劉牧軍 李振南 陳丹
[摘要]目的 探討五志過極護(hù)理在體外反搏治療缺血性腦卒中(CIS)后睡眠障礙(SD)患者中的應(yīng)用效果。方法 選取2018年7月~2019年6月我院收治的120例CIS后SD患者作為研究對(duì)象,按照隨機(jī)抽簽法將其分為對(duì)照組(n=60)與研究組(n=60)。兩組均實(shí)施體外反搏治療方法,對(duì)照組采用常規(guī)內(nèi)科護(hù)理方法,研究組采用五志過極護(hù)理方法。比較兩組護(hù)理前后的匹茲堡睡眠質(zhì)量指數(shù)(PSQI)各因子評(píng)分及總分、健康SF-36量表(中文版) 評(píng)分。結(jié)果 兩組護(hù)理前的睡眠時(shí)長(zhǎng)評(píng)分、入睡時(shí)長(zhǎng)評(píng)分、日間功能評(píng)分、睡眠質(zhì)量評(píng)分、睡眠效率評(píng)分、睡眠障礙評(píng)分、總分比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05);研究組護(hù)理后的睡眠時(shí)長(zhǎng)評(píng)分為(5.15±0.45)分,高于對(duì)照組[(3.93±0.65)分],差異有統(tǒng)計(jì)學(xué)意義(P<0.05);研究組護(hù)理后的入睡時(shí)長(zhǎng)評(píng)分為(1.15±0.33)分,日間功能評(píng)分為(6.75±0.60)分,睡眠質(zhì)量評(píng)分為(1.55±0.25)分,睡眠效率評(píng)分為(0.60±0.25)分,睡眠障礙評(píng)分為(0.85±0.20)分,總分為(15.85±0.65)分,均低于對(duì)照組[(1.45±0.41)、(7.95±0.40)、(1.95±0.60)、(1.05±0.50)、(1.37±0.55)、(17.85±1.54)分],差異有統(tǒng)計(jì)學(xué)意義(P<0.05);兩組護(hù)理前的總體健康評(píng)分、生理功能評(píng)分、生理職能評(píng)分、軀體疼痛評(píng)分、活力評(píng)分、社會(huì)功能評(píng)分、情感職能評(píng)分、精神健康評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05);研究組護(hù)理后的總體健康評(píng)分為(74.65±12.30)分,生理功能評(píng)分為(72.65±13.50)分,生理職能評(píng)分為(66.75±10.45)分,軀體疼痛評(píng)分為(69.85±11.50)分,活力評(píng)分為(80.65±14.50)分,社會(huì)功能評(píng)分為(81.65±14.30)分,情感職能評(píng)分為(90.35±12.50)分,精神健康評(píng)分為(76.85±13.50)分,均高于對(duì)照組[(62.45±10.01)分、(66.35±10.30)分、(58.45±8.70)分、(63.95±10.50)、(71.70±12.30)、(74.65±12.40)、(77.75±13.50)、(66.35±12.50)分],差異有統(tǒng)計(jì)學(xué)意義(P>0.05)。結(jié)論 CIS后SD患者實(shí)施五志過極護(hù)理結(jié)合體外反搏可有效改善其PSQI各因子及總分、生活質(zhì)量評(píng)分。
[關(guān)鍵詞]五志過極護(hù)理;體外反搏;缺血性腦卒中;睡眠障礙;應(yīng)用效果
[中圖分類號(hào)] R248.9? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721(2020)7(c)-0201-04
Application effect of nursing on the five excessive emotions in the external counterpulsation treatment of patients with sleep disorders after ischemic stroke
LIU Mu-jun? ?LI Zhen-nan? ?CHEN Dan
Department of Acupuncture, Massage and Rehabilitation, Shenzhen Hospital (Futian), Guangzhou University of Chinese Medicine, Guangdong Province, Shenzhen? ?518049, China
[Abstract] Objective To explore the application effect of nursing on the five excessive emotions in the external counterpulsation treatment of patients with sleep disorder (SD) after ischemic stroke (CIS). Methods Totally 120 patients with SD after CIS treated in our hospital from July 2018 to June 2019 were selected as research subjects. They were divided into control group (n=60) and study