基于罗伊适应理论护理模式对脑出血患者术后DVT发生率、神经功能和生活能力恢复的影响-现代医学

基于罗伊适应理论护理模式对脑出血患者术后DVT发生率、神经功能和生活能力恢复的影响

单位：达州市中心医院外科, 四川达州 635000

分类号：R473.6

出版年·卷·期（页码）：2019·47·第六期（714-719）

摘要：

目的：探讨基于罗伊适应理论护理模式对脑出血患者术后深静脉血栓（DVT）发生率、美国国立卫生研究院卒中量表（NIHSS）评分及日常生活能力（ADL）评分的影响。方法：选取2016年3月至2018年5月在我院接受治疗的92例脑出血患者作为研究对象，采用随机数字表法将其随机分为常规组46例和研究组46例。两组患者术后恢复期均给予常规护理干预措施，包括脱水、利尿、抗血栓、营养神经、预防并发症和一般康复锻炼护理。研究组患者在此基础上给予基于罗伊适应理论护理干预措施。比较两组患者DVT发生率，评价术后恢复效果，比较两组患者干预前后焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分、NIHSS评分、ADL评分和简明健康相关生活质量量表（SF36）评分。结果：常规组术后DVT发生率为21.74%，研究组为6.52%，两组比较差异有统计学意义（P<0.05）；以脑出血临床神经功能缺损评分为依据进行恢复效果评价，常规组总有效率为67.39%，研究组为89.13%，研究组显著高于常规组（P<0.05）；干预后两组患者NIHSS评分较干预前均显著降低，SAS和SDS评分较干预前也显著降低，ADL评分显著升高，且研究组SAS、SDS、NIHSS评分及ADL评分与常规组比较差异均具有统计学意义（P<0.05）；干预后两组患者生活质量各维度评分和总分较干预前均显著升高，且研究组显著高于常规组，差异均具有统计学意义（P<0.05）。结论：基于罗伊适应理论的护理干预模式应用于脑出血手术患者术后康复护理，可显著降低术后DVT的发生率、缓解患者的负面情绪、改善其神经功能缺损，有利于提升患者的生活质量，值得临床推广应用。

Objective:To explore the effect of Roy's adaptation theory-based nursing model on the incidence of deep venous thrombosis (DVT), the national institutes of health stroke scale (NIHSS) score and activity of daily living(ADL)score in patients with cerebral hemorrhage after operation. Methods:92 patients with cerebral hemorrhage who were treated in our hospital from March 2016 to May 2018 were randomly divided into the routine group (46 cases) and the research group (46 cases). Two groups of patients were given routine nursing intervention measures, including dehydration, diuresis, anti-thrombosis, neurotrophic treatment, prevention of complications and general rehabilitation exercise. Patients in the study group were given Roy's adaptation theory-based nursing model intervention measures. The incidence of DVT was compared between the two groups, and the effect of postoperative recovery was evaluated. The scores of SAS, SDS, NIHSS, ADL and health related quality of life was compared both between groups and in each group before and after intervention. Results:The incidence of DVT was 21.74% in the routine group and 6.52% in the study group. There was a significant difference in the incidence of DVT between the two groups (P<0.05). The scores of NIHSS, SAS, SDS, NIHSS in the two groups after intervention were significantly lower than those before intervention, and ADL were significantly higher than those before intervention (P<0.05). The scores of SAS, SDS, NIHSS in the study group were significantly lower than those in the control group, and ADL was significantly higher than that in the control group (P<0.05). After intervention, the scores of each dimension and total scores of quality of life of the two groups were significantly higher than those before intervention, and those of the study group were significantly higher than those of the conventional group. The differences were statistically significant (P<0.05). Conclusion:The nursing intervention model based on Roy's adaptation theory can significantly reduce the incidence of postoperative DVT, relieve the negative emotions of patients, improve their neurological deficits, and significantly improve the quality of life of patients with cerebral hemorrhage, which is worthy of clinical application.

参考文献：

[1] 于永鹏,谭兰.脑微出血发病机制、流行病学、影像学表现及其临床意义[J].中国卒中杂志,2017,12(8):759-764.
[2] 崔春丽,王智强.脑出血预后的多因素Logistic回归分析[J].中国中医急症,2016,25(6):1037-1038.
[3] 伍应芳.延续性护理对脑出血恢复期并发深静脉血栓的预防效果[J].血栓与止血学,2016,22(5):571-573.
[4] 冷晓晖,吴善凤,王娟,等.行动研究法在预防脑出血患者围手术期深静脉血栓形成中的应用[J].中华现代护理杂志,2015,21(29):3524-3526.
[5] 蔡婷婷,曹梅娟.罗伊适应模式中自我概念在慢性病病人护理中的应用进展[J].护理研究,2016,30(22):3991-3993.
[6] 吕天歌,王柏春.罗伊适应模式对小儿急诊科患儿生理应激状态及家属负性情绪的影响[J].检验医学与临床,2017,14(5):680-682.
[7] 中华医学会神经病学分会.中国脑出血诊断指南[J].中华神经科杂志,2015,48(6):435-444.
[8] FARSI Z,AZARMI S.Effect of Roy's adaptation model-guided education on coping strategies of the veterans with lower extremities amputation:a double-blind randomized controlled clinical trial[J].Int J Community Based Nurs Midwifery,2016,4(2):127-136.
[9] MOHAMMADPOUR A,NAJAFI S,TAVAKKOLIZADEH J,et al.The effects of the Roy's adapatation model on primigravida women's self-concept:a randomized controlled trial[J].AJPRHC,2016,4(2):127-136.
[10] 章春艳,权力,詹燕,等.罗伊适应模式对老年心血管疾病患者院内生活质量的影响研究[J].现代中西医结合杂志,2016,16(16):1813-1814.
[11] 宋水江,戴加勇,汤永国.脑出血相关治疗指南与临床现状[J].中国实用内科杂志,2013,33(8):612-614.
[12] 葛新,陈晓雷,孙吉庆,等.神经内镜微创手术与开颅血肿清除术治疗高血压脑出血疗效比较[J].中国神经精神疾病杂志,2016,42(10):605-608.
[13] SALAZARGONZÁLEZ B C,GALLEGOSCABRIALES E C. Middle-range theory:coping and adaptation with active aging[J].Nurs Sci Q,2017,30(4):330-335.
[14] 张云霞,丁娟,赵一雷.团体生活延续性护理对脑出血患者术后自我效能与生活质量的影响[J].现代医学,2017,45(3),459-462
[15] 张欢,周小燕,张露丹,等.整体护理干预在冠状动脉粥样硬化性心脏病心肌梗死患者行心脏支架置入术中的应用效果[J].现代医学,2018,46(7):815-818.
[16] 蒲卫虹,张琴,何小玉,等.给予人性化理念的心理护理对高血压脑出血术后患者焦虑状态和满意度的影响[J].国际精神病学杂志,2017,44(3):546-548.

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