标题：PRECEDE护理模式对风心病患者术后生活质量、服药依从性及焦虑抑郁状况的影响

      作者：张红 1，邬海燕 1，岳朝换 2    郑州大学第一附属医院心内科 1、入院接诊处 2，河南 郑州 450000

      卷次： 2023年34卷23期

      【摘要】 目的 探究倾向、强化及促成因素(PRECEDE)护理模式对风心病患者术后生活质量(QOL)、服药依从性及焦虑抑郁状况的影响。方法 选择2019年5月至2022年6月郑州大学第一附属医院心内科收治的90例风湿性心脏病患者为研究对象，根据随机数表法分为观察组和对照组各45例。两组患者均行心脏瓣膜置换术，对照组患者接受常规的治疗性护理，观察组患者接受PRECEDE护理，比较两组患者心功能改善情况、护理前和护理1个月后的QOL评分、日常生活能力评分(ADL)、Morisky用药依从性问卷评分、Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果 观察组患者的心功能改善率为93.33%，明显高于对照组的75.56%，差异有统计学意义(P<0.05)；护理前，两组患者的QOL评分和ADL评分比较差异均无统计学意义(P>0.05)，护理 1个月后，两组患者的QOL评分和ADL评分明显高于治疗前，且观察组的QOL评分和ADL评分分别为(20.97±2.50)分、(81.53±4.12)分，明显高于对照组的(15.75±2.47)分、(71.53±4.31)分，差异均有统计学意义(P<0.05)；护理前，两组患者的Morisky评分比较差异无统计学意义(P>0.05)，护理1个月后，对照组患者的Morisky评分与治疗前比较差异无统计学意义(P>0.05)，但观察组患者的Morisky评分明显高于护理前，且明显高于对照组，差异均有统计学意义(P<0.05)；护理前，两组患者的SAS和SDS评分比较差异均无统计学意义(P>0.05)，护理1个月后，两组患者的SAS和SDS评分明显低于治疗前，且观察组患者的SAS和SDS评分分别为(45.54±4.54)分、(46.32±5.04)分，明显低于对照组的 (50.32±4.75)分、(52.25±4.89)分，差异均有统计学意义(P<0.05)。结论 PRECEDE护理应用于心脏瓣膜置换术的风湿性心脏病患者，不仅可提高治疗效果和生活质量，而且还可以改善患者的服药依从性和焦虑抑郁心理。
      【关键词】 风湿性心脏病；倾向、强化及促成因素护理模式；生活质量；焦虑抑郁；服药依从性
      【中图分类号】 R473.5 【文献标识码】 A 【文章编号】 1003—6350（2023）23—3478—04

Effect of predisposing, reinforcing, enabling constructs in educational diagnosis and evaluation nursing model onpostoperative quality of life, medication compliance, and anxiety and depression in patients with rheumatic heartdisease.
ZHANG Hong 1, WU Hai-yan 1, YUE Chao-huan 2. Department of Cardiology 1, Admission Office 2, the FirstAffiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, CHINA
【Abstract】 Objective To explore the effect of PRECEDE (predisposing, reinforcing, enabling constructs in ed-ucational diagnosis and evaluation) nursing model on postoperative quality of life (QOL), medication compliance, andanxiety and depression in patients with rheumatic heart disease. Methods Ninety patients with rheumatic heart diseaseadmitted to the Department of Cardiology, the First Affiliated Hospital of Zhengzhou University from May 2019 to June2022 were selected as the research objects. According to the random number table method, they were divided into an obser-vation group and a control group, with 45 patients in each group. All patients underwent cardiac valve replacement. The pa-tients in the control group were given conventional nursing, while the patients in the observation group adopted PRE-CEDE nursing model. The improvement of cardiac function, QOL score, activities of daily living (ADL) score, Moriskymedication compliance scale score, Zung Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scorewere compared between the two groups before and at one month after nursing. Results The improvement rate of cardi-ac function was 93.33% in the observation group, which was significantly higher than 75.56% in the control group (P<0.05). Before nursing, there was no significant difference in QOL score and ADL score between the two groups (P>0.05). After one month of nursing, the QOL and ADL scores showed an increase in two groups, and the QOL and ADLscores in the observation group were (20.97±2.50) points and (81.53±4.12) points, which were significantly higher than(15.75±2.47) points and (71.53±4.31) points in the control group (P<0.05). Before nursing, there was no significant dif-ference in Morisky score between the two groups (P>0.05). After 1 month of nursing, Morisky score of the control groupshowed no significant difference with that before treatment (P>0.05); however, the Morisky score of the observationgroup was significantly higher than that before nursing, and also significantly higher than that of the control group (P<0.05). Before nursing, there was no significant difference in SAS and SDS scores between the two groups (P>0.05). Af-ter 1 month of nursing, the SAS and SDS scores of the two groups were significantly lower than those before treatment,and scores in the observation group were (45.54±4.54) points and (46.32±5.04) points, which were significantly lowerthan (50.32±4.75) points and (52.25±4.89) points of the control group (P<0.05). Conclusion Application of PRE-CEDE nursing in patients with rheumatic heart disease undergoing cardiac valve replacement surgery can effectively im-prove the treatment effect and quality of life, and improve patients' medication compliance and anxiety and depression.
      【Key words】 Rheumatic heart disease; predisposing, reinforcing, enabling constructs in educational diagnosisand evaluation nursing model; Quality of life; Anxiety and depression; Medication compliance