丁彬霞 胡素琴
(江西省萍鄉(xiāng)市中醫(yī)院內(nèi)九科,萍鄉(xiāng)337000)
中醫(yī)護(hù)理干預(yù)對(duì)冠心病心絞痛療效及生活質(zhì)量的影響
丁彬霞胡素琴
(江西省萍鄉(xiāng)市中醫(yī)院內(nèi)九科,萍鄉(xiāng)337000)
目的探討中醫(yī)護(hù)理干預(yù)對(duì)于冠心病心絞痛患者療效及生活質(zhì)量的影響。方法選取我院2014年12月—2015年12月收治的60例冠心病心絞痛患者作為研究對(duì)象。按照入院順序隨機(jī)均分為實(shí)驗(yàn)組和對(duì)照組,對(duì)照組患者采取常規(guī)護(hù)理,實(shí)驗(yàn)組在對(duì)照組的基礎(chǔ)上,進(jìn)行中醫(yī)護(hù)理干預(yù),主要是對(duì)患者的生活起居、飲食結(jié)構(gòu)、情志護(hù)理等。觀察患者生活質(zhì)量評(píng)分、中醫(yī)證候積分、LVEF、VEGF水平。結(jié)果實(shí)驗(yàn)組患者干預(yù)后生活質(zhì)量評(píng)分高于對(duì)照組和干預(yù)前(P<0.05),實(shí)驗(yàn)組患者干預(yù)后中醫(yī)證候積分高于對(duì)照組和干預(yù)前,LVEF、VEGF水平低于對(duì)照組和干預(yù)前(P<0.05)。結(jié)論中醫(yī)護(hù)理干預(yù)對(duì)于冠心病心絞痛患者療效較好,患者生活質(zhì)量得到有效改善,中醫(yī)證候積分、LVEF、VEGF水平有顯著恢復(fù)。
中醫(yī)護(hù)理;冠心??;心絞痛;生活質(zhì)量;胸痹
冠心病是心血管疾病之一,心絞痛是機(jī)體冠狀動(dòng)脈供血不足所致,主要表現(xiàn)為發(fā)作性胸痛或胸部不適。隨著社會(huì)的發(fā)展,人們生活質(zhì)量的提高,飲食結(jié)構(gòu)的變化等,冠心病心絞痛的發(fā)病率不斷增加[1]。冠心病心絞痛嚴(yán)重影響患者的生活質(zhì)量,研究有效的護(hù)理干預(yù)措施,對(duì)于提高患者的生活質(zhì)量具有重要意義。我院開(kāi)展了中醫(yī)護(hù)理干預(yù)對(duì)于冠心病心絞痛的研究,效果較好?,F(xiàn)報(bào)道如下。
1.1一般資料選取我院2014年12月—2015年12月收治的60例冠心病心絞痛患者作為研究對(duì)象。按照入院順序隨機(jī)均分為實(shí)驗(yàn)組和對(duì)照組,實(shí)驗(yàn)組男性16例,女性14例;年齡為51~75歲,平均年齡為(68.48±8.54)歲。對(duì)照組男性17例,女性13例;年齡為53~75歲,平均年齡為(68.55±7.96)歲。2組患者的性別、年齡等臨床資料對(duì)比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。
1.2納入和排除標(biāo)準(zhǔn)納入標(biāo)準(zhǔn):符合冠心病診斷標(biāo)準(zhǔn);符合本研究治療方案,簽署知情同意協(xié)議書(shū),可配合完成本研究。
排除標(biāo)準(zhǔn):嚴(yán)重心臟瓣膜疾?。恍姆款潉?dòng)者;心房撲動(dòng)者;精神病史者。
1.3護(hù)理方法患者接受對(duì)癥支持治療。對(duì)照組患者采取常規(guī)護(hù)理,對(duì)患者進(jìn)行病癥觀察,檢測(cè)患者血壓、脈搏等生命體征,指導(dǎo)患者飲食、休息等。實(shí)驗(yàn)組在對(duì)照組的基礎(chǔ)上,進(jìn)行中醫(yī)護(hù)理干預(yù),根據(jù)氣陰兩虛證、痰濁壅塞證、氣滯血瘀證、寒凝心脈證進(jìn)行辨證護(hù)理,主要是對(duì)患者的生活起居、飲食結(jié)構(gòu)、情志護(hù)理等。
1.4觀察指標(biāo)觀察患者生活質(zhì)量評(píng)分、中醫(yī)證候積分、LVEF、VEGF水平。
1.5統(tǒng)計(jì)學(xué)分析2組數(shù)據(jù)資料均應(yīng)用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)和分析,數(shù)值采用(x±s)表示,計(jì)數(shù)資料采用率(%)表示,分別用t和χ2檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義用P<0.05表示。
