CAJ | 학술논문

目的：观察康复路径与以专科护士为导向的延续护理对经皮冠状动脉介入治疗（PCI）患者心脏康复的影响，为接受 PCI 患者的心脏康复延续护理提供依据。方法将124例接受 PCI的冠心病患者按照随机数字表法分为对照组和实验组，对照组接受常规的康复指导及随访，实验组在对照组的基础上接受以康复路径表为依据，以专科护士为导向的康复指导及延续护理。分别在2组患者出院后6、12个月时评价其知-信-行水平及冠心病危险因素水平。结果2组最终各有55例患者完成研究。实验组入院时、出院后6、12个月冠心病知识问卷得分分别为（57.61±8.77）、（81.27±6.88）、（88.47±6.10）分，对照组分别为（59.71±7.32）、（68.61±7.12）、（76.85±7.70）分，经重复测量方差分析， F=74.71，P＜0.01；2组3个时段一般自我效能感量表得分、冠心病自我管理行为量表得分比较，F=5.40、14.52，P＜0.05或0.01。2组3个时段冠心病危险因素控制水平比较，除高密度脂蛋白胆固醇与低密度脂蛋白胆固醇外，总胆固醇、三酰甘油、糖化血红蛋白、体质量指数、收缩压、舒张压比较，F=5.82、20.32、4.14、4.15、4.99、7.15，P＜0.05或0.01。结论康复路径与以专科护士为导向的延续护理结合可以提高PCI 患者的知-信-行水平及冠心病危险因素控制水平，是 PCI 术后一种有效的心脏康复模式。
목적：관찰강복로경여이전과호사위도향적연속호리대경피관상동맥개입치료（PCI）환자심장강복적영향，위접수 PCI 환자적심장강복연속호리제공의거。방법장124례접수 PCI적관심병환자안조수궤수자표법분위대조조화실험조，대조조접수상규적강복지도급수방，실험조재대조조적기출상접수이강복로경표위의거，이전과호사위도향적강복지도급연속호리。분별재2조환자출원후6、12개월시평개기지-신-행수평급관심병위험인소수평。결과2조최종각유55례환자완성연구。실험조입원시、출원후6、12개월관심병지식문권득분분별위（57.61±8.77）、（81.27±6.88）、（88.47±6.10）분，대조조분별위（59.71±7.32）、（68.61±7.12）、（76.85±7.70）분，경중복측량방차분석， F=74.71，P＜0.01；2조3개시단일반자아효능감량표득분、관심병자아관리행위량표득분비교，F=5.40、14.52，P＜0.05혹0.01。2조3개시단관심병위험인소공제수평비교，제고밀도지단백담고순여저밀도지단백담고순외，총담고순、삼선감유、당화혈홍단백、체질량지수、수축압、서장압비교，F=5.82、20.32、4.14、4.15、4.99、7.15，P＜0.05혹0.01。결론강복로경여이전과호사위도향적연속호리결합가이제고PCI 환자적지-신-행수평급관심병위험인소공제수평，시 PCI 술후일충유효적심장강복모식。
Objective To evaluate the effects of clinical pathway combined with transitional care implemented by specialty nurses on patients with coronary heart disease after PCI (percutaneous coronary intervention) therapy. Methods Totally 124 patients after PCI were divided into the experimental group and the control group with random digit table. Patients in the control group received routine education and follow- up during hospitalization and discharge period. The experimental group received clinical pathway combined with transitional care implemented by specialty nurses based on routine education. The level of patients′knowledge, attitude, practice and risk factors were compared between the two groups 6 and 12 months after discharge. Results There were 55 patients in each group completed the research ultimately. The Coronary Heart Disease Knowledge Questionnaire in the experimental group scored (57.61 ±8.77), (81.27±6.88) and (88.47±6.10),while the control group scored (59.71±7.32),(68.61±7.12) and (76.85±7.70), after repeated measurement analysis of variance, F=74.71, 14.52, P<0.01. The scores of General Self- Efficacy Scale (GSES) and Coronary Artery Disease Self- Efficacy Scale (CSMS) between two groups at three time points showed statistical significance, F=5.40, 14.52, P<0.05 or 0.01. The risk factors of coronary heart disease such as total cholesterol, triacylglycerol, hemoglobin A1c, body mass index, systolic pressure and diastolic pressure were statistically different between two groups except for high density lipoprotein cholesterol and low density lipoprotein cholesterol, F=5.82, 20.32, 4.14, 4.15, 4.99, 7.15, P<0.05 or 0.01. Conclusions Clinical pathway combined with transitional care implemented by specialty nurses can improve the knowledge-attitude- practice level of patients, help to control the risk factors of coronary heart disease. It is an effective heart rehabilitation model for patients after PCI.