摘要：
目的 分析结核性脓胸患者胸膜纤维板剥脱术后的社会适应状况,探索并检验便捷可行的健康教育方案.方法 采用质性研究与量性研究相结合的方法,第一阶段采用质性研究,选择2008年9月1日至2013年9月1日于山东省胸科医院某胸外科病房行胸膜纤维板剥脱手术的131例住院患者,根据手术类型及年龄段分组后采用随机数字表法进行随机抽样,对抽样患者进行电话访谈,根据访谈结果制定健康教育手册及健康教育临床路径表;第二阶段采用量性研究的方法,选取2016年11月25日至2017年1月13日于同一家医疗机构胸外科病房行胸膜纤维板剥脱手术的70例结核性脓胸患者,根据手术时间分为两组,将2016年12月18日前手术的31例患者作为对照组,接受传统的健康教育;将2016年12月18日后手术的39例患者作为观察组,使用健康教育手册及临床路径表进行健康宣传教育(简称“宣教”).手术前1周内及出院后1个月时分别使用SF-36量表(包括8个维度,分别为生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能和精神健康)测量两组患者的社会适应状况.结果 第一阶段共成功访谈35例患者,提炼出4个社会适应性主题,包括身体不适、心理反应、知识缺乏及适应对策,针对患者康复过程中存在的上述问题,制定患者术后康复手册及健康教育临床路径表.第二阶段手术前1周对照组患者SF-36量表的生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能和精神健康维度得分分别为(77.42±2.81)、(41.13±5.86)、(68.82±3.66)、(62.74±3.29)、(65.00±3.09)、(73.79±3.50)、(46.24±6.12)、(72.00±2.28)分,与观察组患者得分[分别为(78.59±2.32)、(42.95±4.77)、(68.66±3.21)、(61.92±2.93)、(64.36±2.79)、(72.44±2.61)、(49.57±5.32)、(71.49±2.06)分]比较,差异均无统计学意义(t值分别为0.32、0.24、0.03、0.19、0.15、0.32、0.41、0.17,P值分别为0.747、0.808、0.974、0.853、0.878、0.752、0.681、0.868);出院后1个月对照组患者8个维度得分分别为(80.32±1.59)、(46.77±6.32)、(75.27±2.81)、(68.39±3.30)、(74.84±1.51)、(79.03±2.49)、(62.37±4.83)、(77.16±1.58)分,均明显低于观察组患者得分[分别为(85.64±1.15)、(67.31±5.75)、(83.76±1.77)、(78.31±2.27)、(81.03±1.36)、(86.86±2.05)、(77.78±3.74)、(82.56±0.95)分],差异均有统计学意义(t值分别为2.78、2.40、2.66、2.67、3.03、2.45、2.57、3.07,P值分别为0.007、0.002、0.010、0.010、0.003、0.017、0.013、0.003);且对照组患者手术前后仅在生理职能、活力、社会功能及精神健康4个维度得分差异有统计学意义(t值分别为2.53、2.66、1.58、2.24,P值分别为0.017、0.012、0.033、0.033),而观察组患者手术前后各维度得分差异均有统计学意义(t值分别为3.26、7.51、3.85、5.33、5.68、4.42、3.45、5.58,P值分别为0.002、0.000、0.000、0.000、0.000、0.000、0.001、0.000).结论 结核性脓胸患者胸膜纤维板剥脱术后会面临生理、心理、社会方面的压力,健康教育手册及临床路径表的使用,可以提高医院健康教育的效果,促进结核性脓胸患者术后的康复进程.%Objective To investigate the social adaptability of patients with tuberculous empyema having pleural decortication,and to explore and test convenient and feasible health education program.Methods Qualitative and quantitative methods were used.During the first phase the qualitative approach was taken.Of the 131 inpatients with pleural decortication in one thoracic surgery ward of Shandong Provincial Chest Hospital who were in hospital from September 1st 2008 to September 1st 2013,groups were gotten according to surgery type and age.Random sampling method was used to select patients.Telephone interview was applied to the selected patients.The health education booklet and health education clinical pathway were developed according to the analysis of interview transcripts.The quantitative approach was used in the second phase,and 70 patients with tuberculosis empyema having pleural decortication were selected in the same hospital who were in hospital from November 25th 2016 to January 13th 2017,and they were divided into two groups according to the operation time.The control group (n=31) who were operated before December 18th 2016 accepted the traditional health education,and the observation group (n=39) who were operated after December 18th 2016 received health education delivered by well trained nurses with the help of health education booklet and the clinical pathway.The 36-Item Short-Form Health Survey (i.e.SF-36) was used to measure the patients' social adaptability in the two groups in the period of one week before surgery and one month after discharge.Results Thirty-five patients were successfully interviewed in the first phase,and finally four themes of social adaptability were formed:physical discomfort,psychological reaction,lack of knowledge and adapting strategies.Patient patients postoperative rehabilitation manual and health education clinical pathway were developed according to the above themes.In the second stage,the scores of SF36 (PF-physical functioning,RP-role physical,BP-bodily pain,GH-general health,VT-vitality,SF-social functioning,RE-role emotional and MH-mental health) one week before surgery in the control group were 77.42 ± 2.81,41.13± 5.86,68.82±3.66,62.74±3.29,65.00±3.09,73.79±3.50,46.24±6.12,72.00±2.28,and the scores in the observationgroup were 78.59±2.32,42.95±4.77,68.66±3.21,61.92±2.93,64.36±2.79,72.44±2.61,49.57± 5.32,71.49 ± 2.06.There was no significant difference between the two groups (t values were 0.32,0.24,0.03,0.19,0.15,0.32,0.41 and 0.17,and P values were 0.747,0.808,0.974,0.853,0.878,0.752,0.681 and 0.868 respectively).The scores of the control group one month after discharge were 80.32± 1.59,46.77±6.32,75.27±2.81,68.39±3.30,74.84±1.51,79.03±2.49,62.37±4.83,77.16±1.58,which were significantly lower than the scores of the observation group (85.64±1.15,67.31±5.75,83.76±1.77,78.31±2.27,81.03±1.36,86.86±2.05,77.78±3.74,82.56±0.95) (t values were 2.78,2.40,2.66,2.67,3.03,2.45,2.57 and 3.07,and P values were 0.007,0.002,0.010,0.010,0.003,0.017,0.013 and 0.003).There were significant differences in the scores of RP,VT,SF and MH before and after surgery in the control group (t values were 2.53,2.66,1.58 and 2.24,and P values were 0.017,0.012,0.033 and 0.033).On the contrary,significant differences were showed up in each of eight areas in the observation group one month after discharge (t values were 3.26,7.51,3.85,5.33,5.68,4.42,3.45 and 5.58,and P values were 0.002,0.000,0.000,0.000,0.000,0.000,0.001 and 0.000).Conclusion The patients with tuberculous empyema will face varioua stress and challenges from physiological,psychological and social aspects.The effect of health education and the patients' rehabilitation process can be improved by the application of rehabilitation booklet and health education clinical pathway.
