个案管理模式联合认知护理在脑卒中后抑郁患者中的应用效果

摘要

目的 探讨个案管理模式联合认知护理干预对脑卒中后抑郁患者一般状态及认知功能的影响.方法 选取2016年10月—2018年4月于河南省人民医院神经内科治疗的脑卒中后抑郁患者96例,以随机数字表法分为观察组及对照组,各48例.对照组给予常规护理方式,观察组在对照组的基础上再给予个案管理模式联合认知护理干预方式.于干预前后采用简易智力状态检查量表(MMSE)、护士用住院患者观察量表(NOSIE)、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)进行调查,并观察两组患者机体异常情况和住院天数.结果 观察组患者机体异常发生率低于对照组,差异均有统计学意义(P<0.05);干预后,观察组患者NOSIE评分中,个人整洁、兴趣及社会能力项目评分高于对照组,抑郁、激惹及迟缓项目得分低于对照组患者,差异均有统计学意义(P<0.01);两组患者认知障碍发生率、HAMA评分及HAMD评分均下降,两组比较差异均有统计学意义(P<0.05);两组住院天数比较差异均有统计学意义(P<0.05).结论 个案管理模式联合认知护理干预能改善脑卒中后抑郁患者的焦虑、抑郁状态和认知功能,缩短住院时间,值得临床进一步推广使用.%Objective To explore the effects of case nursing combined with cognitive nursing intervention on general status and cognitive function in stroke patients with depression.Methods From October 2016 to April 2018, we selected 96 stroke patients with depression in Department of Neurology of He'nan Provincial People's Hospital. All of the patients were divided into observation group and control group with the random number table, 48 cases in each group. Control group received routine nursing. On the basis of that in control group, observation group applied case nursing combined with cognitive nursing intervention. The investigation was carried out with the Mini-mental State Examination (MMSE), Nurses' Observation Scale for Inpatient Evaluation (NOSIE), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) before and after intervention. We also observed patients' abnormal body condition and hospital days.Results The incidence of abnormal body condition of patients in observation group was lower than that in control group with a statistical difference (P<0.05). After intervention, the scores of NOSIE of patients in observation group, the scores of personal neatness, interest and social competence were higher than those in control group; the scores of depression, irritability and slowness were lower than those in control group; the differences were all statistical (P<0.01). The incidence of cognitive disorder and the scores of HAMA as well as HAMD all decreased after intervention, and the improvements of observation group were statistically better than those of control group (P<0.05). There was statistical differences in the hospital days between two groups (P<0.05). Conclusions Case nursing combined with cognitive nursing intervention can improve depression, anxiety and cognitive function, and shorten hospital days among stroke patients with depression which is worth further promotion in clinical application.