冠心病介入围术期舒适护理对患者心理状态及预后的影响

目的:探讨冠心病介入治疗(PCI)围术期心理结合行为护理的舒适护理对患者心理状态及预后的影响。方法:120例拟行PCI患者行术前空腹血糖、血脂检查,所有患者按随机化分组表随机分入对照组和干预组。对照组按PCI术前和术后护理常规进行;护理干预组除按PCI术前和术后护理常规进行外给予心理及行为护理的舒适护理干预措施。对患者焦虑自评量表(SAS)和抑郁自评量表(SDS)评估进行术前1天在护理前和拔动脉鞘管后12小时进行,并同时检测血清促肾上腺皮质激素(ACTH)、血浆皮质醇(Cor)、血糖及血C反应蛋白(CRP)。所有人选患者均采用门诊或电话随访,随访终点为12个月内的不良血管事件(MACE),包括全因死亡、非致死性心肌梗死(MI)和靶病变血运重建(TLR)。结果:对照组术后的SDS评分、SAS评分、ACTH、Cor和CRP均比术前显著升高(P<0.01),干预组术后SDS评分、ACTH、Cor和CRP均比术前显著升高(P<0.01),但干预组术后SDS评分、ACTH及Cor均比对照组术后的降低(P<0.05)。干预组12个月总MACE比对照组减少(χ2=11.04,P<0.05)。经Logistic多因素回归分析围术期抑郁是影响PCI术后12个月MACE的独立影响因素(OR=1.559,95.0%CI 1.06².29,P=0.023),护理干预是负影响PCI术后12个月MACE的独立影响因素(OR=0.114,95.0%CI 0.022.29,P=0.023),护理干预是负影响PCI术后12个月MACE的独立影响因素(OR=0.114,95.0%CI 0.02⁰.84,P=0.033),护理干预是减少PCI术后12个月MACE的影响因素。结论:冠心病介入治疗围术期可引起患者抑郁的心理应激反应升高,而抑郁是冠心病介入治疗术后不良血管事件的独立影响因素,心理护理结合行为护理的舒适护理干预可减轻围术期的抑郁负性心理反应及减少术后12个月总的不良血管事件。

Influence of perioperative integrative care on stress and prognosis in patients with percutaneous coronary intervention

Objective To investigate the influence of perioperative nursing interference which comprise psychological and behavioral interference on stress and prognosis in patients with percutaneous coronary intervention.Method 120 patients with percutaneous coronary intervention had been devided into control group and interventional group randomly according to randomizational grouped table.The fasting blood glucose and blood fat of all the patients had been detected.The patients in control group had received preoperative care and postoperative care for percutaneous coronary intervention routinely.The patients in interventional group had received psychological and behavioral interference of nursing beside the routine preoperative care and postoperative care during perioperative period.The scores of self-rating depression scale（SDS） and self-rating anxiety scale（SAS） had been evaluated before preoperative care and after 12 hours of extubation for artery sheathing canal.The glucose,C-reactive protein（CRP）,adrenocorticotropic Hormone（ACTH） and cortisol（Cor） in blood had been detected at the same time.All the patients had been followed up for 12 months by outpatient or telephone after operation.The major adverse cardiovascular events（MACE） comprised a11-cause mortality,nonfatal myocardial infarction or target lesion revascularization.Results The scores of SDS and SAS,ACTH,Cor and CRP were all higher after percutaneous coronary intervention than that before percutaneous coronary intervention in control group（P 0.01）.Although the scores of SDS,ACTH,Cor and CRP were higher after percutaneous coronary intervention than that before percutaneous coronary intervention in interventional group（P 0.01）,but the scores of SDS,ACTH and Cor in interventional group reduced significantly as compared with control group respectively after operation（P 0.05）.Being analyzed by logistic multiple factor regression analysis,post-procedure depression was an independent predictor of 12-month MACE（OR = 1.559,95.0% CI 1.06 ~ 2.29,P 0.05）.Perioperative nursing interference was an negative independent predictor of 12-month MACE（OR = 0.114,95.0% CI 0.02 ~ 0.84,P 0.05）.Perioperative nursing interference was an independent factor of reducing 12 month MACE.Conclusion The perioperative depession of patients with percutaneous coronary intervention can increase.Post-procedure depression is an independent predictor of 12-month MACE.Perioperative integrative interference of psychological care combine with behavioral care can reduce the depression during perioperative period and 12-month MACE.