术前动机性访谈护理模式对降低大血管手术后认知功能障碍的作用

目的:探讨动机性访谈技术对降低大血管手术后认知功能障碍发生率的作用.方法:选择全麻体外循环下全弓置换大血管手术病人150例,随机分为对照组和观察组,各75例.对照组术前给予常规护理指导,常规术前访视;观察组在对照组基础上采用术前动机性访谈护理模式进行心理干预.比较2组病人手术前后的焦虑自评量表评分,以及2组术后认知功能障碍发生率和转归情况;术后随访6个月,评价病人远期心理状态.结果:观察组术后2周内焦虑评分、认知功能障碍发生率、收缩压波动最大范围、镇静药物使用率、呼吸机辅助时间、24 h心包胸骨后引流量及ICU停留时间均少于对照组(P<0.05～P<0.01),撤离呼吸机后最低氧合指数明显高于对照组(P<0.01).随访6个月,观察组焦虑自评量表评分和精神障碍发生率均明显低于对照组(P<0.01).结论:术前动机性访谈护理模式能有效改善大血管手术病人紧张、焦虑等不良心理状况,降低术后认知功能障碍的发生率,并有助于改善转归,值得临床推广.

Effect of the preoperative motivational interviewing nursing mode on postoperative cognitive dysfunction in patients treated with great vessel surgery

Objective:To explore the preoperative motivational interviewing nursing mode on the incidence rate of postoperative cognitive dysfunction in patients treated with great vessel surgery.Methods:One hundred and fifty patients treated with aortic surgery with deep hypothermic circulatory arrest were randomly divided into the control group and observation group(75 cases each group).The control group was nursed with conventional care combined with visit before operation,and the observation group was additionally nursed with motivational interviewing based on control group.The scores of self-rating anxiety scale in two groups between before and after operation,and the incidence and prognosis of cognitive dysfunction after operation between two groups were compared.The long-term psychological state in two groups was evaluated after 6 months of following-up.Results:Within two weeks after operation,the anxiety score,incidence of cognitive dysfunction,variation range of systolic blood pressure,use of sedative drug,mechanical ventilation time,drainage volume during the first 24 hours and residence time in ICU in observation group were less than those in control group(P<0.05 to P<0.01),and the lowest oxygenation index in observation group was significantly higher than that in control group(P<0.01).After 6 months of following-up,the anxiety score and incidence rate of cognitive dysfunction in observation group were significantly less than those in control group(P<0.01).Conclusions:The motivational interviewing mode can effectively improve the stress and anxiety,occurrence rate of postoperative cognitive dysfunction,and prognosis of patients treated with great vessel surgery with deep hypothermic circulatory arrest,which is worthy of promotion in clinic.