急诊经皮冠状动脉介入治疗患者早期心脏康复护理方案的构建

doi:10.3761/j.issn.0254-1769.2021.04.004

摘要/Abstract

摘要：

目的构建急诊经皮冠状动脉介入治疗患者早期心脏康复护理方案,为急性心肌梗死患者急诊行经皮冠状动脉介入治疗术后进行早期心脏康复护理提供借鉴。方法成立研究小组,在文献回顾的基础上结合临床经验,初步制订急诊经皮冠状动脉介入治疗患者早期心脏康复护理方案。方案进行2轮德尔菲专家函询,根据专家函询的意见对条目进行修改。结果第1轮函询了16名专家,问卷有效回收率为100%;第2轮函询了16名专家,问卷有效回收率为93.75%。专家权威系数为0.875,第2轮各条目变异系数为0.09~0.21,肯德尔和谐系数为0.64（P<0.001）,重要性赋值均数为4.27~4.80。最终形成急诊经皮冠状动脉介入治疗患者早期心脏康复护理方案,包括运动康复、康复进阶方式、健康宣教、日常生活指导、能量消耗5项一级指标,56项二级指标。结论该研究构建的早期心脏康复护理方案科学可靠,紧密结合临床,具有较强的临床实用价值。

关键词: 急性心肌梗死, 经皮冠状动脉介入治疗, 心脏康复, 护理, 方案

Abstract:

Objective To construct an early cardiac rehabilitation nursing practice program for patients after emergency percutaneous coronary intervention（PCI）,and provide a reference for early cardiac rehabilitation in patients with acute myocardial infarction after emergency PCI. Methods A research team was established to formulate a draft of the early cardiac rehabilitation nursing practice program for patients with emergency PCI based on the literature review combined with clinical experience. 2 rounds of Delphi expert letter inquiries were conducted,and the items based on the opinions of the expert letter inquiries were modified. Results In the first round,16 experts were consulted,and the effective response rate of the questionnaire was 100%.In the second round,16 experts were consulted,and the effective response rate of the questionnaire was 93.75%. The expert authority coefficient was 0.875;the coefficient of variation of items in the second round was 0.09~0.21;the Kendall’s concordance coefficient was 0.64（P<0.001）;the importance value was 4.27~4.80. Eventually,a nursing practice program for early cardiac rehabilitation for patients after emergency PCI was formed,including 5 first-level indicators（exercise rehabilitation,advanced rehabilitation methods,health education,daily life guidance,and energy consumption） and 56 secondary indicators. Conclusion The early cardiac rehabilitation nursing practice program constructed in this study is scientific,reliable and closely integrated with the clinical practice,with strong theoretical bases and clinical practical value.

Key words: Acute Myocardial Infarction, Percutaneous Coronary Intervention, Cardiac Rehabilitation, Nursing, Program

谷雨擎,朱丽丽,李庆印,赵冬云,韩宇,吴元,张峻. 急诊经皮冠状动脉介入治疗患者早期心脏康复护理方案的构建[J]. 中华护理杂志, 2021, 56(4): 502-507.

GU Yuqing,ZHU Lili,LI Qingyin,ZHAO Dongyun,HAN Yu,WU Yuan,ZHANG Jun. Construction of an early cardiac rehabilitation nursing practice program for patients after emergency percutaneous coronary intervention[J]. Chinese Journal of Nursing, 2021, 56(4): 502-507.