group (n=60) by randomly drawing lots. The two groups were both treated with external counterpulsation. Meanwhile, the patients in the control group were treated with conventional nursing, and the patients in the study group were provided with the five excessive emotions nursing. The Pittsburgh sleep quality index (PSQI) factors and total scores, and the score of healthy SF-36 scale (Chinese version) were compared between the two groups before and after nursing. Results The sleep duration score, sleep latency score, daytime function score, sleep quality score, sleep efficiency score, sleep disorder score, and total score between the two groups had no significant differences (P>0.05). After nursing, the score of sleep duration in the study group was (5.15±0.45) points, which was higher than that of the control group of (3.93±0.65) points, the difference was statistically significant (P<0.05). After nursing, the sleep latency score, day function score, sleep quality score, sleep efficiency score, sleep disorder score and total score in the study group were (1.15±0.33), (6.75±0.60), (1.55±0.25), (0.60±0.25), (0.85±0.20) and (15.85±0.65) points, respectively, lower than those of the control group of (1.45±0.41), (7.95±0.40), (1.95±0.60), (1.05±0.50), (1.37±0.55) and (17.85±1.54) points, respectively, the differences were statistically significant (P<0.05). The overall health score, physiological function score, physiological role score, physical pain score, vitality score, social function score, emotional role score, and mental health score in the two groups before nursing had no significant differences (P>0.05). After treatment, the overall health score, physiological function score, physiological role score, physical pain score, vitality score, social function score, emotional role score, and mental health score in the study group were (74.65±12.30), (72.65±13.50), (66.75±10.45), (69.85±11.50), (80.65±14.50), (81.65±14.30), (90.35±12.50) and (76.85±13.50) points, respectively, higher than those of the control group of (62.45±10.01), (66.35±10.30), (58.45±8.70), (63.95±10.50), (71.70±12.30), (74.65±12.40), (77.75±13.50) and (66.35±12.50) points, respectively with statistical differences (P<0.05). Conclusion Implementing nursing on the five excessive emotions combined with external counterpulsation on patients with SD after CIS can effectively improve their PSQI factors, PSQI total score and quality of life score.
