二元应对理论联合IMB模型护理干预对慢性心力衰竭患者生活质量的影响

孙慧; 吴坚; 丁红英

doi:10.16766/j.cnki.issn.1674-4152.004025

二元应对理论联合IMB模型护理干预对慢性心力衰竭患者生活质量的影响

doi: 10.16766/j.cnki.issn.1674-4152.004025

绍兴第二医院医共体总院心血管内科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2023KY377

详细信息

通讯作者:
孙慧，E-mail：18767507271@163.com

中图分类号: R541.6 R473.54
计量
- 文章访问数: 4
- HTML全文浏览量: 5
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2025-01-22
- 网络出版日期: 2025-08-14

The impact of binary coping theory combined with IMB model nursing intervention on the quality of life of patients with chronic heart failure

Department of Cardiovascular Medicine, Shaoxing Second Hospital Medical Community General Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的结合二元应对理论和信息-动机-行为技巧模型(IMB模型)，构建针对慢性心力衰竭患者的护理干预方案，分析其对患者生活质量的影响。方法选取2023年9月—2024年6月绍兴第二医院医共体总院收治的126例慢性心力衰竭患者作为研究对象，采用随机数表法分为对照组(63例)及观察组(63例)。对照组应用常规护理，观察组应用二元应对理论联合IMB模型进行护理干预。干预周期为3个月，比较2组患者干预前后心功能指标、自我管理水平及生活质量。结果干预后，2组患者心功能指标均有所改善，观察组左心室射血分数(LVEF)及6 min步行距离测试(6MWT)高于对照组，且N端钠尿肽前体(NT-proBNP)水平低于对照组(P＜0.05)；干预后，2组患者自我管理水平均提高，观察组心力衰竭患者自我管理量表总分为(120.43±13.46)分，高于对照组[(101.35±15.92)分，P＜0.05]；干预后，2组患者生活质量均有所改善，观察组明尼芬达心功能不全生活质量量表(MLHFQ)总分为(50.73±6.37)分，低于对照组[(56.82±8.74)分，F=8.137, P＜0.001]。结论二元应对理论联合IMB模型护理干预有利于改善慢性心力衰竭患者心功能及自我管理水平，同时提高了患者的生活质量，值得临床应用。
- 慢性心力衰竭 /
- 二元应对理论 /
- IMB模型 /
- 心功能 /
- 自我管理 /
- 生活质量
Abstract: Objective To construct a nursing intervention plan for patients with chronic heart failure combined the theory of binary coping and the Information Motivation Behavioral Skills (IMB) model, and analyze its impact on patients' quality of life. Methods A total of 126 patients with chronic heart failure admitted to the Medical Community General Hospital of Shaoxing Second Hospital from September 2023 to June 2024 were selected as the study subjects and randomly divided into a control group and an observation group, with 63 patients in each group. The control group received routine nursing care, while the observation group received nursing intervention using the binary coping theory combined with the IMB model. The intervention period was 3 months, and the cardiac function indicators, self-management level, and quality of life of the two groups of patients were compared before and after the intervention. Results After the intervention, both groups of patients showed improvement in cardiac function indicators, but the LVEF and 6MWT in the observation group were higher than those in the control group, and the level of NT-proBNP was lower than that in the control group (P < 0.05). The self-management level of both groups of patients improved, however, the total score of the self-management scale for the observation group of heart failure patients was (120.43±13.46) points, which was higher than that of the control group [(101.35±15.92) points, P < 0.05]. The quality of life of both groups of patients improved, but the total score of the Minnesota heart failure quality of life questionnaire (MLHFQ) in the observation group was (50.73±6.37) points, which was lower than that of the control group [(56.82±8.74) points, F=8.137, P < 0.001]. Conclusion The combination of binary coping theory and IMB model nursing intervention is beneficial for improving the cardiac function and self-management level of patients with chronic heart failure, while also improving their quality of life, and is worthy of clinical application.
- Chronic heart failure /
- Binary coping theory /
- IMB model /
- Heart function /
- Self-management /
- Quality of life

HTML全文

表 1 2组慢性心力衰竭患者一般资料比较

Table 1. Comparison of general data of two groups of patients with chronic heart failure

项目	对照组(n=63)	观察组(n=63)	统计量	P值
性别(例)			0.143^a	0.705
男性	41	43
女性	22	20
年龄(x±s，岁)	78.82±4.59	79.13±5.32	0.350^b	0.727
受教育年限(x±s，年)	4.86±1.73	4.92±1.84	0.189^b	0.851
照护者类型(例)			0.385^a	0.535
配偶	46	49
子女	17	14
职业(例)			0.220^a	0.896
在职	8	7
退休	42	41
无业	13	15
心功能分级(例)			0.429^c	0.807
Ⅱ级	20	22
Ⅲ级	36	36
Ⅳ级	7	5
BMI(x±s)	24.16±3.40	23.52±3.57	1.030^b	0.305
注：^a为χ²值，^b为t值，^c为Z值。

