Abstract:

Objective　To explore the effects of Teach-back combined with narrative care on cognitive function and self-management ability in elderly patients after percutaneous coronary intervention (PCI). Methods　This was a prospective study. Eighty-two elderly patients with coronary heart disease who underwent PCI at Xianyang First People's Hospital from July 2021 to June 2023 were selected as the study objects. They were divided into a reference group and an experimental group by the random number table method, with 41 cases in each group. There were 23 males and 18 females in the reference group; they were (68.82±5.39) years old; their disease course was (2.74±0.82) years. There were 21 males and 20 females in the experimental group; they were (69.14±5.67) years old; their disease course was (2.76±0.89) years. The reference group took conventional nursing care. The experimental group received Teach-back and narrative nursing. Both groups were intervened until 30 d after discharge, and were followed up for 6 months. The rehabilitation progress [exercise duration (ED), 6-minute walk test (6MWD), left ventricular ejection fraction (LVEF)], cognitive function [Senior Cognitive Function Scale (SECF) score], and self-management ability [Coronary Heart Disease Self-Management Scale (CSMS) score] were evaluated in the two groups. The incidences of adverse events in both groups were recorded. t and χ² tests were used for the statistical analysis. Results　Before the intervention, there were no statistical differences in the rehabilitation progress, cognitive function, and self-management ability between the two groups (all P>0.05). The ED, LVEF, 6MWT, total score of SECF, and scores of disease knowledge, emergency management, unhealthy habits, symptom management, emotional management, daily life, and treatment compliance in the experimental group were better than those in the reference group [(449.79±58.52) s vs. (391.82±56.48) s, (307.55±9.45) m vs. (266.57±9.78) m, (64.27±6.18)% vs. (56.93±5.74)%, (86.03±7.36) vs. (73.92±7.14), (16.92±1.17) vs. (13.50±1.02), (9.84±1.39) vs. (7.62±1.14), (15.49±1.05) vs. (13.34±1.07), (13.14±1.78) vs. (9.83±1.45), (13.63±1.67) vs. (12.24±1.51), (15.26±1.38) vs. (12.48±1.29), and (6.67±1.08) vs. (5.52±1.10)], with statistical differences (t=4.564, 19.295, 5.572, 7.562, 14.108, 7.907, 9.183, 9.232, 3.953, 9.423, and 4.777; all P<0.05). The incidence of adverse cardiovascular events in the experimental group was lower than that in the control group [4.88% (2/41) vs. 21.95% (9/41)], with a statistical difference (χ²=5.145; P=0.023). Conclusion　Teach-back combined with narrative care for elderly patients after PCI can significantly improve their cognitive function and self-management ability and rehabilitation effect, and reduce the occurrence of adverse events.

Key words:

Coronary heart disease, The elderly, Percutaneous coronary intervention, Teach-back mode, Narrative care, Cognitive function, Self-management ability

摘要：

目的　探讨Teach-back联合叙事护理对老年冠心病患者经皮冠状动脉介入术（PCI）后认知功能及自我管理能力的影响。方法　前瞻性研究，选取2021年7月至2023年6月于咸阳市第一人民医院行PCI治疗的82例老年冠心病患者作为研究对象，按数表法随机分为参照组（41例）和试验组（41例）。参照组男23例、女18例，年龄（68.82±5.39）岁，病程（2.74±0.82）年，给予常规护理；试验组男21例、女20例，年龄（69.14±5.67）岁，病程（2.76±0.89）年，给予Teach-back联合叙事护理，两组均干预至出院30 d，并随访6个月。对两组患者康复进展情况［运动持续时间（ED）、6 min步行试验（6MWD）、左心室射血分数（LVEF）］、认知功能［老年认知功能量表（SECF）评分］和自我管理能力［冠心病自我管理量表（CSMS）］进行评估，并统计两组患者不良事件发生率。统计学方法采用t、χ²检验。结果　干预前，两组患者康复进展情况、认知功能及自我管理能力比较，差异均无统计学意义（均P>0.05）。出院30 d，试验组ED长于参照组［（449.79±58.52）s比（391.82±56.48）s］，6MWT、LVEF、SECF总分、疾病知识、急救管理、不良嗜好、症状管理、情绪管理、日常生活、治疗依从性评分均高于参照组［（307.55±9.45）m比（266.57±9.78）m、（64.27±6.18）%比（56.93±5.74）%、（86.03±7.36）分比（73.92±7.14）分、（16.92±1.17）分比（13.50±1.02）分、（9.84±1.39）分比（7.62±1.14）分、（15.49±1.05）分比（13.34±1.07）分、（13.14±1.78）分比（9.83±1.45）分、（13.63±1.67）分比（12.24±1.51）分、（15.26±1.38）分比（12.48±1.29）分、（6.67±1.08）分比（5.52±1.10）分］，差异均有统计学意义（t=4.564、19.295、5.572、7.562、14.108、7.907、9.183、9.232、3.953、9.423、4.777，均P<0.05）。试验组心血管不良事件发生率为4.88%（2/41），低于参照组的21.95%（9/41），差异有统计学意义（χ²=5.145，P=0.023）。结论　Teach-back联合叙事护理可显著提升老年PCI后患者认知功能、自我管理能力及康复效果，降低不良事件发生。

关键词:

冠心病, 老年, 经皮冠状动脉介入术, Teach-back模式, 叙事护理, 认知功能, 自我管理能力