韓雯琪 付瓊 王丹丹 馬婧華 馬紅
【摘要】 目的:探討持續(xù)護(hù)理質(zhì)量改進(jìn)在瞼板腺按摩聯(lián)合中藥熏眼護(hù)理瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥中的應(yīng)用效果。方法:選擇筆者所在醫(yī)院2018年1-10月收治的瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者100例。采取隨機(jī)數(shù)字表法進(jìn)行分組,觀察組50例,在常規(guī)護(hù)理措施的前提下,對(duì)患者的瞼板腺按摩聯(lián)合中藥熏眼護(hù)理給予持續(xù)護(hù)理質(zhì)量改進(jìn)。對(duì)照組50例,給予常規(guī)護(hù)理措施干預(yù)。比較兩組護(hù)理前后生活質(zhì)量評(píng)分(SF-36)、免疫細(xì)胞因子變化情況、負(fù)面情緒評(píng)分(SAS、SDS)。結(jié)果:(1)觀察組護(hù)理后生活質(zhì)量評(píng)分明顯高于對(duì)照組,兩組護(hù)理后生活質(zhì)量評(píng)分組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。(2)與對(duì)照組對(duì)比,觀察組護(hù)理后的IL-10、NF-κB水平明顯更低,IFN-γ、IL-2水平明顯更高,兩組護(hù)理后的免疫細(xì)胞因子水平組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。(3)觀察組SAS評(píng)分、SDS評(píng)分護(hù)理后明顯比對(duì)照組更低,兩組護(hù)理后負(fù)面情緒評(píng)分組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論:瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者在瞼板腺按摩聯(lián)合中藥熏眼護(hù)理中進(jìn)行持續(xù)護(hù)理質(zhì)量改進(jìn),其效果確切,有利于緩解患者的負(fù)面情緒,有利于提高患者的免疫力,有利于改善患者的預(yù)后。
【關(guān)鍵詞】 持續(xù)護(hù)理質(zhì)量改進(jìn) 瞼板腺按摩 中藥熏眼 聯(lián)合護(hù)理 瞼板腺功能障礙 脂質(zhì)缺乏型干眼癥
doi:10.14033/j.cnki.cfmr.2020.08.042??文獻(xiàn)標(biāo)識(shí)碼 B??文章編號(hào) 1674-6805(2020)08-0-03
Effect of Continuous Nursing Quality Improvement on Treatment of Lipid Deficiency Xerophthalmia with Meibomian Gland Massage Combined with Traditional Chinese Medicine Fumigation/HAN Wenqi, FU Qiong, WANG Dandan, MA Jinghua, MA Hong. //Chinese and Foreign Medical Research, 2020, 18(8): -103
[Abstract] Objective: To explore the effect of continuous nursing quality improvement in meibomian gland massage combined with traditional Chinese medicine fumigation in the treatment of lipid deficiency xerophthalmia caused by tarsal gland dysfunction. Method: A total of 100 patients with lipid deficiency xerophthalmia caused by tarsal gland dysfunction were selected from January to October 2018. Random number table method was used to group, 50 patients in the observation group. On the premise of routine nursing measures, continuous nursing quality improvement was given to patients with tarsal gland massage combined with traditional Chinese medicine fumigation eye care. 50 cases in the control group were given routine nursing intervention. The quality of life score (SF-36), changes of immune cytokines and negative emotion score (SAS, SDS) were compared between the two groups before and after nursing. Result: (1) The quality of life score in the observation group was significantly higher than that in the control group. There was significant difference between the two groups in the quality of life score after nursing (P<0.05). (2) Compared with the control group, the levels of IL-10 and NF-κB in the observation group were significantly lower, and the levels of IFN-γ and IL-2 were significantly higher. The levels of immune cytokines in the two groups were significantly different after nursing (P<0.05). (3) The SAS score and SDS score in the observation group were significantly lower than those in the control group. There were significant differences in the negative emotional score between the two groups after nursing (P<0.05). Conclusion: Continuous nursing quality improvement of patients with lipid deficiency xerophthalmia caused by meibomian gland dysfunction in meibomian gland massage combined with traditional Chinese medicine fumigation eye care is effective, which is conducive to alleviating patients negative emotions, improving patients immunity and improving patients prognosis.
