基于赋能理论模式护理干预对继发性癫痫患者自我管理及生活质量的影响

doi:10.3760/cma.j.issn.1007-1245.2024.24.037

摘要/Abstract

摘要：

目的　探究基于赋能理论模式的护理干预对促进继发性癫痫患者自我管理能力和改善其生活质量的有效性。方法　该研究为随机对照试验。将咸阳市中心医院2021年6月至2023年6月收治的84例继发性癫痫患者按随机数字表法分为两组，各42例。参照组：男28例，女14例，年龄32～64（41.63±5.37）岁；发作类型：单纯型部分发作21例、复杂型部分发作12例、全身性发作9例；采用常规护理措施。试验组：男23例，女19例，年龄36～66（41.06±5.24）岁；发作类型：单纯型部分发作23例、复杂型部分发作11例、全身性发作8例；采用基于赋能理论模式的护理干预。两组均干预3个月。观察并比较两组患者干预前、后的自我管理能力［癫痫患者自我管理量表（ESMS）］、神经功能改善情况［美国国立卫生研究院卒中量表（NIHSS）］、疾病不确定感［Mishel疾病不确定感量表（MUIS）］和生活质量［中文版癫痫患者生活质量评定量-31（QOLIE-31）］，统计两组患者3个月内继发性癫痫发生情况。采用t检验、χ²检验进行统计分析。结果　干预后，试验组ESMS、QOLIE-31评分均高于参照组［（155.21±19.87）分比（121.17±17.63）分、（73.14±8.32）分比（62.29±7.38）分］，差异均有统计学意义（t=8.31、6.32，均P<0.05）；试验组NIHSS、MUIS评分均低于参照组［（21.07±3.08）分比（25.81±3.36）分、（62.48±7.51）分比（72.04±7.36）分］，差异均有统计学意义（t=6.74、5.89，均P<0.05）。试验组3个月内继发性癫痫发作率低于参照组［11.90%（5/42）比38.10%（16/42）］，差异有统计学意义（χ²=7.68，P<0.05）。结论　采用基于赋能理论模式的护理干预可有效增强继发性癫痫患者自我管理能力，改善生活质量，减少疾病复发，对提升神经功能亦具有正面影响。

关键词:

继发性癫痫, 赋能理论, 护理, 自我管理, 生活质量

Abstract:

Objective　To evaluate the effect of nursing intervention based on the empowerment theory model on self-management capability and quality of life in patients with secondary epilepsy. Methods　This study was a randomized controlled trial. A total of 84 patients with secondary epilepsy admitted to Xianyang Central Hospital from June 2021 to June 2023 were divided into two groups according to the random number table method, with 42 cases in each group. In the reference group, there were 28 males and 14 females, aged 32-64 (41.63±5.37) years, and the types of seizures included simple partial seizures in 21 cases, complex partial seizures in 12 cases, and generalized seizures in 9 cases. In the experimental group, there were 23 males and 19 females, aged 36-66 (41.06±5.24) years, and the types of seizures included simple partial seizures in 23 cases, complex partial seizures in 11 cases, and generalized seizures in 8 cases. The reference group received routine nursing measures, the experimental group received nursing intervention based on the empowerment theory model, and both groups were intervened for 3 months. The self-management ability [Epilepsy Self-Management Scale (ESMS)], neurological function improvement [National Institutes of Health Stroke Scale (NIHSS)], disease uncertainty [Mishel Uncertainty in Illness Scale (MUIS)], and quality of life [Chinese version of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31)] were observed and compared between the two groups before and after intervention, and the occurrence of secondary epilepsy within 3 months in the two groups was also evaluated. Statistical methods used were t test and χ² test. Results　After intervention, the scores of ESMS and QOLIE-31 in the experimental group were higher than those in the reference group [(155.21±19.87) points vs. (121.17±17.63) points, (73.14±8.32) points vs. (62.29±7.38) points], with statistically significant differences (t=8.31 and 6.32, both P<0.05); the scores of NIHSS and MUIS in the experimental groups were lower than those in the reference group [(21.07±3.08) points vs. (25.81±3.36) points, (62.48±7.51) points vs. (72.04±7.36) points], with statistically significant differences (t=6.74 and 5.89, both P<0.05). The incidence of secondary epilepsy seizures within 3 months in the experimental group was lower than that in the reference group [11.90% (5/42) vs. 38.10% (16/42)], with a statistically significant difference (χ²=7.68, P<0.05). Conclusion　The nursing intervention based on the empowerment theory model can effectively enhance the self-management in patients with secondary epilepsy, improve the quality of life, reduce the disease recurrence, and has a positive impact on improving neurological function.

Key words:

Secondary epilepsy, Empowerment theory, Nursing, Self-management, Quality of life

杨莎郑毛毛.

基于赋能理论模式护理干预对继发性癫痫患者自我管理及生活质量的影响 [J]. 国际医药卫生导报, 2024, 30(24): 4246-4251.

Yang Sha, Zheng Maomao.

Effect of nursing intervention based on the empowerment theory model on self-management and quality of life in patients with secondary epilepsy [J]. International Medicine and Health Guidance News, 2024, 30(24): 4246-4251.

