同分为配合干预组、传统干预组,各34例。传统干预组患者采用传统干预方法,配合干预组患者采用中药足浴加穴位贴敷配合认知领悟疗法。比较两组肾功能、实验室指标、血流动力学、病情严重程度、心理状态、生命质量,临床疗效,并发症发生情况,不良事件发生情况,干预质量评分及住院时间,干预满意度。结果 干预后,两组患者的血肌酐(Scr)、尿素氮(BUN)、肿瘤坏死因子-α(TNF-α)、急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分、焦虑评分、抑郁评分均低于干预前,白细胞介素(IL)-1、IL-10、辅助性T淋巴细胞1/辅助性T淋巴细胞2(Th1/Th2)、血栓长度、血浆粘度、全血高切粘度、血小板粘附率、生命质量评分均高于干预前(P<0.05);干预后,配合干预组患者的Scr(108.34±13.05)mmol/L、BUN(5.62±0.61)mmol/L、TNF-α(303.10±47.70)ng/L、血栓长度(54.02±9.56)mm、血浆粘度(2.02±0.30)mPa·s、全血高切粘度(6.23±0.38)mPa·s、血小板粘附率(82.02±9.03)%、APACHEⅡ评分(12.92±1.83)分、焦虑评分(23.55±3.83)分、抑郁评分(24.54±3.85)分均低于传统干预组的(152.41±16.82)mmol/L、(7.27±0.82)mmol/L、(458.30±77.40)ng/L、(59.12±9.02)mm、(2.36±0.33)mPa·s、(6.75±0.36)mPa·s、(90.75±9.04)%、(15.07±1.96)分、(38.66±3.71)分、(38.61±3.91)分,IL-1(35.70±0.34)ng/L、IL-10(242.70±17.30)ng/L、Th1/Th2(15.12±0.47)、生命质量评分(83.66±5.11)分高于传统干预组的(31.61±0.45)ng/L、(184.10±23.90)ng/L、(10.22±0.03)、(75.80±4.94)分(P<0.05)。配合干预组患者的总有效率94.12%(32/34)高于传统干预组的73.53%(25/34)(χ^(2)=5.314,P<0.05)。配合干预组患者的并发症发生率11.76%(4/34)低于传统干预组的32.35%(11/34)(χ^(2)=4.191,P<0.05)。配合干预组患者的不良事件发生率11.76%(4/34)低于传统干预组的41.18%(14/34)(χ^(2)=7.556,P<0.05)。配合干预组患者的操作技术、干预管理评分分别为(98.72±1.14)、(95.70±1.74)分,均高于传统干预组的(80.91±1.00)、(82.62±1.95)分,住院时间(8.91±1.34)d短于传统干预组的(12.27±2.30)d(P<0.05)。配合干预组患者的干预满意度91.18%(31/34)高于传统干预组的70.59%(24/34)(χ^(2)=4.660,P<0.05)。结论 重症脓毒血症连续性血液净化干预中采用中药足浴加穴位贴敷配合认知领悟疗法较传统干预更能对患者心理状态、生命质量进行改善,是一项值得推广的护理措施。

Objective To explore the effects of traditional Chinese medicine foot bath and acupoint application combined with cognitive comprehend therapy on the psychological status and quality of life of patients with severe sepsis undergoing continuous blood purification.Methods A retrospective selection was conducted on 68 patients with severe sepsis who underwent continuous blood purification.According to different intervention methods,they were divided into combined intervention group and traditional intervention group,with 34 cases in each group.Patients in the traditional intervention group were treated with traditional intervention methods,and those in the combined intervention group were treated with traditional Chinese medicine foot bath and acupoint application combined with cognitive comprehend therapy.Both groups were compared in terms of renal function,laboratory indicators,hemodynamics,severity of illness,psychological status,quality of life,clinical efficacy,occrrence of complications,occurrence of adverse reactions,intervention quality score,hospitalization time,and intervention satisfaction.Results After the intervention,the serum creatinine(Scr),blood urea nitrogen(BUN),tumor necrosis factor-α(TNF-α),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score,anxiety score and depression score of both groups were lower than those before the intervention;the interleukin-1(IL-1),IL-10,helper T lymphocyte 1/helper T lymphocyte 2(Th1/Th2),thrombus length,plasma viscosity,whole blood high-shear viscosity,platelet adhesion rate,and quality of life score were all higher than those before the intervention(P<0.05).After the intervention,in the combined intervention group,Scr was(108.34±13.05) mmol/L,BUN was(5.62±0.61) mmol/L,TNF-α was(303.10±47.70) ng/L,the thrombus length was(54.02±9.56) mm,the plasma viscosity was(2.02±0.30) mPa·s,the whole blood high-shear viscosity was(6.23±0.38) mPa·s,the platelet adhesion rate was(82.02±9.03) %,APACHEⅡ score was(12.92± 1.83) points,the anxiety score was(23.55±3.83) points and the depression score was(24.54±3.85) points,which were lower than(152.41±16.82) mmol/L,(7.27±0.82) mmol/L,(458.30±77.40) ng/L,(59.12±9.02) mm,(2.36±0.33) mPa·s,(6.75±0.36) mPa·s,(90.75±9.04) %,(15.07±1.96) points,(38.66±3.71) points and(38.61±3.91) points in the traditional intervention group;IL-1 was(35.70±0.34) ng/L,IL-10 was(242.70±17.30) ng/L,Th1/Th2 was(15.12±0.47) and the quality of life score was(83.66±5.11) points,which were higher than(31.61±0.45) ng/L,(184.10±23.90) ng/L,(10.22±0.03) and(75.80±4.94) points in the traditional intervention group(P<0.05).The total effective rate of the combined intervention group was 94.12%(32/34),which was higher than the traditional intervention group's 73.53%(25/34)(χ^(2)=5.314,P<0.05).The complication rate in the combined intervention group was 11.76%(4/34),which was lower than the traditional intervention group's 32.35%(11/34)(χ^(2)=4.191,P<0.05).The incidence of adverse events in the combined intervention group was 11.76%(4/34),which was lower than the traditional intervention group's 41.18%(14/34)(χ^(2)=7.556,P<0.05).The operational skills and intervention management scores of the combined intervention group were(98.72±1.14) and(95.70±1.74) points,which were higher than(80.91±1.00) and(82.62± 1.95) points of the traditional intervention group;the hospitalization time of(8.91±1.34) d was shorter than(12.27±2.30) d of the traditional intervention group(P<0.05).The intervention satisfaction rate of patients in the combined intervention group was 91.18%(31/34),which was higher than the traditional intervention group's 70.59%(24/34)(χ^(2)=4.660,P<0.05).Conclusion Traditional Chinese medicine foot bath and acupoint application combined with cognitive comprehend therapy can better improve the psychological status and quality of life of patients with severe sepsis undergoing continuous blood purification intervention,which is a nursing measure worth promoting.