认知行为干预联合HFMEA模式在甲状腺切除术患者中的应用效果

廖燕 罗丽华 赵珂琪 吕晶

【摘要】 目的：探讨认知行为干预联合医疗失效模式及效应分析（HFMEA）模式在甲状腺切除术患者中的应用效果。方法：选择2017年6月-2020年12月本院收治的84例甲状腺切除术患者作为研究对象，采用随机数字表法将患者分为对照组和联合组，每组42例。对照组进行HFMEA模式干预，联合组进行认知行为干预联合HFMEA模式。比较两组干预前后心理状态、自我护理能力及术后并发症发生情况。结果：联合组干预1个月后SAS、SDS评分均低于对照组（P<0.05）;联合组干预后1个月自我护理技能、自我护理责任感、综合能力评分均高于对照组（P<0.05）;联合组术后并发症发生率为7.14%，低于对照组的23.81%（P<0.05）。结论：认知行为干预联合HFMEA模式能改善甲状腺切除术患者的心理状态，提高自我护理能力，降低术后并发症发生率，值得应用。

【关键词】 认知行为干预 HFMEA模式 甲状腺切除术 自我护理能力

Application of Cognitive Behavioral Intervention Combined with HFMEA Model in Patients Undergoing Thyroidectomy/LIAO Yan， LUO Lihua， ZHAO Keqi， LYU Jing. //Medical Innovation of China， 2021， 18（32）： -111

[Abstract] Objective： To explore the application effect of cognitive behavioral intervention combined with healthcare failure mode and effect analysis （HFMEA） model in patients undergoing thyroidectomy. Method： A total of 84 patients undergoing thyroidectomy in our hospital from June 2017 to December 2020 were selected as the study objects， they were divided into the control group and the combined group according to the random number table method， 42 cases in each group. The control group underwent HFMEA mode intervention， and the combined group underwent cognitive behavioral intervention combined with HFMEA model. The psychological status and self-care ability before and after intervention， and postoperative complications of two groups were compared. Result： After intervention for 1 month， the SAS score and SDS score of the combined group were lower than those of the control group （P<0.05）. After intervention for 1 month， the self-care skills， self-care responsibility and comprehensive ability scores of the combined group were higher than those of the control group （P<0.05）. The total incidence of postoperative complications in the combined group was 7.14%， which was lower than 23.81% in the control group （P<0.05）. Conclusion： Cognitive behavioral intervention combined with HFMEA model can improve the mental state of patients undergoing thyroidectomy， improve self-care ability， and reduce the occurrence of postoperative complications， it is worthy of application.

[Key words] Cognitive behavior intervention HFMEA model Thyroidectomy Self-care ability

First-author’s address： Jiujiang Third People’s Hospital， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2021.32.027

甲狀腺切除术是临床上治疗甲状腺疾病的常用手段，由于甲状腺的特殊位置及解剖结构，手术存在较大的风险，术后并发症较多，对手术医师及围术期的护理均提出了更高的要求。医疗失效模式及效应分析（HFMEA）是一种新型干预模式，通过对术中、术后可能发生的失效进行量化的评估，提前进行风险的预防和管理，避免或减少不良事件的发生，在甲状腺切除术患者中起到了一定效果[1]。但在手术创伤、麻醉药物、疼痛等较多刺激因素的影响下，患者在围术期可出现不同程度的心理应激反应，对手术及预后造成不利影响。……