2.12組患者生活質(zhì)量評(píng)分對(duì)比實(shí)驗(yàn)組患者干預(yù)后生活質(zhì)量評(píng)分高于對(duì)照組和干預(yù)前(P<0.05),見(jiàn)表1。
表1 2組患者生活質(zhì)量評(píng)分對(duì)比(±s)
表1 2組患者生活質(zhì)量評(píng)分對(duì)比(±s)
注:與同組干預(yù)前對(duì)比,△P<0.05,與對(duì)照組對(duì)比,*P<0.05
組別例數(shù)軀體癥狀時(shí)間干預(yù)前自理能力20.49±0.4921.49±0.66社會(huì)功能17.79±0.54心理功能QOL總分17.49±0.2882.39±2.46實(shí)驗(yàn)組30干預(yù)后17.59±1.02△*18.39±1.52△*15.29±0.51△*14.19±1.25△*71.79±4.66△*對(duì)照組30干預(yù)前19.88±0.6421.19±0.7117.09±.6118.09±0.5478.19±2.68干預(yù)后18.87±0.25△20.88±0.64△16.79±0.75△15.79±0.46△76.88±1.56△
2.22組患者中醫(yī)證候積分、LVEF、VEGF水平對(duì)比實(shí)驗(yàn)組患者干預(yù)后中醫(yī)證候積分高于對(duì)照組和干預(yù)前,LVEF、VEGF水平低于對(duì)照組和干預(yù)前(P<0.05),見(jiàn)表2。
表2 2組患者中醫(yī)證候積分、LVEF、VEGF水平對(duì)比(s)
表2 2組患者中醫(yī)證候積分、LVEF、VEGF水平對(duì)比(s)
注:與同組干預(yù)前對(duì)比,△P<0.05,與對(duì)照組對(duì)比,*P<0.05
組別例數(shù)LVEF(%)實(shí)驗(yàn)組3056.34±8.74時(shí)間干預(yù)前中醫(yī)證候積分(分)8.76±3.44 VEGFLVEF(ng/L)干預(yù)后3.41±2.55△*對(duì)照組30干預(yù)前7.82±2.6656.27±7.5161.52±7.33干預(yù)后4.75±2.45△54.68±7.24△62.67±7.44△60.15±8.44△*65.01±8.22 73.49±8.24△*
冠心病心絞痛主要以40歲以上人群多見(jiàn),患者疼痛難忍,對(duì)生活質(zhì)量造成嚴(yán)重影響[2-3]。中醫(yī)研究認(rèn)為,冠心病心絞痛屬“真心痛”“胸痹”“胸痹心痛”“心痛”范疇,主要因外邪內(nèi)侵、情志不遂、飲食失節(jié)等引起,患者心脈瘀阻,發(fā)生疼痛[4-6]。該病癥本虛標(biāo)實(shí),虛實(shí)夾雜,在護(hù)理過(guò)程中,應(yīng)該根據(jù)患者的不同特點(diǎn),進(jìn)行對(duì)癥護(hù)理[7]。
一般情況下,可將冠心病心絞痛分為氣陰兩虛證、痰濁壅塞證、氣滯血瘀證、寒凝心脈證[8-9]。各種病癥臨床表現(xiàn)各異,護(hù)理措施則也有區(qū)別。氣陰兩虛證患者,主要表現(xiàn)為心胸隱痛,頭暈?zāi)垦?,口干盜汗等,進(jìn)行護(hù)理的時(shí)候,則主要是要益氣養(yǎng)血、活血通絡(luò)。對(duì)患者進(jìn)行護(hù)理指導(dǎo),要患者動(dòng)靜結(jié)合,主要是要多休息,活動(dòng)要適宜。飲食方面則以紅棗蓮子、桂圓粥等為主,而且要做好保暖工作,減少外感風(fēng)寒的發(fā)生[10]。痰濁壅塞證患者,主要表現(xiàn)為胸悶如窒,心痛則相對(duì)輕微,形體肥胖等。護(hù)理的時(shí)候,則要通陽(yáng)泄?jié)?、豁痰開(kāi)結(jié)。指導(dǎo)患者飲食宜清淡,平時(shí)可多進(jìn)食薏仁粥、扁豆等,保持心情舒暢。氣滯血瘀證患者,胸悶刺痛,固定不移,護(hù)理的時(shí)候,主要是要活血化瘀、通絡(luò)止痛。重點(diǎn)對(duì)患者進(jìn)行情志護(hù)理,飲食則以行氣活血開(kāi)郁為主。寒凝心脈證患者心痛如絞,腰酸乏力,護(hù)理以驅(qū)寒活血、宣痹通陽(yáng)為主,保持溫度、多呼吸新鮮空氣。飲食則少量多餐,減少心臟負(fù)擔(dān)。
