基于PDCA循环管理配合心理疏导对ICU呼吸机相关性肺炎患者自我感受负担、应付方式及并发症的影响

Influence of PDCA cycle management combined with psychological counseling on self-perceived burden,coping styles and complications of patients with ventilator-associated pneumonia in ICU

目的:分析基于PDCA循环管理配合心理疏导对ICU呼吸机相关性肺炎(VAP)患者自我感受负担、应付方式及并发症的影响。方法:选取2015年1月至2018年1月我院ICU诊治的VAP患者72例,采用随机数字表法将其分为观察组、对照组各36例,对照组给予常规干预,观察组在此基础上实施PDCA循环管理配合心理疏导,比较两组干预前后炎症因子水平[白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)]、自我感受负担[自我感受负担量表(SPBS)]、负性情绪[医院焦虑抑郁量表(HADS)]、应付方式[医学应对问卷(MCMQ)]及并发症。结果:干预后观察组WBC、CRP、PCT水平明显低于对照组(t=-6.326,-2.930,-12.359;P<0.01);干预后观察组SPBS、HAD-A、HAD-D评分均明显低于对照组(t=-9.253,-9.434,-8.877;P<0.01);干预后观察组MCMQ问卷中面对评分高于对照组(t=5.853,P<0.01),而回避、屈服评分低于对照组(t=-5.773,-9.742;P<0.01);干预后观察组并发症发生率5.56%低于对照组22.22%(χ~2=4.181,P<0.05)。结论:基于PDCA循环管理配合心理疏导可明显改善ICU病房VAP患者炎症因子水平,减轻其自我感受负担、负性情绪,促进患者积极应对疾病,减少相关并发症,值得在临床推广实践。

Objective:To analyze the influence of PDCA cycle management combined with psychological counseling on self-perceptual burden,coping styles and complications of patients with ventilator-associated pneumonia(VAP)in ICU.Methods:A total of 72 patients with VAP diagnosed and treated in ICU of the hospital from January 2015 to January 2018 were selected.They were randomly divided into the observation group and the control group with 36 cases in each group.The control group was given routine intervention,and on this basis,the observation group was given PDCA cycle management combined with psychological counseling.Levels of inflammatory factors[white blood cell count(WBC),C-reaction protein(CRP),procalcitonin(PCT)],self-perceptual burden[Self-Perceived Burden Scale(SPBS)],negative emotions[Hospital Anxiety and Depression Scale(HADS)],coping style[Medical Coping Modes Questionnaire(MCMQ)]and complications were compared between the two groups before and after intervention.Results:The levels of WBC,CRP and PCT,scores of SPBS,HAD-A and HAD-D in the observation group were significantly lower than those in the control group after intervention(t=-6.326,-2.930,-12.359,-9.253,-9.434,-8.877;P<0.01).The facing score in MCMQ of observation group was higher than that of the control group(t=5.853,P<0.01),while scores of avoidance and yielding were lower than those of the control group after intervention(t=-5.773,-9.742;P<0.01).The incidence of complications in the observation group after intervention was lower than that in the control group(5.56%vs 22.22%)(χ~2=4.181,P<0.05).Conclusion:PDCA cycle management combined with psychological counseling can significantly improve the levels of inflammatory factors in patients with VAP in ICU,reduce their self-perceived burden and negative emotions,promote patients to actively respond to diseases,and reduce related complications.