[Key words] Continuous improvement of nursing quality Meibomian gland massage Eye fumigation with traditional Chinese medicine Combined nursing Meibomian gland dysfunction Lipid deficiency xerophthalmia
First-authors address: Zigui County Peoples Hospital, Zigui 443600, China
本研究選擇瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者進(jìn)行對(duì)照試驗(yàn),探討瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者在眼部按摩和中藥護(hù)理中實(shí)施持續(xù)護(hù)理質(zhì)量改進(jìn)的效果。
1 資料與方法
1.1 一般資料
選擇筆者所在醫(yī)院2018年1-10月收治的瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者100例。納入標(biāo)準(zhǔn):均確診為瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥[1]。排除標(biāo)準(zhǔn):合并嚴(yán)重心、腦、腎疾病、惡性腫瘤的患者等。采取隨機(jī)數(shù)字表法進(jìn)行分組,觀察組50例,男33例,女17例,年齡50~69歲,平均(58.23±6.32)歲;對(duì)照組50例,男30例,女20例,年齡51~69歲,平均(58.82±6.96)歲。兩組一般資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。全部患者均簽署本研究知情同意書(shū),本研究通過(guò)醫(yī)院倫理委員會(huì)批準(zhǔn)。
1.2 方法
對(duì)照組給予常規(guī)護(hù)理措施干預(yù),按照醫(yī)囑對(duì)患者病情進(jìn)行護(hù)理,例如生活護(hù)理、指導(dǎo)患者正確用藥等。
觀察組在常規(guī)護(hù)理措施的前提下,對(duì)患者的瞼板腺按摩聯(lián)合中藥熏眼護(hù)理給予持續(xù)護(hù)理質(zhì)量改進(jìn)。選擇護(hù)理經(jīng)驗(yàn)豐富的護(hù)理人員組織持續(xù)護(hù)理質(zhì)量改進(jìn)小組,組長(zhǎng)由護(hù)士長(zhǎng)擔(dān)任,負(fù)責(zé)制定護(hù)理改進(jìn)的整體計(jì)劃,組織全部小組成員共同參與討論護(hù)理改進(jìn)的詳細(xì)細(xì)節(jié),全面完善瞼板腺按摩護(hù)理、中藥熏眼護(hù)理、健康教育護(hù)理的制度。具體護(hù)理內(nèi)容如下:(1)瞼板腺按摩護(hù)理。先是蒸汽熏蒸(熱噴),再用玻璃棒按摩瞼板腺,按摩時(shí)間15 min/次,1次/d。(2)中藥熏眼護(hù)理。中藥熏蒸中藥含:菊花、枸杞子、金銀花、桑葉、麥冬、密蒙花,各10 g;薄荷6 g。把全部中藥材制作成藥液,稀釋加入熏蒸儀,距離眼睛2~3 cm,讓藥液的蒸汽熏眼,每次時(shí)間為20 min,治療2次/d。(3)健康教育。叮囑患者需要注意眼部衛(wèi)生,及時(shí)清除眼部分泌物,避免眼部感染。對(duì)患者普及瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥的相關(guān)知識(shí),包括瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥發(fā)病機(jī)制、高危因素、治療、轉(zhuǎn)歸等,叮囑患者需要保持輕松的心情,需要對(duì)瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥的治療抱有樂(lè)觀的心態(tài),叮囑患者養(yǎng)成良好的用眼的衛(wèi)生習(xí)慣。
1.3 觀察指標(biāo)及評(píng)價(jià)標(biāo)準(zhǔn)
比較兩組患者護(hù)理前護(hù)理后生活質(zhì)量評(píng)分(SF-36)、免疫細(xì)胞因子變化情況、負(fù)面情緒評(píng)分(SAS、SDS)。采取SAS評(píng)量表和SDS評(píng)量表評(píng)估患者負(fù)面情緒,SDS抑郁評(píng)量法,以53分為界限,分?jǐn)?shù)越高表示抑郁越嚴(yán)重;SAS焦慮評(píng)量法,SAS以50分為界限,分?jǐn)?shù)越高表示焦慮越嚴(yán)重。采用SF-36評(píng)量表評(píng)估患者生活質(zhì)量,隨訪其3個(gè)月,SF-36評(píng)量表各項(xiàng)評(píng)分范圍為0~100分,評(píng)分越高表示生活質(zhì)量越好[2-4]。
1.4 統(tǒng)計(jì)學(xué)處理
