Zhao Suyun (趙素云), Song Hong (宋 鴻)

Department of Intervention, Suzhou City Hospital, Suzhou 234000, China

ABSTRACT OBJECTIVE: To study the effects on self-efficacy and quality of life in patients undergoing coronary intervention,by traditional Chinese medicine nursing combined with refined nursing. METHODS: A total of 124 patients, who needed to undergo coronary intervention in our hospital, were randomly divided into the fine group and the combined group, with 62 patients in each group. The two groups of patients were enrolled in the PCI routine nursing procedure, in which the fine group was given refined nursing, and the joint group, based on that, added the traditional Chinese medicine nursing. The self-management (self-management scale of coronary heart disease), self-efficacy (self-efficacy scale of coronary heart disease), quality of life score (Seattle angina questionaire (SAQ), TCM symptom score] of the two groups were observed before and after treatment. The incidence of postoperative complications after nursing intervention was recorded. RESULTS: After nursing intervention, each score and total scores of the self-administration scale of the combined group were higher than those of the fine group (P ＜ 0.05). After the nursing intervention, each score and the total scores of the self-efficacy scale of the combined group were higher than the fine group (P ＜ 0.05) After the nursing intervention, the SAQ score of the combined group was significantly higher than that of the fine group (P ＜ 0.05). After the nursing intervention, TCM symptom score of the combined group was significantly lower than that of the fine group(P ＜ 0.05). After nursing intervention, the postoperative complication rate of the combined group was 79.03%, which was lower than that of the fine group (59.68%) (P ＜ 0.05). CONCLUSION: Patients with coronary intervention, who use traditional Chinese medicine combined with refined nursing, can improve their quality of life, clinical symptoms and postoperative complications by improving their self-management and efficacy, which is conducive to the recovery of patients' follow-up.

KEYWORDS: Coronary intervention; Traditional Chinese medicine nursing; Refined

Coronary atherosclerotic heart disease is an organic stenosis and obstruction of the coronary arteries,which causes heart disease due to ischemia, hypoxia or necrosis. It is called coronary heart disease together with coronary artery spasm. With the continuous improvement of per capita material and living standards in recent years, people's lifestyles and dietary patterns etc. have undergone major changes, leading to a significant increase in the incidence of coronary heart disease, and a tendency to develop younger. Its disability and mortality rates is the first among cardiovascular disease[1]. At present, the common treatments for coronary heart disease include drugs, surgery, and intervention. Among them, coronary intervention is effective, and the trauma to the body is relatively small, and the course of treatment is short.It has become one of the main means of blood transfer reconstruction in patients with coronary heart disease[2].

The study by He Cuizhu et al[3]found the problems as follows: surgery cannot reverse the pathological process of coronary atherosclerosis and patients are prone to different degrees of physiological and psychological response after surgery. The patient's self-management level is generally low, and has certain impact on the surgical effect and prognosis. Thus a good nursing model is particularly important. Based on thar, this paper combines TCM characteristic nursing with refined nursing to observe the self-efficacy and quality of life of patients undergoing coronary intervention. The results of the study are reported as follows.

MATERIALS AND METHODS

General information

A total of 124 patients with coronary intervention who need to undergo coronary intervention from March 2015 to March 2018 were seclected in the study. According to the random number table method,the patients were divided into the fine group and the combined group, with 62 patients in each group. There were 35 males and 27 females in the fine group; the age ranged from 40 to 72 years old, with an average of(53.14±11.72) years; the course of disease was 0.5 to 10 years, with an average of (4.27±2.26) years; the number of stents was as follows: 1 in 22 cases, 2 in 27 cases,3 cases and above in 13 cases; comorbidities were as follows: 46 cases of hypertension, 25 cases of diabetes, 33 cases of hyperlipidemia; and 28 cases of family history.There were 39 males and 23 females in the combined group; the age ranged from 40 to 72 years old, with an average of (54.66±12.05) years; the course of disease was 0.5 to 10 years, with an average of (4.52±1.33) years;the number of stents was as follows: 1 in 23 cases, 2 in 25 cases, 3 cases and above in 14 cases; comorbidities are as followss: 40 cases of hypertension, 28 cases of diabetes,31 cases of hyperlipidemia; and 30 cases of family history. There was no significant difference in the general information between the two groups (P ＞ 0.05).

Inclusion criteria: ①All are in line with the diagnostic criteria for coronary heart disease in Internal Medicine[4], and are planned for coronary interventional surgery; ②All are in line with Diagnostic Criteria for Blood Stasis Syndrome in the "Guidelines for Clinical Research of New Drugs in Traditional Chinese Medicine (Trial)"[5]③All are the first to undergo coronary intervention and have no surgical related contraindications; ④Postoperative condition is stable, and has no serious complications; ⑤All have no cognitive,understanding, hearing, vision and other obstacles,and can accurately understand the scale content, have normal communication and express self-willingness and appeal; ⑥Patients and their families are all informed and volunteered to participate in this study; ⑦The study was approved by the Medical Ethics Committee of our hospital.

