跨理论模型联合微信随访在急性缺血性脑卒中合并血脂异常患者血脂管理中的应用

The application of transtheoretical model combined with WeChat follow-up in blood lipid management of acute ischemic stroke patients with concomitant dyslipidemia

目的探究跨理论模型联合微信随访对急性缺血性脑卒中合并血脂异常患者的血脂水平、血脂管理健康知识、态度和行为水平等方面的影响。方法前瞻性收集2022年12月至2023年11月青海省人民医院神经内科收治的急性缺血性脑卒中合并血脂异常患者,并随机分为联合干预组和常规对照组。联合干预组给予跨理论模型联合微信随访干预,常规对照组给予传统健康教育。比较两组间血脂生化指标[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(ApoA1)和载脂蛋白B(ApoB)]、血脂管理健康知识-态度-行为水平、干预依从性、护理满意度以及心理状态的差异。结果共纳入急性缺血性脑卒中合并血脂异常患者120例,联合干预组和常规对照组各60例。治疗前,两组患者在基线资料和各检测指标水平方面无统计学差异(P>0.05)。干预3个月后,两组患者的TC、TG、LDL-C和ApoB水平较干预前均显著下降(P<0.05),ApoA1、HDL-C较干预前均显著升高(P<0.05),且联合干预组患者TC、TG、LDL-C和ApoB水平显著低于常规对照组,ApoA1和HDL-C水平显著高于常规对照组(P<0.05);两组患者的血脂管理知识、态度、行为评分均升高,联合干预组患者各评分均显著高于常规对照组(P<0.05)。干预3个月后,联合干预组患者依从性和护理满意度均显著高于常规对照组(P<0.05);联合干预组的躯体化、强迫症状、人际关系、抑郁、焦虑、敌对、恐惧、偏执、精神病性评分均显著低于常规对照组(P<0.05)。结论应用跨理论模型联合微信随访可以有效改善急性缺血性脑卒中合并血脂异常患者的血脂水平,提高患者对血脂管理的健康知识、态度和行为水平,增加患者的干预依从性、护理满意度并改善患者心理状态。

Objective To explore the application of the transtheoretical model combined with WeChat follow-up on the levels of lipid levels,health knowledge of lipid management,attitudes and behaviours in acute ischemic stroke patients with concomitant dyslipidemia.Methods Data of patients diagnosed with acute ischemic stroke concomitant with dyslipidemia admitted to the Neurology Department of Qinghai Provincial People's Hospital between December 2022 and November 2023 were collected and randomly divided into the combined intervention group and the conventional control group.The combined intervention group received transtheoretical model combined with WeChat follow-up intervention,while the conventional control group received traditional health education.The differences of blood lipid biochemical indicators[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A1(ApoA1)and apolipoprotein B(ApoB)],health knowledge-attitude-behavior level of blood lipid management,intervention compliance,nursing satisfaction,and psychological status between two groups were compared.Results A total of 120 patients with acute ischemic stroke complicated by dyslipidemia were included,with 60 in the combined intervention group and 60 in the conventional control group.Before treatment,there were no statistically significant differences in baseline characteristics between the two groups(P>0.05).After three months of intervention,serum levels of TC,TG,LDL-C,and ApoB were significantly lower in both groups compared to pre-intervention levels(P<0.05),while serum levels of ApoA1 and HDL-C increased(P<0.05).Patients in the combined intervention group exhibited significantly lower levels of TC,TG,LDL-C,and ApoB compared to the conventional control group,with significantly higher levels of ApoA1 and HDL-C(P<0.05).Knowledge,attitude and behavioural scores for lipid management were elevated in both groups,with each score significantly higher in the combined intervention group than in the conventional control group(P<0.05).After 3 months of intervention,the compliance and nursing satisfaction of patients in the combined intervention group were significantly higher than those in the conventional control group(P<0.05).The scores of somatization,obsessive-compulsive symptoms,interpersonal relationships,depression,anxiety,hostility,fear,paranoia,and psychoticism in the combined intervention group were significantly lower than those in the conventional control group(P<0.05).Conclusion The application of the transtheoretical model combined with WeChat follow-up can effectively improve the lipid profiles of patients with acute ischemic stroke concomitant with dyslipidemia.It also can enhance patients'health knowledge,attitudes,and behavioral patterns regarding lipid management,increases intervention adherence and nursing satisfaction,and ameliorate psychological well-being.