管孝艳 何秀雯

【摘要】目的 探讨基于行为分阶段改变理论（TTM）的协同护理模式对慢性心力衰竭患者自我护理能力及生活质量的影响。方法 选取我院心内科2018年01月～2019年09月间64例慢性心力衰竭患者，随机均分为对照组和观察组，各32例。对照组给予心内科常规护理、院内健康宣教和出院指导等护理干预，观察组在对照组基础上实施基于TTM协同护理模式。对比两组入院时和出院6个月的自我护理行为评价（SCHFI量表）、生活质量（MLHFQ）及再入院率和死亡率。结果 入院时，两组SCHFI、MLHFQ各条目评分比较均无明显差异（P>0.05）;出院6个月随访，观察组SCHFI各条目评分均明显高于对照组，观察组生活质量各条目评分均明显低于对照组，说明观察组患者自护能力和生活质量均明显优于对照组;出院6个月内观察组再入院率明顯低于对照组（P<0.05），两组患者出院6个月内均无死亡（P>0.05）。结论 对慢性心力衰竭患者实施基于TTM的协同护理模式，可显著提高患者自我护理能力及生活质量，减少患者再次发病入院治疗的几率。

【关键词】分阶段;行为改变;协同护理;慢性心衰;自护能力;生活质量

【中图分类号】R473.5 【文献标识码】A 【文章编号】ISSN.2095.6681.2020.21..03

【Abstract】Objective To explore the effect of the collaborative nursing model based on the behavioral phase change theory（TTM）on the self-care ability and quality of life of patients with chronic heart failure.Methods A total of 64 patients with chronic heart failure from January 2018 to September 2019 in our department of cardiology were randomly divided into a control group and an observation group，32 cases each.The control group was given nursing interventions such as cardiology routine nursing，hospital health education and discharge guidance.The observation group implemented a TTM-based collaborative nursing model based on the control group.The self-care behavior evaluation（SCHFI scale），quality of life（MLHFQ），readmission rate and mortality rate at admission and at 6 months of discharge were compared between the two groups.Results At admission，there was no significant difference in the scores of SCHFI and MLHFQ between the two groups（P>0.05）.After 6 months of discharge，the SCHFI scores of the observation group were significantly higher than the control group，and the scores of the quality of life of the observation group were all obvious Lower than the control group，indicating that the self-care ability and quality of life of the observation group were significantly better than the control group;the re-admission rate of the observation group was significantly lower than the control group within 6 months of discharge（P<0.05），and the discharge of the two groups of patients was 6 months There were no deaths（P>0.05）.Conclusion Implementing the TTM-based collaborative care model for patients with chronic heart failure can significantly improve the patient's self-care ability and quality of life，and reduce the patient's chance of being admitted to the hospital again.

【Key words】Staged;Behavior change;Collaborative nursing;Chronic heart failure;Self-care ability;Quality of life

现代社会人们生活工作的压力不断上升，导致心脏病的发病率也在不断增加，尤其是慢性心力衰竭（以下简称慢性心衰）心脏类疾病的发病率更高[1]。《中国心血管病报告2018》指出，慢性心衰的患病率及死亡率在我国呈不断上升的趋势，是引发多种类型心脏病的严重时期，也是一种十分复杂的临床疾病症状症候群[2]。自我……