CAJ | 학술논문

目的从护理学角度研究影响门脉高压患者β受体阻滞剂应答率的相关因素,探讨目标护理模式对提高应答率的效果.方法 83例有服药指征的患者常规用药3个月后依心率及多普勒超声结果确定有无应答.采用社会支持量表及自拟的调查表,调查患者的就医行为、服药依从性等因素,采用单因素及多因素回归分析法,筛选主要的影响指标并编制为目标护理计划表,将52例无应答的患者随机分为研究组27例与对照组25例,研究组由护士根据目标护理计划表,在Orem自理理论框架指导下,分别提供不同的补偿性护理及辅助教育；对照组行常规护理宣教,干预3个月后行相关指标对比.结果患者自护责任感、对用药目的和目标、骤停服药的危害等知识知晓度、测量心率并依心率调整剂量的技能等与应答与否密切相关,多因素回归分析结果发现自护责任感、骤停用药、对社会支持利用度及是否遵医嘱复诊是应答率的独立影响因素.采用目标护理模式后,研究组对测心率及依心率调整剂量方法的掌握及骤停用药现象等指标较对照组明显改善,应答率明显提高.结论对服用β受体阻滞剂预防门脉高压再出血无治疗反应者,应分析患者的遵医行为与服药依从性,重点做好用药目标、骤停用药危害性及遵医嘱复诊重要性的宣教,采用目标护理模式是提高应答率的有效手段.
목적 종호이학각도연구영향문맥고압환자β수체조체제응답솔적상관인소,탐토목표호리모식대제고응답솔적효과.방법 83례유복약지정적환자상규용약3개월후의심솔급다보륵초성결과학정유무응답.채용사회지지량표급자의적조사표,조사환자적취의행위、복약의종성등인소,채용단인소급다인소회귀분석법,사선주요적영향지표병편제위목표호리계화표,장52례무응답적환자수궤분위연구조27례여대조조25례,연구조유호사근거목표호리계화표,재Orem자리이론광가지도하,분별제공불동적보상성호리급보조교육；대조조행상규호리선교,간예3개월후행상관지표대비.결과 환자자호책임감、대용약목적화목표、취정복약적위해등지식지효도、측량심솔병의심솔조정제량적기능등여응답여부밀절상관,다인소회귀분석결과발현자호책임감、취정용약、대사회지지이용도급시부준의촉복진시응답솔적독립영향인소.채용목표호리모식후,연구조대측심솔급의심솔조정제량방법적장악급취정용약현상등지표교대조조명현개선,응답솔명현제고.결론 대복용β수체조체제예방문맥고압재출혈무치료반응자,응분석환자적준의행위여복약의종성,중점주호용약목표、취정용약위해성급준의촉복진중요성적선교,채용목표호리모식시제고응답솔적유효수단.
Objective To analyze factors influencing β-blocker response rates of patients with portal hypertension and to explore the effect of nursing interference for increasing response rates with goal-directed nursing model. Methods 83 cases of portal hypertension were enrolled.Questionnaire about medical visiting behaviors and medication compliance were compared and analyzed after routine medication for 3 months.Bivariate and multivariate regression analysis were performed and related factors were used to establish a goal-directed nursing model for nursing interference guidance.52 non-response patients were randomly divided into the study group(27 cases)and the control group(25 cases).In the study group,compensation system and supportive-education according to Orem model were given,while the control group was given routine nursirng.Response rates and related factors were compared after 3 months of nursing intervention. Results Awareness of self-care responsibility,knowledge about the medication target,risk of sudden drug withdrawal,related medical knowledge,ability for pulse rate measurement and dose adjustment according to pulse rate changes were related to the response rates.Multivariate regression analysis showed that awareness of self-care responsibility,sudden drug withdrawal,utilization of social support and regular return visit were the independent factors.In the study group,ability for pulse rate measurement and dose adjustment acconding to pulse rate changes improved,phenomenon of sudden drug withdrawal declined and response rate increased,comparing with the control grpup. Conclusins For patients fail to respond to β-blockers,compliance behavior and medication compliance should be analyzed,and much attention should be paid to the education of the related medical knowledge,risk of sudden drug withdrawal and drag using targets.Goal-directed medel could be a guidance for nursing intervention to increase the response rates.