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参考文献 17

[1]	国家心血管病中心. 中国心血管健康与疾病报告2019[M]. 北京: 科学出版社, 2020.
	National Center for Cardiovascular Disease, China. China cardiovascular disease report 2019[M]. Beijing: Encyclopedia of China Publishing House, 2020.
[2]	Firoozeh A, Maryam T, Kaynoosh H, et al. The assessment of cardiac rehabilitation on echocardiographic parameters of left ventricular systolic function in patients treated by primary percutaneous coronary intervention due to acute ST-segment elevation myocardial infarction:a randomized clinical trial[J]. Int Cardiovasc Res, 2017,11(4):130-136.
[3]	Kim C, Kim DY, Lee DW. The impact of early regular cardiac rehabilitation program on myocardial function after acute myocardial infarction[J]. Ann Rehabil Med, 2011,35(4):535-540. DOI URL PMID
[4]	Goel K, Lennon RJ, Tilbury RT. et al. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community[J]. Circulation, 2011,123(21):2344-2352. DOI URL
[5]	Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2018,39(2):119-177. DOI URL PMID
[6]	JCS Joint Working Group. Guidelines for rehabilitation in patients with cardiovascular disease(JCS 2012)[J]. Circ J, 2014,78(8):2022-2093. DOI URL PMID
[7]	蹇祥玉, 路海云, 罗莹怡, 等. 急性ST段抬高型心肌梗死患者急诊PCI术后Ⅰ期心脏康复护理研究[J]. 护理学杂志, 2016,31(23):1-4.
	Jian XY, Lu HY, Luo YY, et al. Study on phase Ⅰ cardiac rehabilitation nursing for acute ST-segment elevation myocardial infarction patients after emergency PCI[J]. J Nurs Sci, 2016,31(23):1-4.
[8]	马玉平, 黄国莹. 早期康复运动训练对急性心肌梗死PCI术后患者康复效果的影响[J]. 中国保健营养, 2019,29(5):291.
	Ma YP, Huang GY. The effect of early rehabilitation exercise training on the rehabilitation effect of patients with acute myocardial infarction after PCI[J]. China Heal Care Nutr, 2016,29(5):291.
[9]	陈丽娜, 段培蓓, 张学萍. 早期心脏康复计划对急性心肌梗死PCI术后生活质量的影响[J]. 中西医结合护理(中英文), 2017, 3(2):89-91.
10	Chen LN, Duan PB, Zhang XP. Effects of early cardiac rehabilitation program on quality of life in acute myocardial infarction patients after percutaneous coronary intervention[J]. Nurs Integr Tradit Chin West Med, 2017,3(2):89-91.
[10]	顾淑芳, 于艳艳, 张丽敏. 急性心肌梗死患者行冠状动脉介入术后即刻康复训练的效果研究[J]. 中华护理杂志, 2018,53(2):173-178.
	Gu SF, Yu YY, Zhang LM. Effects of immediate exercise training after radial artery coronary intervention in patients with acute myocardial infarction[J]. Chin J Nurs, 2018,53(2):173-178.
[11]	孔雪. 经桡动脉行急诊PCI的急性心梗患者的早期康复[D]. 石河子:石河子大学, 2015.
	Kong X. Early rehabilitation of acute myocardial infarction patients undergoing emergency PCI via radial artery[D]. Shihezi:Shihezi University, 2015.
[12]	徐志晶, 夏海鸥. 德尔菲法在护理研究中的应用现状[J]. 护理学杂志, 2008,23(6):78-80.
	Xu ZJ, Xia HO. The Delphi technigue and its appljcation in nursing research[J]. J Nurs Sci, 2008,23(6):78-80.
[13]	郝模. 卫生政策学[M]. 2版. 北京: 人民卫生出版社, 2013: 250-270.
	Hao M. Hi-valued health policymaking[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2013: 250-270.
[14]	郭航远, 郭诗天, 孟立平. 我国心脏康复专业认证的初步探索[J]. 心脑血管病防治, 2019,19(6):491-493.
	Cuo HY, Cuo ST, Meng LP. Preliminary exploration of the centification of cardiac rehabilitation in China[J]. Prev Treat Cardio Cereb Vasc Dis, 2019,19(6):491-493.
[15]	郭航远. 我国心脏康复的困境与对策[J]. 中国全科医学, 2019,22(12):1381-1384.
	Guo HY. Difficulties and countermeasures of cardiac rehabilitation in China[J]. Chin Gen Pract, 2019,22(12):1381-1384.
[16]	毕春晖, 刘素莲, 谭霞. 等. 延续护理对经皮冠状动脉支架植入术后患者自我护理能力和健康行为的影响[J]. 中华护理杂志, 2013,48(6):503-506.
	Bi CH, Liu SL, Tan X, et al. Effect of transitional care on self-care agency and healthy behaviors in patients treated by percutaneous coronary intervention[J]. Chin J Nurs, 2013,48(6):503-506.
[17]	郝云霞, 周政, 刘庆荣, 等. 从心血管专科发展看护理在心脏康复中的作用[J]. 中华护理杂志, 2015,50(6):645-649.
	Hao YX, Zhou Z, Liu QR, et al. The role of nursing in cardiac rehabilitation from the development of cardiovascular specialty[J]. Chin J Nurs, 2015,50(6):645-649.