下载: 导出CSV

表 2 2组慢性心力衰竭患者心功能指标比较(x±s)

Table 2. Comparison of cardiac function indicators in two groups of patients with chronic heart failure(x±s)

组别	例数	LVEF(%)		NT-proBNP(ng/L)		6MWT(m)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	63	48.28±4.22	50.68±5.09^b	687.92±157.46	394.72±90.51^b	375.68±50.19	455.93±60.12^b
观察组	63	47.76±5.13	52.79±4.81^b	691.33±143.29	357.93±80.75^b	377.42±52.73	481.29±53.33
统计量		0.621^a	2.233^c	0.172^a	2.319^c	0.190^a	2.488^c
P值		0.536	0.020	0.864	0.018	0.850	0.016
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 3 2组慢性心力衰竭患者自我管理水平比较(x±s，分)

Table 3. Comparison of self-management levels between two groups of patients with chronic heart failure(x±s, points)

组别	例数	自我管理信心		自我管理行为		自我心理管理
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	63	11.87±3.10	12.25±3.55	40.32±10.18	50.29±8.02^b	10.72±2.76	12.93±3.59^b
观察组	63	11.94±2.83	15.16±2.64^b	39.77±9.76	57.16±6.81^b	10.66±2.94	15.40±2.78^b
统计量		0.132^a	4.783^c	0.310^a	7.893^c	0.118^a	5.033^c
P值		0.895	＜0.001	0.757	＜0.001	0.906	＜0.001

组别	例数	自我管理认知		自我管理信息		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	63	9.73±1.72	12.01±2.49^b	10.10±2.45	13.51±2.37^b	82.79±17.76	101.35±15.92^b
观察组	63	9.88±1.65	16.17±1.84^b	10.18±2.27	16.10±1.86^b	83.93±16.95	120.43±13.46^b
统计量		0.500^a	4.164^c	0.190^a	4.101^c	0.369^a	16.539^c
P值		0.618	＜0.001	0.850	＜0.001	0.713	＜0.001
注：^a为t值，^c为F值; 与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 4 2组慢性心力衰竭患者生活质量比较(x±s，分)

Table 4. Comparison of the quality of life of two groups of patients with chronic heart failure(x±s, points)

组别	例数	躯体领域		情绪领域		其他领域		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	63	25.67±6.10	24.03±5.32^b	15.78±4.31	14.85±3.25	20.11±5.49	18.47±4.28^b	60.72±11.64	56.82±8.74^b
观察组	63	24.59±5.83	22.18±4.26^b	16.24±4.59	10.83±3.10^b	19.83±4.72	16.90±3.51^b	61.49±10.38	50.73±6.37^b
统计量		1.383^a	3.014^c	0.580^a	5.705^c	0.307^a	3.529^c	0.392^a	8.137^c
P值		0.169	0.001	0.563	＜0.001	0.759	0.001	0.696	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

参考文献(18)

