目的: 探讨基于行为分阶段转变理论（transtheoretical model and stages of change,TTM）的护理干预方案在慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）稳定期患者中的价值。方法: 选择2021年1月至2023年5月我院收治的186例COPD稳定期患者,随机数字表法分观察组与对照组,各93例。对照组出院前1周开始常规护理干预,观察组在对照组基础上给予基于TTM的护理干预,两组均干预6月。干预前及干预6月后,比较两组患者肺功能[第1秒用力呼气容积占预计值百分比（percentage of forced expiratory volume in one second,FEV1%）、第1秒用力呼气容积（forced expiratory volume in one second,FEV1）、FEV1/用力肺活量（FEV1/forced vital capacity,FVC）]、6分钟行走试验（6-minute walk test,6MWT）距离、血气指标[氧分压（PaO2）、二氧化碳分压（PaCO2）、氧饱和度（oxygen saturation,SaO2）]、呼吸困难程度。结果: 干预后,两组FEV1%、FEV1、FEV1/FVC、6MWT均增加,且观察组高于对照组,差异有统计学意义（t=2.463、5.248、3.391、4.208,P均<0.05）。干预后,两组PaO2、SaO2均增加,且观察组高于对照组（t=8.371、5.458,P均<0.05）,两组PaCO2均下降,且观察组低于对照组,差异有统计学意义（t=8.128,P均<0.05）。干预后,观察组呼吸困难整体情况优于对照组,观察组呼吸困难1级人数40.86%显著高于对照组21.51%,3级人数21.51%显著低于对照组40.86%（P<0.05）。结论: 基于TTM的护理干预方案能够提高COPD稳定期患者肺功能及运动耐力,改善其血气指标,减少呼吸困难情况。
Abstract
Objective To explore the value of nursing intervention scheme based on the transtheoretical model and stages of change (TTM) in stable chronic obstructive pulmonary disease (COPD) patients. Methods A total of 186 patients with stable COPD treated in our hospital from January 2021 to May 2023 were selected and divided into observation group and control group by random number table method, with 93 cases in each group. The control group started routine nursing intervention 1 week before discharge, and the observation group gave TTM based nursing intervention based on the control group, and both groups intervened for 6 months. Before the intervention and 6 months after the intervention, the lung function [percentage of forced expiratory volume in one second (FEV1%) of the predicted value, forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC)], 6-minute walk test (6MWT) distance, blood gas indicators [partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), oxygen saturation (SaO2)], and degree of dyspnea of the two groups were detected and compared. Results After intervention, FEV1%, FEV1, FEV1/FVC and 6MWT were increased in both groups, and the observation group was higher than the control group, the difference was statistically significant (t=2.463, 5.248, 3.391, 4.208, P<0.05). After intervention, PaO2 and SaO2 increased in both groups, and the observation group was higher than the control group (t=8.371 and 5.458, P<0.05) ; PaCO2 decreased in both groups, and the observation group was lower than the control group, the difference was statistically significant (t=8.128, P<0.05). After the intervention, the overall dyspnea in the observation group was better than that in the control group, the number of grade 1 patients in the observation group was 40.86% significantly higher than that in the control group, and the number of grade 3 patients in the observation group was 21.51% significantly lower than that in the control group (P<0.05). Conclusion The nursing intervention scheme based on TTM can improve lung function and exercise endurance, improve blood gas index and reduce dyspnea in stable COPD patients.
关键词
慢性阻塞性肺疾病稳定期 /
行为分阶段转变理论 /
综合康复护理干预 /
肺功能 /
呼吸功能
Key words
stable phase of chronic obstructive pulmonary disease /
the transtheoretical model and stages of change /
comprehensive rehabilitation nursing intervention /
lung function /
respiratory function
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] CHRISTENSON S A, SMITH B M, BAFADHEL M, et al.Chronic obstructive pulmonary disease[J]. Lancet, 2022, 399(10342): 2227-2242.
[2] CALVERLEY P M A, WALKER P P. Contemporary Concise Review 2022: Chronic obstructive pulmonary disease[J]. Respirology, 2023, 28(5): 428-436.
[3] ARANBURU-IMATZ A, LÓPEZ-CARRASCO J C, MORENO-LUQUE A, et al. Nurse-led interventions in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2022, 19(15): 9101.
