干预图在急性冠脉综合征合并中重度慢性肾病患者中的应用研究

doi:10.3761/j.issn.0254-1769.2022.13.003

摘要/Abstract

摘要：

目的基于干预图制订干预策略,以探讨其对急性冠脉综合征合并中重度慢性肾病患者服药依从性的影响。方法采用便利抽样法,选取2020年9月—2021年4月温州市某三级甲等医院心内科收治的101例急性冠脉综合征合并中重度慢性肾病患者作为研究对象,随机分为试验组与对照组。试验组采用干预图制订的用药干预策略,对照组采用常规用药策略。比较两组的服药依从性、生活质量和因心血管事件再住院情况。结果共有97例患者完成研究,试验组48例,对照组49例。出院时和出院1个月,两组的服药依从性评分和36条简明健康状况调查量表总分比较,差异无统计学意义（P>0.05）,出院3个月和出院6个月时,两组的服药依从性评分和36条简明健康状况调查量表总分比较,差异有统计学意义（P<0.05）。两组出院后6个月因心血管事件再住院率比较,差异有统计学意义（P<0.05）,且Cox比例风险模型显示,试验组再住院风险相对较低（HR=0.430,95%CI为0.187~0.990）。结论采用干预图制订的用药干预策略可提高急性冠脉综合征合并中重度慢性肾病患者的服药依从性,提升其生活质量,改善其临床预后。

关键词: 干预图, 思考-行动-维持行为改变理论模型, 急性冠脉综合征, 中重度慢性肾病, 服药依从性, 行为改变, 护理

Abstract:

Objective An intervention strategy was developed based on an intervention map to investigate its effect on medication adherence in patients with acute coronary syndrome combined with moderate to severe chronic kidney disease. Methods A convenience sampling method was used to select 101 patients with acute coronary syndrome combined with moderate-to-severe chronic kidney disease admitted to the cardiology department of a tertiary hospital in Wenzhou from September 2020 to April 2021,and they were selected as study subjects and randomly divided into a test group and a control group. The test group used the medication intervention strategy developed by the intervention mapping,and the control group used the conventional medication strategy. The medication adherence,quality of life and rehospitalization due to cardiovascular events were compared between the 2 groups. Results A total of 97 patients completed the study with 48 in the test group and 49 in the control group. There were no significant differences in medication adherence scores and 36 concise health status survey scales scores between the two groups at discharge and 1 month after discharge（P>0.05）,and the scores were higher in the test group at both 3 months and 6 months after discharge（P<0.05）. The readmission rates for cardiovascular events 6 months after discharge between the 2 groups were compared,and the difference was statistically significant （P<0.05）,and the Cox proportional risk model showed that the risk of rehospitalization was relatively lower in the test group（HR=0.430,95%CI=0.187~0.990）. Conclusion Medication intervention strategies developed by inter-vention mapping can improve medication adherence,quality of life and clinical prognosis in patients with acute coronary syndrome combined with moderate-to-severe chronic kidney disease.

Key words: Intervention Mapping, Think-Act-Maintain Behavior Change Theoretical Model, Acute Coronary Syndrome, Moderate To Severe Chronic Kidney Disease, Medication Adherence, Behavior Change, Nursing Care

潘培培, 许文仙, 杨晔琴, 周浩, 卢中秋. 干预图在急性冠脉综合征合并中重度慢性肾病患者中的应用研究[J]. 中华护理杂志, 2022, 57(13): 1555-1561.

PAN Peipei, XU Wenxian, YANG Yeqin, ZHOU Hao, LU Zhongqiu. Intervention mapping in medication adherence in patients with acute coronary syndrome combined with moderate to severe chronic kidney disease[J]. Chinese Journal of Nursing, 2022, 57(13): 1555-1561.

图/表 6

表1 基于文献回顾和半结构式访谈的需求评估

Table 1 Needs assessment based on literature review and in-depth interviews

表2 急性冠脉综合征合并中重度慢性肾病患者服药依从性干预策略

Table2 Medication adherence intervention strategies for patients with acute coronary syndrome combined with moderate to severe chronic kidney disease

表3 两组一般资料比较[例（百分比,%）]

Table 3 General information of the two groups of patients[cases（percentage,%）]

表4 两组服药依从性量表得分的比较（分,$\bar{x}$±s）

Table 4 Effect of pre-and post-intervention and differ-ent groups on medication adherence scores（scores,$\bar{x}$±s）

表5 两组36条简明健康状况调查量表总分的比较（分,$\bar{x}$±s）

Table 5 Effects of pre-and post-intervention and different groups on total scores of 36 Brief Health Status Survey Scales（scores,$\bar{x}$±s）

表6 两组出院后因心血管事件再住院率比较[例（百分率,%）]

Table 6 Comparison of post-discharge readmission rates for cardiovascular events between the 2 groups [cases（percentage,%）]

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