标题：双主体三步法对脑血管动脉瘤介入治疗患者康复进度、急性应激障碍及功能康复的影响

      作者：张丽丽 1，李晓 1，段旭华 2，王静杰 3，郭怡 1，李娟 1，周纪妹 1，景毅鹏 4    郑州大学第一附属医院介入手术室 1、放射介入科 2、神经内科 3、神经介入科 4，河南 郑州 450000

      卷次： 2024年35卷14期

      【摘要】 目的 探究双主体三步法对脑血管动脉瘤介入治疗患者康复进度、急性应激障碍及功能康复的影响。方法 选取2021年6月至2023年6月郑州大学第一附属医院收治的244例脑血管动脉瘤患者作为研究对象，按随机数表法分为对照组和观察组各122例，对照组患者给予常规护理，观察组患者于此基础上给予双主体三步法护理模式，干预至出院后3个月。比较两组患者的康复进度，以及干预前后的急性应激障碍量表(ASDS)评分、医学应对方式问卷(MCMQ)评分、Fugl-Meyer运动功能测评法(FMA)评分和改良Barthel指数(BI)。结果 观察组患者术后清醒时间、尿管留置时间、住院时间分别为(11.32±1.85) h、(7.20±0.68) d、(18.36±3.18) d，明显短于对照组的(24.35±2.36) h、(11.75±0.83) d、(20.14±3.76) d，差异均有统计学意义(P<0.05)；干预后，观察组患者ASDS量表中分离症状、再体验症状、高警觉症状、回避症状评分分别为(7.10±1.10)分、(6.56±0.96)分、(11.03±1.69)分、(5.32±0.67)分，明显低于对照组的(8.32±1.27)分、(8.24±1.12)分、(13.14±1.13)分、(7.56±1.18)分，差异均有统计学意义(P<0.05)；干预后，观察组患者MCMQ量表中回避、面对、屈服评分分别为(11.24±2.36)分、(26.06±3.17)分、(8.32±1.38)分，明显低于对照组的(16.36±3.22)分、(20.53±4.14)分、(10.29±2.15)分，差异均有统计学意义(P<0.05)；干预后，观察组患者FMA、BI评分分别为(70.69±5.10)分、(81.02±5.24)分，明显低于对照组的(64.59±44.32)分、(76.33±4.69)分，差异均有统计学意义(P<0.05)。结论 双主体三步法应用于脑血管动脉瘤患者的管理，可减轻患者急性应激障碍，改善其应对方式，加速术后康复进度，提高肢体运动及日常生活能力。
      【关键词】 双主体三步法；动脉瘤；介入治疗；急性应激障碍；功能康复
      【中图分类号】 R473.73 【文献标识码】 A 【文章编号】 1003—6350（2024）14—2103—05

Effect of two-subject three-step method on rehabilitation progress, acute stress disorder, and functionalrehabilitation of patients with cerebrovascular aneurysm undergoing interventional therapy.
ZHANG Li-li 1, LIXiao 1, DUAN Xu-hua 2, WANG Jing-jie 3, GUO Yi 1, LI Juan 1, ZHOU Ji-mei 1, JING Yi-peng 4. Interventional OperatingRoom 1, Department of Interventional Radiology 2, Department of Neurology 3, Department of Neurointervention 4, the FirstAffiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, CHINA
【Abstract】 Objective To explore the effects of two-subject three-step method on the rehabilitation progress,acute stress disorder, and functional rehabilitation of patients with cerebrovascular aneurysm undergoing interventionaltherapy. Methods A total of 244 patients with cerebrovascular aneurysm admitted to the First Affiliated Hospital ofZhengzhou University from June 2021 to June 2023 were selected and randomly divided into a control group and an ob-servation group according to the random number table method, each with 122 patients. The patients in the control groupwere given routine care, while the patients in the observation group were given a two-subject three-step nursing modelbased on routine care, until three months after discharge. The rehabilitation progress of the two groups of patients wascompared, as well as the scores of the Acute Stress Disorder Scale (ASDS), the Medical Coping Modes Questionnaire(MCMQ), the Fugl-Meyer Assessment of Motor Function (FMA), and the Modified Barthel Index (BI) before and afterintervention. Results In the observation group, the postoperative waking time, urinary catheter retention time, andlength of hospital stay were (11.32±1.85) h, (7.20±0.68) d, and (18.36±3.18) d, respectively, significantly shorter than(24.35±2.36) h, (11.75±0.83) d, (20.14±3.76) d in the control group (P<0.05). After intervention, the scores of dissocia-tion symptom, reexperience symptom, hypervigilance symptom, and avoidance symptom in the observation group were(7.10±1.10) points, (6.56±0.96) points, (11.03±1.69) points, (5.32±0.67) points, respectively, significantly lower than(8.32±1.27) points, (8.24±1.12) points, (13.14±1.13) points, (7.56±1.18) points in the control group (P<0.05). After in-tervention, the avoidance, facing, and yield scores in MCMQ scale of patients in the observation group were (11.24±2.36) points, (26.06±3.17) points, and (8.32±1.38) points, which were significantly lower than (16.36±3.22) points,(20.53±4.14) points, and (10.29±2.15) points in the control group (P<0.05). After intervention, the FMA and BI scores ofthe observation group were (70.69±5.10) points and (81.02±5.24) points, respectively, which were significantly lowerthan (64.59 ±44.32) points and (76.33± 4.69) points of the control group (P<0.05). Conclusion The application oftwo-subject three-step method in the management of patients with cerebrovascular aneurysms can alleviate acute stressdisorder, improve their coping style, accelerate the progress of postoperative rehabilitation, and improve the ability oflimb movement and daily life.
      【Key words】 Two-subject three-step method; Aneurysm; Interventional therapy; Acute stress disorder; Function-al rehabilitation