作者：向圣晓1，2，柏基香3，吉莉3，王菁菁3，陈浚3，谢萍1，3

单位：

1.225009江苏省扬州市，扬州大学护理学院　2.223812江苏省宿迁市第一人民医院护理部3.225001江苏省扬州市，苏北人民医院护理部

Units：

1.School of Nursing, Yangzhou University, Yangzhou 225009, China2.Nursing Department, Suqian First People's Hospital, Suqian 223812, China3.Nursing Department, Subei People's Hospital, Yangzhou 225001, China

关键词：

认知障碍；卒中后认知障碍；病例管理；分层分级管理；Triangle管理理论

Keywords：

Cognition disorders; Post-stroke cognitive impairment; Case management; Hierarchical management;Triangle management theory

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.214

Funds：

江苏省卫生健康委科研课题（H2018032）

摘要：

目的　基于Triangle管理理论构建卒中后认知障碍（PSCI）分层分级管理模型，并评价其应用效果。方法　根据蒙特利尔认知评估量表（MoCA）、日常生活能力量表（ADL）、简明精神状态量表（MMSE）评分对PSCI进行分层，然后基于Triangle管理理论，参考护理分级理论，以相关指南对认知障碍患者的综合护理措施为实践依据，综合质性访谈结果，构建基于Triangle管理理论的PSCI分层分级管理模型初稿；之后，经专家函询及预试验修正形成基于Triangle管理理论的PSCI分层分级管理模型。选取2020-09-01至2021-10-01在苏北人民医院及医联体成员单位就诊的PSCI患者120例为研究对象。采用随机数字表法将患者分为对照组、观察组，各60例。对照组进行常规管理，观察组采用基于Triangle管理理论的PSCI分层分级管理模型进行管理，两组均干预6个月。比较两组一般资料，干预前及干预后1、6个月MMSE评分，干预前及干预后3、6个月ADL、24项汉密尔顿抑郁量表（HAMD-24）评分，干预前、干预后3个月生化指标〔神经生长因子（NGF）、同型半胱氨酸（Hcy）〕，干预后3、6个月干预效果，干预期间再入院率。结果　两轮专家函询的专家权威系数均为0.812，且Kendall协调系数为0.538（P ＜0.05）。干预方法与时间在定向力、记忆力、注意力和计算力评分及MMSE总分上存在交互作用（P ＜0.05）；干预方法在定向力、注意力和计算力评分及MMSE总分上主效应显著（P ＜0.05）；时间在记忆力、回忆能力、注意力和计算力、语言能力评分及MMSE总分上主效应显著（P ＜0.05）。观察组干预后1、6个月定向力评分高于对照组，干预后6个月注意力和计算力评分及MMSE总分高于对照组（P ＜0.05）。时间在ADL评分上主效应显著（P ＜0.05）。干预方法与时间在HAMD-24评分上存在交互作用（P ＜0.05）；干预方法、时间在HAMD-24评分上主效应显著（P ＜0.05）。观察组干预后3、6个月HAMD-24评分低于对照组（P ＜0.05）。观察组干预后3个月NGF高于对照组，Hcy低于对照组（P ＜0.05）。观察组干预后6个月干预效果优于对照组（P ＜0.05）。观察组再入院率低于对照组（P ＜0.05）。结论　本研究构建的基于Triangle管理理论的PSCI分层分级管理模型可以有效改善PSCI患者认知功能，缓解抑郁情绪，还能升高NGF，降低Hcy，提升干预效果，且安全性好。

Abstract：

Objective　To construct a hierarchical management model for post-stroke cognitive impairment (PSCI)based on Triangle management theory and evaluate its application effect. Methods　The PSCI was stratified according to MontrealCognitive Assessment (MoCA) , Ability of Daily Living (ADL) , Mini-Mental State Examination (MMSE) scores, and then basedon the Triangle management theory, referring to the nursing classification theory, taking the comprehensive nursing measures forpatients with cognitive impairment in relevant guidelines as a practical basis, and synthesizing the results of qualitative interviews,the first draft of the hierarchical management model for PSCI based on Triangle management theory was constructed. After that,the hierarchical management model for PSCI based on Triangle management theory was formed after expert consultation and preexperimentrevision. From 2020-09-01 to 2021-10-01, 120 patients with PSCI who were treated in Subei People's Hospital andmember units of the medical alliance were selected as the research objects. The random number table method was used to dividethe patients into control group and observation group, 60 cases in each group. The control group was given routine management,and the observation group was managed with the hierarchical management model for PSCI based on Triangle management theory,and both groups were intervened for 6 months. The general data, MMSE score before intervention and at 1 month and 6 monthsafter intervention, ADL and Hamilton Depression Scale-24 (HAMD-24) scores before intervention and at 3 and 6 months afterintervention, biochemical indexes [nerve growth factor (NGF) and homocysteine (Hcy) ] before intervention and at 3 monthsafter intervention, intervention effects at 3 and 6 months after intervention, and readmission rate during the intervention werecompared between the two groups. Results　The expert authority coefficient for both rounds of expert correspondence was 0.812,and the Kendall coordination coefficient was 0.538 (P < 0.05) . There was an interaction between intervention method and timeon orientation, memory, attention and calculation scores and total MMSE score (P < 0.05) ; there was a significant main effect ofintervention method on orientation, attention and calculation scores and total MMSE score (P < 0.05) ; there was a significant maineffect of time on memory, recall ability, attention and calculation, and verbal ability scores and total MMSE score (P < 0.05) . Theobservation group had higher orientation scores than the control group at 1 month and 6 months after intervention, and higherattention and calculation scores and total MMSE score than the control group at 6 months after intervention (P < 0.05) . The maineffect of time on ADL score was significant (P < 0.05) . There was an interaction between intervention method and time on HAMD-24 score (P < 0.05) ; main effect of intervention method and time on HAMD-24 score was significant (P < 0.05) . HAMD-24 scoreswere lower in the observation group than in the control group at 3 and 6 months after intervention (P < 0.05) . NGF was higher andHcy was lower in the observation group than in the control group at 3 months after intervention (P < 0.05) . The intervention effectwas better in the observation group than in the control group at 6 months after intervention (P < 0.05) . The readmission rate in theobservation group was lower than that in the control group (P < 0.05) . Conclusion　The hierarchical management model for PSCIbased on Triangle management theory constructed in this study can effectively improve the cognitive function of PSCI patients,relieve depression, increase NGF, reduce Hcy, and improve the effect of intervention, with good safety.

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