采用SPSS 20.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料以(x±s)表示,采用t檢驗(yàn),計(jì)數(shù)資料以率(%)表示,采用字2檢驗(yàn),P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2 結(jié)果
2.1 兩組護(hù)理前后生活質(zhì)量評(píng)分比較
兩組護(hù)理前生活質(zhì)量評(píng)分組內(nèi)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),兩組護(hù)理后生活質(zhì)量各項(xiàng)評(píng)分明顯比護(hù)理前提高(P<0.05);觀察組護(hù)理后生活質(zhì)量評(píng)分明顯高于對(duì)照組,兩組護(hù)理后生活質(zhì)量評(píng)分組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表1。
2.2 兩組護(hù)理前后的免疫細(xì)胞因子變化情況比較
兩組護(hù)理前免疫細(xì)胞因子水平比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05);護(hù)理后的IL-10、NF-κB水平明顯低于護(hù)理前,IFN-γ、IL-2水平明顯高于護(hù)理前,兩組患者護(hù)理后的免疫細(xì)胞因子水平組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05);與對(duì)照組對(duì)比,觀察組護(hù)理后的IL-10、NF-κB水平明顯更低,IFN-γ、IL-2水平明顯更高,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表2。
2.3 兩組護(hù)理前后負(fù)面情緒評(píng)分比較
兩組護(hù)理前負(fù)面情緒評(píng)分組內(nèi)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),兩組SAS評(píng)分、SDS評(píng)分護(hù)理后明顯比護(hù)理前降低(P<0.05)。觀察組SAS評(píng)分、SDS評(píng)分護(hù)理后明顯比對(duì)照組更低,兩組護(hù)理后負(fù)面情緒評(píng)分組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表3。
3 討論
瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥是一種常見(jiàn)的眼部疾病,由瞼板腺功能障礙所致,導(dǎo)致瞼板腺分泌失調(diào)、導(dǎo)管受阻,容易引發(fā)患者淚膜異常、眼表受損等并發(fā)癥[5-7]。該疾病對(duì)患者的身心健康造成不良的影響,因此,必須對(duì)瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者進(jìn)行積極有效的護(hù)理[8-10]。持續(xù)質(zhì)量改進(jìn)(CQI)指的是基于全面的質(zhì)量管理,對(duì)管理過(guò)程、管理環(huán)節(jié)進(jìn)行標(biāo)準(zhǔn)化、細(xì)節(jié)化、科學(xué)化的循環(huán)管理[11-12]。
本研究對(duì)瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者實(shí)施持續(xù)護(hù)理質(zhì)量改進(jìn),結(jié)果顯示經(jīng)過(guò)持續(xù)質(zhì)量改進(jìn)護(hù)理后,患者的免疫能力得到明顯的提高,負(fù)面情緒得到明顯的改善,生活質(zhì)量得到明顯的提高。由此可見(jiàn),持續(xù)護(hù)理質(zhì)量改進(jìn)應(yīng)用于瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者的護(hù)理中獲得了明顯的效果。本研究護(hù)理措施注重對(duì)患者普及干眼癥的知識(shí),叮囑患者需要抱有樂(lè)觀的心態(tài),叮囑患者養(yǎng)成良好的用眼的衛(wèi)生習(xí)慣。不僅可以增加患者對(duì)疾病的認(rèn)知,而且讓患者可以避免不必要的擔(dān)心,提高治療信心。
綜上所述,瞼板腺功能障礙所致脂質(zhì)缺乏型干眼癥患者在瞼板腺按摩聯(lián)合中藥熏眼護(hù)理中進(jìn)行持續(xù)護(hù)理質(zhì)量改進(jìn),其效果確切,有利于緩解患者的負(fù)面情緒,有利于提高患者的免疫力,改善患者的預(yù)后。
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(收稿日期:2019-11-21) (本文編輯:何玉勤)
①秭歸縣人民醫(yī)院 湖北 秭歸 443600
通信作者:王丹丹