目的探讨思维导图式健康教育在创伤性颈脊髓损伤患者术后康复中的应用效果。
方法采用回顾性队列研究分析2019年8月至2023年9月郑州市骨科医院收治的64例创伤性颈脊髓损伤患者的临床资料，其中男51例，女13例；年龄20~75岁［（52.7±12.5）岁］。损伤节段：C 3/4 8例，C 4/5 18例，C 5/6 22例，C 6/7 16例。美国脊髓损伤协会（ASIA）分级：A级3例，B级15例，C级18例，D级28例。患者均行颈椎减压融合内固定术。32例术后接受常规护理健康教育（常规教育组），32例术后接受思维导图式护理健康教育（导图式教育组）。出院前4 h采用出院准备度量表（RHDS）评分和出院指导质量量表（QDTS）评分比较2组出院准备度和出院指导质量。健康教育前、出院时及出院后6个月采用焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分、创伤后成长量表（PTGI）评分比较2组焦虑、抑郁及创伤后成长水平。出院后6个月比较两组并发症发生率。
结果患者均获随访6个月。出院前4 h，导图式教育组RHDS总分和QDTS总分分别为（86.5±7.8）分、（142.9±2.7）分，均高于常规教育组的（75.2±5.3）分、（125.3±2.3）分（ P<0.01）。健康教育前，两组SAS评分、SDS评分及PTGI总分差异均无统计学意义（ P>0.05）。出院时，导图式教育组SAS评分和SDS评分分别为（41.6±0.9）分、（41.4±1.1）分，均低于常规教育组的（47.2±0.8）分、（47.0±0.7）分（ P<0.01）；PTGI总分为（72.4±4.3）分，高于常规教育组的（53.8±2.3）分（ P<0.01）。出院后6个月，导图式教育组SAS评分和SDS评分分别为（31.2±0.8）分、（31.0±1.0）分，均低于常规教育组的（44.6±1.1）分、（42.4±0.9）分（ P<0.01）；PTGI总分为（85.8±1.9）分，高于常规教育组的（68.0±1.6）分（ P<0.01）。出院后6个月，导图式教育组并发症发生率为6%（2/32），低于常规教育组的34%（11/32）（ P<0.05）。
结论与常规护理健康教育比较，思维导图式护理健康教育能提高创伤性颈脊髓损伤患者术后出院准备度和出院指导质量，减轻焦虑、抑郁等负性情绪，改善心理状况，促进创伤后成长，降低并发症发生率。
ObjectiveTo explore the application effects of mind map-based health education in improving rehabilitation of patients with traumatic cervical spinal cord injury after surgery.
MethodsA retrospective cohort study was conducted to analyze the clinical data of 64 patients with traumatic cervical spinal cord injury admitted to Zhengzhou Orthopedic Hospital from August 2019 to September 2023, including 51 males and 13 females, aged 20-75 years [(52.7±12.5)years]. The injured segments were located at C 3/4 in 8 patients, at C 4/5 in 18, at C 5/6 in 22, and at C 6/7 in 16. The American Spinal Injury Association (ASIA) Scale was grade A in 3 patieats, grade B in 15, grade C in 18, and grade D in 28. All the patients underwent cervical decompression and fusion with internal fixation. Thirty-two patients received conventional nursing health education after surgery (conventional education group), while the other 32 patients received mind map-based nursing health education (mind map education group). Readiness for hospital discharge scale (RHDS) and quality of discharge teaching scale (QDTS) were used to compare the discharge readiness and quality of discharge instruction between the two groups at 4 hours before discharge. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), and post-traumatic growth inventory (PTGI) were used to compare the anxiety, depression, and post-traumatic growth levels between the two groups before the health education, at discharge, and at 6 months after discharge. The incidence of complications was also compared between the two groups at 6 months after discharge.
ResultsAll the patients were followed up for 6 months. At 4 hours before discharge, the total scores of RHDS and QDTS were (86.5±7.8)points and (142.9±2.7)points in the mind map education group, which were higher than (75.2±5.3)points and (125.3±2.3)points in the conventional education group ( P<0.01). Before the health education, no statistically significant differences were found in SAS scores, SDS scores, or PTGI total scores between the two groups ( P>0.05). At discharge, the SAS and SDS scores were (41.6±0.9)points and (41.4±1.1)points in the mind map education group, which were lower than (47.2±0.8)points and (47.0±0.7)points in the conventional education group ( P<0.01); the PTGI total score was (72.4±4.3)points, which was higher than (53.8±2.3)points in the conventional education group ( P<0.01). At 6 months after discharge, the SAS and SDS scores were (31.2±0.8)points and (31.0±1.0)points in the mind map education group, which were lower than (44.6±1.1)points and (42.4±0.9)points in the conventional education group ( P<0.01); the PTGI total score was (85.8±1.9)points, which was higher than (68.0±1.6)points in the conventional education group ( P<0.01); the complication rate was 6% (2/32) in the mind map education group, which was lower than 34% (11/32) in the conventional education group ( P<0.05).
ConclusionCompared with conventional nursing health education, mind map-based nursing health education can improve the discharge readiness and quality of discharge instruction for patients with traumatic cervical spinal cord injury after surgery, alleviate negative emotions such as anxiety and depression, improve their psychological status, promote post-traumatic growth, and reduce the incidence of complications.
卢锴璇,陈丽丽,张静,等. 思维导图式健康教育在创伤性颈脊髓损伤患者术后康复中的应用效果[J]. 中华创伤杂志,2025,41(03)：297-304.
DOI:10.3760/cma.j.cn501098-20240912-00555版权归中华医学会所有。
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卢锴璇：研究设计及实施、论文撰写；陈丽丽、张静：研究设计、数据整理；刘欣茹：研究实施、数据收集；魏岚：论文指导及修改、经费支持
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