Exclusion criteria: ① surgical failure or serious complications; ②serious deterioration and death during the intervention; ③ poor compliance, unable to accept relevant interventions, nursing, review, etc. on time;④ combination with serious heart, lung, liver, renal dysfunction, autoimmune system defects; ⑤ combination with primary malignant tumors, and infectious diseases;⑥ a history of mental illness, vague thinking and consciousness.

Methods

Both groups of patients were adopted in the PCI routine nursing procedures, including: on-time drug delivery, PCI treatment, medical advice, medical record,vital signs monitoring, diet and exercise guidance, etc.,in which fine group was given refine nursing and joint group, on this basis, added traditional Chinese medicine treatment.

Fine nursing

Admission nursing: ①After admission, the responsible nurse introduced the inpatient environment to the patient and family members, explaining the admission instructions, informing the accompanying nursing system,etc., and establishing a good relationship between the nurses and patients; ②The responsible nurse had a gereral understanding of the situation of the patient and provided targeted instructions on common knowledge of diseases, surgical instructions, adverse reactions of drugs and postoperative complications, etc. He/she promptly answered patients' questions, providing psychological counseling to patients with nervous emotions such as nervousness, anxiety, and worry, and introducing patients to successful cases to maintain a good mentality, so that patients could actively cooperate with inspection and treatment.

Surgical nursing: ①Nurse stablized the patients'nervousness before operation, communicating with the expression, eyes, handshake, etc., so that they had a feeling of being cared for and respected. Patients are informed that the nursing staff would accompany them during the operation; ②When a patient entered in the operation room, he/she was awake. According to the patient's age and understanding ability, appropriate positive suggestive language to communicate with other medical staff, was choosen to help patients establish surgical confidence and relieve pre-operative tension.

Postoperative nursing: ①Patients and their family members were timely informed of the successful operation news, and patients' various signs were monitored; ②Family members of patients were informed of the possible complications and preventive exercise,and appropriate early functional training according to the patient's recovery; ③Patients and their family members of patients were informed of the importance of good living habits, timely getting answers to their questions, so that they can build confidence in rehabilitation.

Discharge nursing: ①Nurses explained to the patient and family members the home care process,operation methods and precautions after discharge,and enjoined the patients to take regular diet, strike a balance between work and rest. If you were ill, come to the hospital immediately; ②according to the recovery manual and patient situation, nurses made exercise plan and informed the review time.

Traditional Chinese medicine nursing

TCM emotional nursing: ① temperament and interest overwhelm each other. Nursing staff care for patients with bad emotions, according to the constraints of the five phases, such as: over sadness harms lungs,and joy overwhelms sorrow; over joy harms heart and fear overwhelms happiness; over fear harms kidney and thinking overwhelms fears; thinking harms spleen and anger overwhelms thinking; anger harms liver and sadness overwhelms anger. The patient's psychological emotions, should be properly guided, and the intensity and duration of the emotions should be focused, to avoid excessive stimulation and new problems.

② Empathy: empathy is to appropriately shift the patient's attention, dilute and eliminate bad emotions, and receive examination and treatment with a relaxed and happy attitude.

③ Language enlightenment: Telling the patient about the hazards of the disease is to inform the patients of the need for treatment; Pointing out the favorable treatment of the disease, is to patiently comfort the patient and take good care of the patient's daily routine;Guiding the patient to undergo appropriate treatment is to inform patients about disease, and surgery related attention matters; Advising the patient by using the pain of illness to is to try to find emotional knots, help patients improve bad mood, enhce patient cooperation,and reduce negative emotions.

④ Five notes therapy: According to the traditional medical theory, five notes refer to Gong, Shang, Jiao, Zhi,Yu, which are in correspondence with five zang viscera.In the course of nursing, according to the patient's emotion, appropriate music can be choosen to release the patients'tension.

Acupuncture point massage of Chinese medicine:Take the acupuncture points of Gongsun (SP 4), Taichong(LV 3), Zusanli (ST 36), Shenmen (HT 7), Xuehai(HT 7) and Neiguan (PC 6) for massage. Massage intensity: according to patient's condition from light to heavy; frequency of massage: 5-10min/time, 2 times/d;massage time: admission to discharge.

Observation indicators

The scores of self-management, self-efficacy and quality of life of the two groups were observed before and after treatment, and the incidence of postoperative complications after nursing intervention was recorded.

Self-management[6]

Before and after the nursing intervention, the patients and their families were given a self-management scale for coronary heart disease. The scale consisted of 27 items, including 7 dimensions and they were respectively daily life management, bad habit management, disease knowledge management, symptom management,emergency management, treatment compliance management, and emotional cognition management, with 1 to 5 points for each item. And the total score is from 27 to 135 points, The higher the score is, the higher the selfmanagement level is.

Self-efficacy[7]

Before and after t he nursing intervention, the patients and their families were given a self-efficacy scale for coronary heart disease. The scale consisted of 14 items, including 2 dimensions of functional maintenance and symptom maintenance, with 0 to 4 points for each item. And the total is from 0 to 56 points. The higher the score is, the stronger the self-efficacy is.