[1]	HEIDENREICH P A, BOZKURT B, AGUILAR D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2022, 145(18): e895-e1032.
[2]	MASCOLO A, DI MAURO G, CAPPETTA D, et al. Current and future therapeutic perspective in chronic heart failure[J]. Pharmacol Res, 2022, 175: 106035. DOI: 10.1016/j.phrs.2021.106035.
[3]	ALVAREZ P, SIANIS A, BROWN J, et al. Chronic disease management in heart failure: focus on telemedicine and remote monitoring[J]. Rev Cardiovasc Med, 2021, 22(2): 403-413.
[4]	朱玉珊, 朱小平. 基于IMB模型的康复干预对老年脑梗死患者上肢功能运动功能及神经功能的影响[J]. 中国实用神经疾病杂志, 2024, 27(6): 774-778. ZHU Y S, ZHU X P. Effect of rehabilitation intervention based on IMB model on upper limb function, motor function, and nerve function in elderly patients with cerebral infarction[J]. Chinese Journal of Practical Nervous Diseases, 2024, 27(6): 774-778.
[5]	卢璇, 尹卫, 张建薇. 基于IMB模型的出院准备服务在老年慢性心力衰竭患者中的应用[J]. 中国医药导报, 2023, 20(9): 160-164. LU X, YIN W, ZHANG J W. Application of discharge planning based on IMB model in the elderly patients with chronic heart failure[J]. China Medical Herald, 2023, 20(9): 160-164.
[6]	黎景徽, 钟美容, 韦丽华. 二元疾病管理理论在接受PCI的老年冠心病患者居家心脏康复中的应用效果[J]. 实用心脑肺血管病杂志, 2024, 32(5): 32-37. LI J H, ZHONG M R, WEI L H. Application Effect of Dyadic Illness Management Theory in Home-Based Cardiac Rehabilitation of Elderly Coronary Heart Disease Patients Undergoing PCI[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2024, 32(5): 32-37.
[7]	周晗, 刘鹏. 2010欧洲心脏病协会年会心脏起搏和再同步治疗指南更新: 2007欧洲心脏病协会年会心脏再同步化治疗指南疗指南和2008欧洲心脏病协会年会急性和慢性心力衰竭诊断和治疗指南的更新[J]. 中国医学前沿杂志(电子版), 2010, 2(4): 43-49. ZHOU H, LIU P. Update of the 2010 European Society of Cardiology Annual Meeting Guidelines for Cardiac Pacing and Resynchronization Therapy-Update of the 2007 European Society of Cardiology Annual Meeting Guidelines for Cardiac resynchronization Therapy and the 2008 European Society of Cardiology Annual Meeting Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure[J]. Chinese Journal of the Frontiers of Medical Science(Electronic Version), 2010, 2(4): 43-49.
[8]	张坤. 心力衰竭自我管理量表开发及健康教育研究[D]. 青岛: 青岛大学, 2014. ZHANG K. Research on the development of self-management Scales for Heart failure and health education[D]. Qingdao: Qingdao University, 2014.
[9]	朱燕波, 杜金行, 林琳, 等. 明尼苏达心功能不全生命质量量表中文版的研制及临床试用[J]. 中华行为医学与脑科学杂志, 2010, 19(2): 178-181. ZHU Y B, DU J X, LIN L, et al. The translating, editing and testing of the Minnesota living with heart failure questionnaire of Chinese version[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2010, 19(2): 178-181.
[10]	KING-DAILEY K, FRAZIER S, BRESSLER S, et al. The role of nurse practitioners in the management of heart failure patients and programs[J]. Curr Cardiol Rep, 2022, 24(12): 1945-1956.
[11]	黄宇理, 姚慧强, 张先林, 等. 三甲医院指导下社区慢性心力衰竭患者按分期管理的效果分析[J]. 中华全科医学, 2023, 21(6): 977-980, 1007. doi: 10.16766/j.cnki.issn.1674-4152.003029 HUANG Y L, YAO H Q, ZHANG X L, et al. Effect analysis of community chronic heart failure patients managed by stages under the guidance of third-class hospitals[J]. Chinese Journal of General Practice, 2023, 21(6): 977-980, 1007. doi: 10.16766/j.cnki.issn.1674-4152.003029
[12]	何丽青, 张茜, 郑贝贝, 等. 二元疾病管理理论在慢性心力衰竭病人及其照顾者中的应用进展[J]. 护理研究, 2022, 36(17): 3111-3115. HE L Q, ZHANG Q, ZHENG B B, et al. Application progress on dyadic illness management theory in patients with chronic heart failure and their caregivers[J]. Chinese Nursing Research, 2022, 36(17): 3111-3115.
[13]	冷欣. 基于IMB模型的慢性心衰患者自我护理行为的二元干预方案构建研究[D]. 长春: 吉林大学, 2024. LENG X. Research on the Construction of a binary intervention Program for Self-care Behaviors of Patients with Chronic Heart Failure Based on the IMB model[D]. Changchun: Jilin University, 2024.
[14]	DING H, JAYASENA R, CHEN S H, et al. The effects of telemonitoring on patient compliance with self-management recommendations and outcomes of the innovative telemonitoring enhanced care program for chronic heart failure: randomized controlled trial[J]. J Med Internet Res, 2020, 22(7): e17559. DOI: 10.2196/17559.
[15]	ZHANG N, LI Q, CHEN S X, et al. Effectiveness of nurse-led electronic health interventions on illness management in patients with chronic heart failure: a systematic review and meta-analysis[J]. Int J Nurs Stud, 2024, 150: 104630. DOI: 10.1016/j.ijnurstu.2023.104630.
[16]	范文海, 于明明. 慢性病患者及其照顾者二元症状评价研究进展[J]. 中华护理教育, 2023, 20(8): 1014-1019. FAN W H, YU M M. Research progress of dyadic symptom evaluation in patients with chronic diseases and their caregivers[J]. Chinese Journal of Nursing Education, 2023, 20(8): 1014-1019.
[17]	高蕊, 姚思雨, 邢彩溢, 等. 二元应对在肺癌患者配偶照顾负担与生活质量间的中介作用分析[J]. 现代医学, 2024, 52(1): 108-114. GAO R, YAO S Y, XING C Y, et al. Dyadic coping mediatingcare burden and quality of life in spouse of lung cancer patient[J]. Modern Medical Journal, 2024, 52(1): 108-114.
[18]	梁浩, 王雪冬, 孙海玲, 等. 慢性心力衰竭不良预后的风险模型构建[J]. 河北医学, 2024, 30(10): 1705-1711. LIANG H, WANG X D, SUN H L, et al. Risk Model Construction for Adverse Prognosis in Chronic Heart Failure[J]. Hebei Medicine, 2024, 30(10): 1705-1711.