矛盾意向训练联合术前访视对白内障手术患者的护理效果分析

Analysis of the Nursing Effects of Paradoxical Intention Training Combined with Pre⁃operative Visits on Cataract Surgery Patients

目的 观察矛盾意向训练联合术前访视对白内障手术患者术前心理应激及术中血压、心率波动的影响。方法 纳入2022年2月—2023年2月于六安市中医院就诊并接受手术治疗的白内障患者98例,根据信封法随机分为联合组和对照组,各49例。对照组采用常规护理和术前访视干预方法,联合组在对照组基础上联合矛盾意向训练护理。记录并比较2组患者手术时间、住院时间以及手术过程中的收缩压、舒张压和心率,计算波动范围。分别于干预前及干预后使用焦虑自评量表(SAS)及抑郁自评量表(SDS)评估患者心理状态,中文版舒适状况量表(GCQ)评估患者舒适度,中文版低视力者生活质量量表(CLVQOL)评估患者生活质量。结果 (1)围手术期指标:2组患者手术时间和住院时间比较,差异无统计学意义(P>0.05)。(2)术中血压、心率:联合组术中收缩压、舒张压及心率波动范围均低于对照组,差异均有统计学意义(t_(收缩压)=3.053,P=0.003;t_(舒张压)=3.617、t_(心率)=3.608,均P=0.001)。(3)SAS、SDS评分:2组患者干预后SAS、SDS评分均较本组干预前降低(SAS:t_(联合组)=12.571、t_(对照组)=10.121,均P=0.000;SDS:t_(联合组)=19.619、t_(对照组)=15.642,均P=0.000),联合组患者干预后SAS、SDS评分均低于对照组(t_(SAS)=3.125、t_(SDS)=3.136,均P=0.002),差异均有统计学意义。(4)GCQ评分:2组患者干预后GCQ总分均较本组干预前升高(t_(联合组)=16.011、t_(对照组)=12.831,均P=0.000),联合组患者干预后GCQ总分高于对照组(t=4.499,P=0.000),差异均有统计学意义。(5)CLVQOL评分:2组患者干预后CLVQOL各维度评分均高于本组干预前(远视力:t_(联合组)=14.267、t_(对照组)=11.065,均P=0.000;调节能力:t_(联合组)=16.767、t_(对照组)=12.015,均P=0.000;读和精细动作:t_(联合组)=20.622、t_(对照组)=20.419,均P=0.000;日常生活能力:t_(联合组)=12.493、t_(对照组)=8.298,均P=0.000),联合组患者干预后CLVQOL各维度评分均高于对照组(t_(远视力)=3.214,P=0.002;t_(调节能力)=2.859,P=0.005;t_(读和精细动作)=2.380,P=0.019;t_(日常生活能力)=2.962,P=0.004),差异均有统计学意义。结论 使用矛盾意向训练联合术前访视干预白内障手术患者,可有效缓解其术前心理应激反应,减少术中血压、心率波动范围,提升舒适度和生活质量。

OBJECTIVE To investigate the effects of paradoxical intention training combined with preoperative visits on preoperative psychological stress and intraoperative blood pressure and heart rate fluctuations in cataract surgery patients.METHODS A total of 98 cataract patients treated surgically at Lu´an Hospital of Traditional Chinese Medicine from February 2022 to February 2023 were enrolled and randomly divided into a control group(CG)and a combined group(OG),with 49 cases in each group.The control group received routine nursing care and preoperative visits,while the combined group received paradoxical intention training in addition to the control group´s care.The surgery duration,hospitalization time,systolic blood pressure,diastolic blood pressure,and heart rate during surgery were recorded and compared between the two groups.Psychological status was assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS)before and after intervention.Patient comfort was evaluated using the Chinese version of the general comfort questionnaire(GCQ),and quality of life was assessed using the Chinese low vision quality of life questionnaire(CLVQOL).RESULTS(1)Perioperative indicators:There were no statistically significant differences in surgery duration and hospitalization time between the two groups(P>0.05).(2)Intraoperative blood pressure and heart rate:The combined group had significantly lower fluctuations in systolic blood pressure,diastolic blood pressure,and heart rate during surgery compared to the control group(tsystolic=3.053,P=0.003;tdiastolic=3.617,theart rate=3.608,both P=0.001).(3)SAS and SDS scores:Post-intervention SAS and SDS scores were significantly lower in both groups compared to pre-intervention scores(SAS:tOG=12.571,tCG=10.121,both P=0.000.SDS:tOG=19.619,tCG=15.642,both P=0.000).The combined group had significantly lower SAS and SDS scores post-intervention compared to the control group(tSAS=3.125,tSDS=3.136,both P=0.002).(4)GCQ scores:Post-intervention GCQ scores were significantly higher in both groups compared to pre-intervention scores(tOG=16.011,tCG=12.831,both P=0.000).The combined group had significantly higher post-intervention GCQ scores compared to the control group(t=4.499,P=0.000).(5)CLVQOL scores:Post-intervention CLVQOL scores in all dimensions were significantly higher in both groups compared to pre-intervention scores(Distance vision:tOG=14.267,tCG=11.065,both P=0.000;Adjustment ability:tOG=16.767,tCG==12.015,both P=0.000;Reading and fine movements:tOG=20.622,tCG=20.419,both P=0.000;Daily living ability:tOG=12.493,tCG=8.298,both P=0.000).The combined group had significantly higher post-intervention CLVQOL scores in all dimensions compared to the control group(tdistance=3.214,P=0.002;tadjustment=2.859,P=0.005;treading=2.380,P=0.019;tdaily living=2.962,P=0.004).CONCLUSIONS The usage of paradoxical intention training combined with preoperative visits can effectively alleviate preoperative psychological stress reactions,reduce intraoperative blood pressure and heart rate fluctuations,and improve comfort and quality of life in cataract surgery patients.