Quality of life[8-9]

① Seattle angina questionaire (SAQ): The Seattle angina questionnaire was distributed to patients and their family members before and after nursing intervention.The questionnaire consisted of 19 items. The higher the score is, the better the quality of life is.

TCM symptom scores: Refer to relevant symptoms in the "Evaluation of Diagnostic Criteria for TCM Syndrome of Post-interventional Coronary Heart Disease", including physical weakness, chest pain,spontaneous sweating, palpitations, shortness of breath,and mental disability. The point is from 0 to 3 and the score is from 0 to 18. The lower the score is, the better the recovery is.and sboth were bilateral tests.

RESULTS

Self-management of patients before and after nursing intervention

After the nursing intervention, the scores and total scores of the self-administration scale of the combined group were higher than those of the fine group (P ＜ 0.05).See Table 1.

Complications

Postoperative complications included difficulty in sfalling asleep, back pain, cerebral hemorrhage, urinary retention, and pseudoaneurysm.

Self-efficacy of patients before and after nursing intervention

After the nursing intervention, the scores and total scores of the self-efficacy scale in the combined group were higher than those in the fine group (P ＜ 0.05). Sees Table 2.

Life quality of patients before and after nursing intervention

After nursing intervention, the SAQ score of the combined group was significantly higher than that of the fine group (P ＜ 0.05). After the nursing intervention, the TCM symptom score of the combined group was significantly lower than that of the fine group (P ＜ 0.05). See Table 3.

Statistical methods

The data in this paper were processed by statistical software SPSS17.0. The data was input into EXCEl form by doubles. The measurement material was expressed by Mean±SD (xˉ±s). When the normal distribution and variance were consistent, an independent sample t test was used between the two groups. Counting data was expressed by the number of cases (%), and the disordered classification data was expressed by using χ2test. P ＜0.05 is considered statistically significant,

Postoperative complications after nursing intervention

After nursing intervention, the postoperativecomplication rate was 79.03%, which was lower than that of the fine group of 59.68% (P ＜ 0.05). See Table 4.

Table 1. Self-management of patients before and after nursing intervention (x-±S, points))

Table 2. Self-efficacy of patients before and after nursing intervention (x-±S, points)

Table 3. Life quality of patients before and after nursing intervention (x-±s, points)

Table 4 Postoperative complications after nursing intervention [cases (%)]

DISCUSSION

Coronary intervention is currently the safest and most effective angioplasty technique. It can mechanically occlude blood vessels and relieve clinical symptoms.However, most of the surgical patients are middleaged and elderly people and have basic diseases related.Moreover, the disease and surgery related knowledge is less understood. Pre-existing anxiety, depression and other emotions, and postoperative lifelong illness, are common,having the psychological pressure on patients[10].

The postoperative condition is still complicated and the course of disease is relatively long. Some patients have relatively weak self-management and efficacy improvement. The traditional nursing mode is only a single knowledge infusion, which is relatively lack of physical and mental care for patients, and cannot effectively improve patient compliance. It has serious influence on operation impact and is not conducive to prognosis

Modern medical nursing believes that choosing the right nursing mode during the perioperative period can enhance the surgical results. Fine nursing is a highquality nursing model focusing on the needs of patients.By scientific and efficient humanized nursing mode, it optimizes nursing services while establishing a good relationship between nurses and patients, regulating nursing behaviors from nursing details, improving the quality of comprehensive nursing, and reducing the incidence of surgical accidents and postoperative complications[11].

Traditional Chinese medicine believes that surgical treatment of stagnation and blood consumption, mostly lead to qi and blood loss for postoperative patients, and both show a certain degree of mental dysfunction, poor mood, having a certain impact on the surgical outcome and prognosis[12]. Traditional Chinese medicine nursing is a comprehensive nursing mode under the guidance of the basic theory of traditional Chinese medicine. It is a series of nursing methods obtained through a large number of clinical practice, helping patients to improve the therapeutic effect from physiology to psychological,thus helping them to obtain the ideal therapeutic experience[13].

This paper combines two nursing models and finds that combined nursing can not only improve patient selfmanagement ability and self-efficacy, but also improve quality of life and postoperative complications, which is similar to the research achivements of Lin Xueqin[14].The special nursing of traditional Chinese medicine can strengthen the targeted nursing on the basis of fine nursing. It can consciously alleviate the bad emotions of patients through the method of mutual generation and restriction of the seven emotions, help them release positive emotions, establish their confidence in rehabilitation and improve the compliance of treatment.Patients with vascular smooth muscle, to some extent,can relieve coronary artery spasm by point stimulation,and thus relieve the preoperative and postoperative discomfort[15].

In summary, traditional Chinese medicine combined with refined nursing can improve the self-management and efficacy of patients undergoing coronary intervention,improve the clinical symptoms, improve the quality of life, ensure the surgical treatment effect, and reduce postoperative complications.