目的: 从康复进程、疼痛情况与负面情绪等角度,评价基于Kano模型的早期康复干预对急性主动脉夹层（acute aortic dissection,AAD）术后患者的影响及临床意义。方法: 将2020年9月—2023年9月在西安交通大学第一附属医院120例AAD手术患者纳入本次研究,采用随机数表法分为观察组（行基于Kano模型的早期康复干预方案,n=62）,对照组（行常规处理,n=58）。ELISA检测患者肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、白细胞介素（interleukin,IL）-6以及C反应蛋白（C-reactive protein,CRP）水平,视觉模拟评分法（visual analogue scale,VAS）评价其疼痛情况;焦虑自评量表（self-rating anxiety scale,SAS）与抑郁量表评分（self-rating depression scale,SDS）评估其心理状态,简明健康调查量表（the 36-item short form health survey,SF-36）评估其生活质量;统计患者各项康复进程指标以及并发症发生率。结果: ①干预后两组患者术后第3,7 d VAS评分、TNF-α、IL-6以及CRP水平均呈逐渐下降的趋势,且观察组VAS评分、TNF-α、IL-6以及CRP水平均明显低于对照组;②两组患者干预后第2、4周及三个月,SAS、SDS评分均呈逐渐下降的趋势,而SF-36的各项评分均呈逐渐上升的趋势,且观察组SAS、SDS评分均明显低于对照组,SF-36的各项评分均明显高于对照组;③观察组的康复进程指标：术后呼吸机脱机、首次下床、ICU停留、引流管拔除、尿管拔除、住院时间以及并发症发生率均明显低于对照组。结论: 基于Kano模型的早期康复干预能够通过改善AAD术后患者的康复进程与疼痛情况,降低其负面情绪,使其生活质量得到有效提升。
Abstract
Objective To evaluate the effect and clinical significance of early rehabilitation intervention based on Kano model on postoperative patients with acute aortic dissection (AAD) from the perspectives of rehabilitation process, pain and negative emotion. Methods 120 patients who underwent AAD surgery in the First Affiliated Hospital of Xi’an Jiaotong University from September 2020 to September 2023 were included in this study, and were divided into an observation group (n=62) with Kano model-based early rehabilitation nursing care, and a control group (n=58) with conventional nursing care intervention by using randomized number table method. The patients' TNF-α, IL-6 and CRP levels were measured by ELISA, their pain was evaluated by VAS score, their psychological status was evaluated by SAS and SDS score, and their quality of life was evaluated by SF-36; the patients' rehabilitation process indicators and complication rates were counted. Results ①VAS score, TNF-α, IL-6 and CRP levels showed a gradual decrease in both groups on the 3rd and 7th days after the operation, and VAS score, TNF-α, IL-6 and CRP levels in the observation group were significantly lower than those in the control group; ②SAS and SDS scores showed a gradual decrease in both groups in the 2nd, 4th weeks and three months after the intervention, and SAS and SDS scores were significantly lower than those of the control group, and SF-36 scores were significantly higher than those of the control group; ③The recovery process indicators of the observation group: postoperative ventilator removal, first time out of bed, ICU stay, drain removal, urinary catheter removal, hospitalization time, and complication rate were significantly lower than those of the control group. Conclusion Early rehabilitation nursing based on the Kano model can improve the rehabilitation process and pain of postoperative AAD patients, reduce their negative emotions, and effectively improve their quality of life.
关键词
Kano 模型 /
早期康复干预 /
主动脉夹层术 /
康复情况
Key words
Kano model /
early rehabilitation intervention /
aortic coarctation /
recovery
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基金
西安交通大学第一附属医院科研基金“路径式早期康复护理在主动脉夹层术后患者中的应用”（2022HL-73）
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