论著

以 IMB 模型为基础延续护理平台在帕金森病患者中的应用

Application of continuous care platform based on IMB model in Parkinson’s patients

:235-240
 
       目的   分析以信息-动机-行为技巧(IMB)模型为基础延续护理平台在帕金森病患者中的应用效果。方法   纳入河南省人民医院在2019年1月至2022年1月期收治的帕金森病患者96例进行研究,将其依据随机数表法分为对照组和观察组,均为48例,对照组均给予常规护理干预,观察组均给予以IMB模型为基础延续护理平台干预。比较两组主要照顾者干预前24 h(T0)和完成干预24 h(T1)内的心理状态评分、自我效能、希望水平、运动能力、肌张力、认知功能,并评估T1时刻的Barthel指数。结果   观察组患者T1时的汉密尔顿焦虑量表(HAMA)(16.64±2.57)分、汉密尔顿抑郁量表(HAMD)(16.38±1.69)分均低于对照组(20.65±1.68)(19.57±2.65)分(t=10.116、5.407,P<0.001),观察组患者T1时的自我效能(7.24±1.48)分、希望水平(44.51±4.07分)均高于对照组(6.02±1.74)(38.95±4.54)分(t=3.357、3.311,P<0.001),观察组患者T1时的运动能力评分(43.62±4.01)分高于对照组(39.17±5.25)分(t=4.715,P<0.001),肌张力评分(0.72±0.21)分低于对照组(1.13±0.52)分(t=5.118,P<0.001),观察组患者T1时刻的Barthel指数评估依靠帮助完成率(6.25%)、部分完成率(10.42%)低于对照组(25.00%)、(27.08%)(χ 2 =6.353、5.263,P<0.05),观察组患者T1时刻的命名能力(3.46±0.51)、延迟回忆(3.78±0.21)分、语言能力(3.29±0.48)分、注意力评分(3.95±0.10)分均高于对照组(2.91±0.98 )(3.21±0.96)(2.87±0.82)(3.76±0.05)分(t=3.698、3.675、3.846、4.305,P<0.001)。结论   以IMB模型为基础延续护理平台干预能够改善帕金森病患者的负性情绪,提升自我效能、希望水平,改善运动能力、肌张力、日常生活能力、认知水平。
       Objective  To analyze the application effect of the information motivation behavioral skills(IMB)model as a continuous care platform in Parkinson’s patients.Methods  A study was conducted on 96 Parkinson’s patients enrolled in our hospital from January 2019 to January 2022.They were divided into a control group and an observation group based on a  random number table method,with 48 patients in each group.The control group received routine nursing intervention,while the observation group received continuous nursing platform intervention based on the IMB model.The psychological state scores,self-efficacy,hope level,motor ability,muscle tone,cognitive function of the two main caregivers 24 hours before intervention(T0)and 24 hours after completion of intervention(T1),and evaluate the Barthel index at T1 time were compared.Results  The Hamilton Anxiety Scale(HAMA)[(16.64±2.57)points] and Hamilton Depression Scale(HAMD)[(16.38±1.69 points)scores]of patients in the observation group at T1 were lower than those in the control group [(20.65±1.68)points,(19.57±2.65)points](t=10.116,5.407,P<0.001).The self-efficacy of patients in the observation group at T1 was(7.24±1.48)points.The hope level [(44.51±4.07)points] was higher than that of the control group [(6.02±1.74)points,(38.95±4.54)points](t=3.357,3.311,P<0.001).The motor ability score at T1 time in the observation group [(43.62±4.01)points] was higher than that in the control group [(39.17±5.25)points](t=4.715,P<0.001),and the muscle tone score [(0.72±0.21)points] was lower than that in the control group [(1.13±0.52)points](t=5.118,P<0.001).The Barthel index evaluation of patients in the observation group at T1 time relied on help completion rate(6.25%)and partial completion rate(10.42%),which were lower than those in the control group(25.00%)and(27.08%)(χ 2 =6.353,5.263,P=0.012,0.022).The naming ability [(3.46±0.51)points],delayed recall [(3.78±0.21)points],language ability [(3.29±0.48)points],attention scores [(3.95±0.10)points] were higher than the control group [(2.91±0.98)points,(3.21±0.96)points,(2.87±0.82)points,(3.76±0.05)points](t=3.698,3.675,3.846,4.305,P=<0.001,<0.001,<0.001).Conclusions  Continuing nursing platform intervention based on the IMB model can improve the negative emotions,self-efficacy,hope level,motor ability,muscle tone,daily living ability,and cognitive level of Parkinson’s patients.
论著

膝骨关节炎患者术前衰弱列线图预测模型的建立

Establishment of a preoperative frailty nomogram prediction model in patients with knee osteoarthritis

:179-186
 
       目的   基于Nomogram初步构建膝骨关节炎(KOA)患者术前衰弱的风险预测模型。方法   便利选取172例于2021年12月—2022年8月在广州市某三甲医院关节外科接受择期膝关节置换术的KOA患者为研究对象,依据衰弱的发生与否分为衰弱组(n=111)和非衰弱组(n=61),通过单因素分析筛选变量,纳入Logistic回归分析,并构建列线图模型。结果   单因素分析结果显示年龄、BMI、膝关节疼痛年限、合并症、抑郁、焦虑、疼痛、睡眠障碍、营养状况等在不同组间比较差异存在统计学的意义(P<0.05)。多因素Logistic回归分析表明,BMI异常(OR=3.360)、膝关节疼痛年限>5年(OR=14.188)、抑郁(OR=5.608)、睡眠障碍(OR=25.480)是KOA患者术前衰弱的独立危险因素(P<0.05)。基于此,建立了预测膝骨关节炎患者术前衰弱风险的列线图预测模型。结果显示C-index为0.915,校正曲线接近理想曲线,ROC曲线下面积(AUC)为0.919(95%CI:0.878~0.961),可见该预测模型具有较好的区分度和准确度。结论   根据BMI、膝关节疼痛年限、抑郁以及睡眠障碍这四个独立危险因素,可以准确地预测膝骨关节炎患者术前衰弱的风险。
    Objective  To develop a nomogram for predicting the risk of preoperative frailty in knee osteoarthritis patients.Methods  A convenience sample of 172 patients who underwent elective knee arthroplasty at a Grade-A hospital in Guangzhou from December 2021 to August 2022 was selected.The patients were divided into two groups based on the presence of preoperative frailty:frailty group(n=111)and non-frailty group(n=61).The variables with statistical differences were screened by univariate analysis for multivariate logistic regression analysis,and the nomogram prediction model was established.Results  Univariate analysis identified significant differences between the groups in age,BMI,years of knee pain,complications,depression,anxiety,pain,sleep disturbance,and nutrition(P<0.05).Multivariate logistic regression showed that abnormal BMI(OR=3.360),years of knee pain > 5(OR=14.188),depression(OR=5.608),and sleep disorders(OR=25.480)were independent  risk factors for preoperative frailty in knee osteoarthritis patients(P<0.05).Based on these findings,a nomogram prediction model was established.Model verification results demonstrated that the nomogram had good differentiation and accuracy in predicting the risk of preoperative frailty,with a C-index of 0.915,an area under the ROC curve of 0.919(95% CI:0.878~0.961),and a calibration curve slope close to 1.Conclusions  The nomogram,based on four independent risk factors(BMI,years of knee pain,depression,and sleep disturbance),effectively predicts the risk of preoperative frailty in knee osteoarthritis patients.
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