[4] HU Y Q, ZHU N, WEN B, et al.Individualized nursing interventions in patients with comorbid chronic obstructive pulmonary disease and chronic heart failure[J]. Altern Ther Health Med, 2023, 29(8): 329-333.
[5] 贾志阳, 周志刚. 基于自我效能理论的护理干预在COPD患者中的应用效果[J]. 中华现代护理杂志, 2020, 26(21): 2925-2928.
[6] HAN M J, FU Y P, JI Q Y, et al.The effectiveness of theory-based smoking cessation interventions in patients with chronic obstructive pulmonary disease: a meta-analysis[J]. BMC Public Health, 2023, 23(1): 1510.
[7] IMERI H, TOTH J, ARNOLD A, et al.Use of the transtheoretical model in medication adherence: A systematic review[J]. Res Social Adm Pharm, 2022, 18(5): 2778-2785.
[8] WATAKAKOSOL R, SUTTIWAN P, NGAMAKE S T, et al.Integration of the theory of planned behavior and transtheoretical model of change for prediction of intentions to reduce or stop alcohol use among thai adolescents[J]. Subst Use Misuse, 2021, 56(1): 72-80.
[9] 望露, 杨倩蓉, 全丽丽. 基于行为分阶段转变理论的护理模式对肺结核患者的护理效果分析[J]. 中国防痨杂志, 2024, 46(z1): 253-255.
[10] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南 (2013年修订版)[J]. 中华结核和呼吸杂志, 2013, 36(4): 255-264.
[11] ATS COMMITTEE ON PROFICIENCY STANDARDS FOR CLINICAL PULMONARY FUNCTION LABORATORIES. ATS statement: guidelines for the six-minute walk test[J]. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
[12] 陈果, 李小惠, 李蔚. 应用改良版英国医学研究委员会呼吸问卷、自我评估测试问卷和临床问卷评估慢性阻塞性肺疾病患者健康状况的比较研究[J]. 实用医院临床杂志, 2015, 12(1): 59-60.
[13] 李慧茹, 周林琼, 段春磊, 等. 早期慢性阻塞性肺疾病危险因素及诊断和管理的国际研究进展[J]. 中华危重病急救医学, 2023, 35(12): 1340-1344.
[14] 赵科, 杨宏昕, 高源源. 肾上腺素β2受体激动药与抗胆碱能药物治疗慢性阻塞性肺疾病的研究进展[J]. 中国新药与临床杂志, 2021, 40(3): 172-178.
[15] 罗政, 张红云, 高艳红, 等. 正念减压结合运动训练对老年慢性阻塞性肺疾病稳定期患者睡眠的影响[J]. 中华护理杂志, 2022, 57(11): 1285-1290.
[16] 王文娟, 丁静媛. 行为分阶段转变理论下的护理干预对肺结核患者自遵医行为及生活质量的影响[J]. 生命科学仪器, 2023, 21(1): 442.
[17] 吴珍珍, 李雪梅, 刘锦峰, 等. 行为分阶段转变理论护理对艾滋病患者自我管理效能、遵医行为及生活质量的影响[J]. 中国性科学, 2021, 30(11): 145-148.
[18] 徐琛, 周巍, 苏靖. 基于行为阶段转变理论模型的康复方案在产后盆底功能障碍患者中的应用价值[J]. 检验医学与临床, 2023, 20(19): 2928-2932.
[19] 张会洁. 基于行为分阶段转变理论模型的群组管理模式对哮喘慢性持续期患者服药依从性及疾病知识掌握度的影响[J]. 中国药物与临床, 2021, 21(24): 4092-4094.
[20] 顾昊, 赵芳, 阮敏, 等. 基于阶段转变理论的社区健康教育对老年2型糖尿病患者自我管理行为的影响[J]. 中国医药导刊, 2021, 23(03): 173-176.
[21] 吴林珂, 张琦婉, 俞颖, 等. 行为分阶段转变理论的个案管理模式在慢性阻塞性肺疾病稳定期患者中的应用[J]. 中国医药导报, 2024, 21(5): 176-180.
[22] 祁玉凤, 邵强, 沈兵. 慢性阻塞性肺疾病患者CAT评分与肺功能及血气分析等指标的相关性分析[J]. 中华全科医学, 2021, 19(9): 1504-1506.
基金
2021年度江苏省老年健康科研项目“神经丝蛋白轻链对老年脑卒中发病风险的预测价值研究”（LX2021002）
PDF(2187 KB)