[Key words] Nursing on the five excessive emotions; External counterpulsation; Ischemic stroke; Sleep disorder; Application effect
缺血性腦卒中(CIS)后睡眠障礙(SD)為臨床常見疾病癥狀,但目前臨床醫(yī)學(xué)界尚無統(tǒng)一定義[1-2],其主要指因急性腦血管病而導(dǎo)致患者睡眠質(zhì)量紊亂、睡眠時(shí)長(zhǎng)紊亂及睡眠節(jié)律紊亂。最常見表現(xiàn)形式為失眠,而持續(xù)SD則易導(dǎo)致患者產(chǎn)生或加重焦慮情緒、抑郁情緒,導(dǎo)致患者日間生活質(zhì)量明顯下降,更增加患者的腦卒中復(fù)發(fā)風(fēng)險(xiǎn)率及病死率[3-4]。體外反搏屬于無創(chuàng)性輔助循環(huán)機(jī)械裝置,相關(guān)臨床研究顯示,運(yùn)用體外反搏起到一定的CIS后SD治療效果[5-6]。作為臨床常用CIS護(hù)理治療輔助手段體外反搏,臨床長(zhǎng)期實(shí)踐中發(fā)現(xiàn),通過體外反搏與中醫(yī)特色護(hù)理手段-五志過極護(hù)理相互結(jié)合,可明顯改善CIS后SD作用[7]。本研究旨在探討五志過極護(hù)理在體外反搏治療CIS后SD患者的應(yīng)用效果,現(xiàn)報(bào)道如下。
1資料與方法
1.1一般資料
選取2018年7月~2019年6月我院收治的120例CIS后SD患者為研究對(duì)象,采用隨機(jī)抽簽法分為對(duì)照組(n=60)與研究組(n=60)。研究組中,男34例,女26例;年齡45~80歲,平均(63.50±9.50)歲。對(duì)照組中,男36例,女24例;年齡45~80歲,平均(63.25±9.70)歲。兩組的一般資料作比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。所有患者知情同意,本研究經(jīng)醫(yī)院醫(yī)學(xué)倫理委員會(huì)審核批準(zhǔn)。納入標(biāo)準(zhǔn):①經(jīng)臨床相關(guān)檢查診斷為CIS后SD;②符合腦卒中診斷標(biāo)準(zhǔn)(1995年全國(guó)第四屆腦血管病學(xué)術(shù)會(huì)議制定)[8]。排除標(biāo)準(zhǔn):①意識(shí)障礙、神志不清患者;②合并重要臟器疾病患者;③皮膚過敏者。
1.2方法
兩組均實(shí)施體外反搏治療方法,具體為:將氣囊包扎于患者小腿、大腿、臀部分,運(yùn)用心電觸發(fā),當(dāng)心臟舒張時(shí),也就是四肢的血液往心臟涌動(dòng)的時(shí)候,序貫性地逐段加壓小腿、大腿、臀部,以驅(qū)動(dòng)血液回返,以促進(jìn)回返心臟血量;當(dāng)心臟收縮時(shí),放松氣囊,以減輕外周阻力,以減輕心臟負(fù)擔(dān),改善患者分心臟功能,改善末梢循環(huán)。
同時(shí),對(duì)照組行常規(guī)內(nèi)科護(hù)理方法,具體為:依照常規(guī)分級(jí)護(hù)理要求實(shí)施入院護(hù)理干預(yù),飲食指導(dǎo)干預(yù),用藥指導(dǎo)干預(yù),遵醫(yī)執(zhí)行護(hù)理操作干預(yù)等。
研究組在此基礎(chǔ)上實(shí)施五志過極護(hù)理方法,具體措施如下。結(jié)合四診合參以作診斷分類,以確定患者具體五志過極屬性,而制定針對(duì)性食療方案、針對(duì)性七情疏導(dǎo)護(hù)理方向、食療方案、針對(duì)性健身導(dǎo)引氣功方案及針對(duì)性穴位貼敷定穴;由專門護(hù)理人員給予患者實(shí)施入院評(píng)估,由管床護(hù)理人員負(fù)責(zé)七情疏導(dǎo)護(hù)理實(shí)施、監(jiān)督宣教;護(hù)理人員每日下午4點(diǎn)組織并分組開展學(xué)習(xí)健身功法及練習(xí)健身功法,統(tǒng)一由中藥房提供食療茶水及湯,護(hù)士指導(dǎo)患者自行熬制藥粥,2次/d;1個(gè)療程7 d,共2個(gè)療程。
1.3觀察指標(biāo)及評(píng)價(jià)標(biāo)準(zhǔn)
觀察比較兩組護(hù)理前后匹茲堡睡眠質(zhì)量指數(shù)(PSQI)各因子評(píng)分及總分[9]、健康SF-36量表(中文版)評(píng)分[10]。
采用PSQI有較高信度與效度,包括18個(gè)條目,每個(gè)成分7個(gè)因子,每個(gè)因子成分以0~3分4個(gè)等級(jí)計(jì)分,總分為累計(jì)各因子成分得分;總分范圍為0~21分;入睡時(shí)長(zhǎng)、日間功能、睡眠質(zhì)量、睡眠效率、睡眠障礙、總分維度的分值越低越好,而睡眠時(shí)長(zhǎng)維度采用反向計(jì)分,即越高越好。
健康SF-36量表(中文版)評(píng)分8個(gè)維度,36個(gè)條目,即生理機(jī)能評(píng)分、生理功能評(píng)分、軀體疼痛評(píng)分、活力評(píng)分、社會(huì)功能評(píng)分、情感職能評(píng)分、精神健康評(píng)分、總體健康狀況評(píng)分;患者得分值越高則說明其生活質(zhì)量越好。
1.4統(tǒng)計(jì)學(xué)方法
