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心悸失眠症患者症状体验的质性研究
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上海市浦东新区医学学科建设立项项目心血管内科临床高原学科(PWYgy2018-03);浦东新区卫生和计划生育委员会学科建设重点专科(PWZzk2017-19);浦东新区卫生和计划生育委员会学科建设重点学科群(PWZxq2017-01);上海市卫计委重点专科(ZK2019B25)


A qualitative study on the symptom experience of insomnia patients with heart palpitations
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    摘要:

    目的 在症状管理理论模型指导下,探讨患者症状体验的质性研究,以期为医护人员全面掌握心悸失眠症患者的症状提供依据,并对患者进行科学性的症状管理以促进患者心脏康复。方法 采用现象学研究法,对23例心悸失眠症患者进行半结构式访谈,运用Colaizzi 7步分析法对访谈资料进行分析。结果 分别从心悸失眠症患者症状感知、症状评估、症状反应3方面分析。症状感知(perception)包括3个主题:躯体症状感知(神疲乏力;胸闷心慌,气促气短,心悸健忘,头晕头痛,肢体麻木,头身困重,腰膝酸软,耳鸣,畏寒肢冷;食欲不振或者食后腹胀;疼痛,胸痛;以及夜尿频繁)、心理症状感知(紧张,焦虑,抑郁,情绪遗留现象)、以及社会适应改变。症状评估(evaluation):包括2个主题:分为主观、客观两方面。客观原因(包括疾病因素,工作性质、生活环境、突发生活事件等)。主观原因(包括性格因素、电子产品使用、睡眠认知)。症状反应(response):包括3个主题:身体与行为(身体与用药行为、身体与饮食行为、身体与运动、身体与中医护理技术);心理与行为;社会文化与行为。结论 心悸失眠症患者在症状体验方面有多种表现及诸多影响因素,但多数患者担心西药的不良反应,不愿意采取西药治疗失眠,在中药汤剂的服用上存在难坚持性,愿意尝试中医中药以及中医护理技术等方式促进睡眠。在症状管理理论指导下,以心悸失眠症患者症状体验的自我评估为中心,医护人员可以进行中医护理技术方案的构建,并对其症状进行有效的干预,以改善心悸患者的双心健康,并提高患者自我管理能力。

    Abstract:

    Objective:Under the guidance of symptom management theory(SMT), to explore the qualitative study of patients" symptom experience, in order to provide the basis for medical staff to fully grasp the symptoms of insomnia patients with palpitation, and SMT for patients to promote cardiac rehabilitation. Methods:23 patients with insomnia with palpitation were interviewed by phenomenological method. Colaizzi 7-step analysis was used to analyze the interview data. Results:The symptom perception, symptom evaluation and symptom response of insomnia patients with palpitation were analyzed. Perception consists of three themes: somatic symptom perception (fatigue; Chest tightness and palpitation, shortness of breath, palpitation and forgetfulness, dizziness and headache, numbness of limbs, headache of head and body, weakness of waist and knee, tinnitus, fear of cold limbs cold; Pain, chest pain; Loss of appetite; And frequent nocturia), perception of psychological symptoms (nervousness, anxiety, depression, emotional hangover), and changes in social adaptation. Evaluation consists of two themes: subjective and objective. Objective reasons (including disease factors, nature of work, living environment, sudden life events, etc.). Subjective reasons (including personality factors, electronic product use, sleep perception). Symptoms response: including three themes: body and behavior (body and medication behavior, body and eating behavior, body and exercise, body and traditional Chinese medicine (TCM) nursing technology); Psychology and behavior; Social culture and behavior. Conclusions:The insomnia patients with palpitation have a variety of symptoms and many influencing factors, but most patients are worried about the adverse reactions of western medicine, are not willing to take western medicine to treat insomnia, it is difficult to adhere to the use of TCM decoction, and willing to try TCM nursing technology to promote sleep. Under the guidance of SMT, with self-assessment of symptom experience of insomnia patients as the center, medical staff can construct TCM nursing technology plan and effectively intervene their symptoms, so as to improve the double-heart health of patients with palpitation and improve patients" self-management ability.

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马创,张华春,孙唯珺,魏芳,田蓓.心悸失眠症患者症状体验的质性研究[OL]. NursRxiv,2021,
DOI:10.12209/issn2708-3845.20210209001

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  • 收稿日期:2021-02-09
  • 最后修改日期:2021-02-09
  • 录用日期:2021-02-09
  • 在线发布日期: 2021-02-09
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