本文研究結(jié)果顯示,實(shí)驗(yàn)組患者干預(yù)后生活質(zhì)量評(píng)分高于對(duì)照組和干預(yù)前(P<0.05)。實(shí)驗(yàn)組患者干預(yù)后中醫(yī)證候積分高于對(duì)照組和干預(yù)前,LVEF、VEGF水平低于對(duì)照組和干預(yù)前(P<0.05)。通過(guò)中醫(yī)護(hù)理干預(yù),患者的生活質(zhì)量得到改善,中醫(yī)證候積分、LVEF、VEGF水平均得到有效的恢復(fù)。冠心病心絞痛患者冠狀動(dòng)脈管狹窄或阻塞,心肌供血不足,心臟收縮功能下降,LVEF能夠顯示其改善水平。VEGF是唯一特異性促進(jìn)血管內(nèi)皮細(xì)胞有絲分裂的生長(zhǎng)因子,可以促進(jìn)血管新生,增加血管通透性。其水平變化反應(yīng)了心肌缺血的程度。這兩種水平的改善,均表明護(hù)理效果較好。
總之,中醫(yī)護(hù)理干預(yù)對(duì)于冠心病心絞痛患者療效較好,患者生活質(zhì)量得到有效改善,中醫(yī)證候積分、LVEF、VEGF水平有顯著恢復(fù)。
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Effect of TCM Nursing Intervention on Curative Effect and Quality of Life of Patients with Angina Pectoris of Coronary Heart Disease
DING Binxia,HU Suqin
(Department of Internal Medicine,Pingxiang Hospital of TCM,Jiangxi Province,Pingxiang 337000,China)
Objective To explore the effect of TCM nursing intervention on curative effect and quality of life of patients with angina pectoris of coronary heart disease.Methods 60 cases of patients with angina pectoris of coronary heart disease were randomly divided into experiment group and control group.The control group was cared by routine nursing.On the basis of the control group,the experiment group was cared by traditional Chinese medicine nursing,mainly on the daily life,diet and emotion nursing.The quality of life score,TCM syndrome score and levels of LVEF and VEGF were observed.Results The scores of quality of life of the experiment group after intervention were higher than those of the control group and before intervention(P<0.05).The TCM syndrome score of the experiment group after intervention were higher than that of the control group and before intervention(P<0.05).The levels of LVEF and VEGF of the experiment group after intervention were lower than those of the control group and before intervention(P<0.05).Conclusion TCM nursing intervention has good clinical effect for the patients with angina pectoris of coronary heart disease. TCM syndrome score and levels of LVEF and VEGF had significant recovery.
TCM nursing;coronary heart disease;angina pectoris;quality of life;chest discomfort
10.3969/j.issn.1672-2779.2016.18.047
1672-2779(2016)-18-0106-02
(本文編輯:李海燕本文校對(duì):潘志平2016-05-05)