采用SPSS 21.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行分析,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,采用t檢驗(yàn);計(jì)數(shù)資料以率表示,采用χ2檢驗(yàn),以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2結(jié)果
2.1兩組護(hù)理前后PSQI各因子評(píng)分及總分的比較
兩組護(hù)理前的PSQI各因子及總分比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05);兩組護(hù)理后的睡眠時(shí)長(zhǎng)評(píng)分高于護(hù)理前,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);研究組護(hù)理后的睡眠時(shí)長(zhǎng)評(píng)分高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);兩組護(hù)理后的入睡時(shí)長(zhǎng)評(píng)分、日間功能評(píng)分、睡眠質(zhì)量評(píng)分、睡眠效率評(píng)分、睡眠障礙評(píng)分、總分低于護(hù)理前,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);研究組護(hù)理后入睡時(shí)長(zhǎng)評(píng)分、日間功能評(píng)分、睡眠質(zhì)量評(píng)分、睡眠效率評(píng)分、睡眠障礙評(píng)分、總分低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)(表1)。
2.2兩組護(hù)理前后生活質(zhì)量評(píng)分的比較
兩組護(hù)理前的生活質(zhì)量評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05);兩組護(hù)理后的生活質(zhì)量評(píng)分高于護(hù)理前,研究組護(hù)理后的生活質(zhì)量評(píng)分高于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)(表2)。
3討論
CIS主要是因?yàn)槟X局部血液循環(huán)不利,進(jìn)而導(dǎo)致患者發(fā)生神經(jīng)功能缺損綜合征,該疾病發(fā)病率較高,且病死率、致殘率也較高,易致使患者合并認(rèn)知障礙、抑郁、焦慮等精神障礙及SD等,而明顯降低患者的生活質(zhì)量,對(duì)其家庭、社會(huì)帶來嚴(yán)重經(jīng)濟(jì)負(fù)擔(dān)。SD主要指人們的睡眠質(zhì)量、睡眠時(shí)長(zhǎng)或睡眠節(jié)律紊亂[11]。CIS患者具備自身特點(diǎn),即存在CIS后病理狀態(tài),以及存在發(fā)生CIS的病理因素,同時(shí)有合并不同程度的抑郁心態(tài)、焦慮心態(tài)、狂躁心態(tài)、無助心態(tài)等[12-13]。
中醫(yī)角度而言,通過增加CIS的缺血部位血液灌流,以提高臟腑營(yíng)氣陰液補(bǔ)充,從而可治療CIS后失眠。但由于CIS的病機(jī)錯(cuò)雜,而通過補(bǔ)充營(yíng)氣陰液不足可較好改善SD[14-15]。本研究通過實(shí)施五志過極護(hù)理干預(yù)措施,可更好地達(dá)到“調(diào)和陰陽(yáng)”的效果。而對(duì)CIS患者的SD的良好改善[16]。本研究結(jié)果顯示,兩組護(hù)理前PSQI各因子評(píng)分及生活質(zhì)量評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05);研究組護(hù)理后入睡時(shí)長(zhǎng)評(píng)分、日間功能評(píng)分、睡眠質(zhì)量評(píng)分、睡眠效率評(píng)分、睡眠障礙評(píng)分、總分低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);研究組護(hù)理后睡眠時(shí)長(zhǎng)評(píng)分、總體健康評(píng)分、生理功能評(píng)分、生理職能評(píng)分、軀體疼痛評(píng)分、活力評(píng)分、社會(huì)功能評(píng)分、情感職能評(píng)分、精神健康評(píng)分高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);提示運(yùn)用中醫(yī)特色護(hù)理的五志過極護(hù)理干預(yù)措施,通過將以五志過化火理論與中醫(yī)特色護(hù)理相互結(jié)合,更好提高個(gè)體化治療效果,對(duì)于CIS后SD的疾病特點(diǎn),可取得良好的改善效果,以改善其預(yù)后、提高其生活質(zhì)量[17-18]。
綜上所述,臨床結(jié)合CIS后SD患者疾病特點(diǎn),在給予體外反搏治療中,聯(lián)合五志過極護(hù)理干預(yù)措施,有效改善其PSQI各因子及總分,有效提高其生活質(zhì)量評(píng)分,改善疾病預(yù)后,臨床有較高的應(yīng)用價(jià)值。
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(收稿日期:2019-08-15)