参考文献

[1] 田聪,吴润秋,张旭,等. 颅脑胶质瘤术后癫痫发作的相关影响因素分析[J]. 中国医刊,2022,57(12):1337-1340. DOI:10.3969/j.issn.1008-1070.2022.12.017.
[2] 唐敏,朱健. 热性惊厥患儿继发癫痫发作的危险因素及构建列线图预测模型[J]. 中国医师进修杂志,2024,47(2):129-134. DOI:10.3760/cma.j.cn115455-20220519- 00463.
[3] 李琳琳,邓倩. 菖蒲麻胆汤结合丙戊酸钠对卒中后癫痫的康复影响研究[J]. 国际医药卫生导报,2023,29(23):3383-3387. DOI:10.3760/cma.j.issn.1007-1245.2023. 23.014.
[4] 王萱,江文. 新发难治性癫痫持续状态/热性感染相关性癫痫综合征:癫痫持续状态诊疗的新挑战[J]. 中华神经科杂志,2024,57(4):309-314. DOI:10.3760/cma.j.cn113694- 20231030-00280.
[5] 葛志强,许悦,徐清,等. 颅脑外伤手术后继发癫痫的危险因素分析[J]. 浙江临床医学,2021,23(12):1742-1743,1746.
[6] 王芳,王喜玲,陈文丽,等. 神经功能损伤与脑卒中后继发性癫痫的相关性分析[J]. 中西医结合心脑血管病杂志,2022,20(11):2084-2087. DOI:10.12102/j.issn.1672-1349. 2022.11.037.
[7] 葛满秀,于佳妮,储亚琴,等. 赋能健康教育模式用于肺癌放化疗患者对自我效能感及自我管理能力的影响[J]. 中国医药导报,2024,21(7):170-173. DOI:10.20047/j.issn1673- 7210.2024.07.37.
[8] 郭凤娟, 谢梦珂, 杨巧芳. 赋能理论在心血管疾病患者中的应用进展[J]. 中西医结合护理(中英文),2020,6(10):416-419. DOI:10.11997/nitcwm.202010105.
[9] 李世绰,洪震.临床诊疗指南.癫痫病分册[M].北京:人民卫生出版社,2015:36.
[10] Dilorio C, Faherty B, Manteuffel B. The development and testing of an instrument to measure self-efficacy in individuals with epilepsy[J]. J Neurosci Nurs, 1992,24(1):9-13.DOI: 10.1097/01376517-199202000-00004.
[11] 侯东哲,张颖,巫嘉陵,等. 中文版美国国立卫生院脑卒中量表的信度与效度研究[J]. 中华物理医学与康复杂志,2012,34(5):372-374. DOI:10.3760/cma.j.issn.0254-1424.2012. 05.013.
[12] 叶增杰,佘颖,梁木子,等. 中文版Mishel疾病不确定感量表的重新修订及其在中国恶性肿瘤患者中的信效度检验[J]. 中国全科医学,2018,21(9):1091-1097. DOI:10.3969/j.issn.1007-9572.2018.00.068.
[13] 刘雪琴,任晓琳,周谷兰,等. 成年癫痫患者生活质量-31量表的信度和效度[J]. 中华神经医学杂志,2003,2(2):106-109. DOI:10.3760/cma.j.issn.1671-8925.2003.02.013.
[14] 谷鸿秋,杨昕,王春娟,等. 蛛网膜下腔出血继发症状性癫痫的发生率、危险因素及院内结局:来自中国卒中联盟登记数据库的分析[J]. 中国卒中杂志,2020,15(6):620-625. DOI:10.3969/j.issn.1673-5765.2020.06.009.
[15] 张楠,冀兵. 创伤后癫痫发病机制及治疗的研究进展[J]. 中西医结合心脑血管病杂志,2023,21(2):311-314. DOI:10.12102/j.issn.1672-1349.2023.02.021.
[16] 蔡燕珊,颜耿杰,陈融清,等. 抗抑郁药在癫痫治疗中的作用机制研究进展[J]. 中国实用神经疾病杂志,2022,25(4):523-528. DOI:10.12083/SYSJ.220178.
[17] 黄远鑫,李育. 焦虑、抑郁对成人癫痫患者生活质量的影响[J]. 临床与病理杂志,2021,41(8):1832-1837. DOI:10.3978/j.issn.2095-6959.2021.08.018.
[18] 巴桑斯甲,沙雷皓,陈蕾. 癫痫发作预测的研究进展[J]. 中华神经科杂志,2023,56(11):1309-1318. DOI:10.3760/cma.j.cn113694-20230311-00178.
[19] 唐姗姗,李邦静,罗曦. 赋能理论模式护理对老年继发性癫痫患者不良情绪、自我管理能力和生活质量的影响[J]. 老年医学与保健,2023,29(2):336-341. DOI:10.3969/j.issn.1008-8296.2023.02.032.
[20] 陈德芳,成红霞,胡晓雅. 多元化护理对癫痫患者疾病不确定感及认知功能的影响[J]. 国际护理学杂志,2020,39(16):3025-3028. DOI:10.3760/cma.j.cn221370-20190411- 00937.
[21] 王晨子,高媛媛,尹瑞娟,等. 优质护理干预对脑卒中继发癫痫患者神经功能和生活质量的影响[J]. 护理实践与研究,2020,17(20):78-80. DOI:10.3969/j.issn.1672-9676.2020. 20.029.
[22] 郝文女,李晓静,李新霞. 基于赋能理论的延续护理对COPD病人生存质量的影响[J]. 护理研究,2020,34(8):1368-1372. DOI:10.12102/j.issn.1009-6493.2020.08.012.
[23] 徐榆林,王晓东,李豪,等. 赋能理论在慢性病家庭主要照顾者中的研究进展[J]. 护士进修杂志,2020,35(22):2065-2069. DOI:10.16821/j.cnki.hsjx.2020.22.010.
[24] 蒋燕萍,曾玉萍,杨蓉. 预见性护理对降低脑卒中后继发性癫痫发作及神经功能恢复的效果分析[J]. 四川医学,2020,41(3):313-316. DOI:10.16252/j.cnki.issn1004-0501- 2020.03.019.