基于症状管理理论的类风湿关节炎合并抑郁症精准护理模式的构建与效果评价

Facing the limited medical resource, precision medicine has being quickly becoming the most potential modern medical service model owing to its high quality and high efficiency. With the development of precision medicine, the concept of precision has been introduced into the nursing field. Nursing researchers, for example, determined the relationship between biomarkers and disease symptoms through in-depth study of complex symptoms, and then implemented symptom management. Precision nursing models appropriate to patients with rheumatoid arthritis (RA) because the depression is high incidence and the screen of depression is high heterogeneity in the process of RA diagnosis and treatment. A mixed methods design will be used. Firstly, we aim to identify possible biomarkers in Chinese patients with RA complicated with depression by using inflammatory cytokine antibody array. Secondly, qualitative studies will be employed to understand the overview of the care needs in Chinese patients with RA complicated with depression and the longitudinal characteristics of the needs emerge. Based on the information collected in the qualitative studies, we will apply the method of Delphi consulting to construct a precision nursing model for RA patients complicated with depression based on symptom management theory. Thirdly, a randomized controlled trial and a qualitative study will be used to verify the effectiveness of the precision nursing model. The results of this study can improve RA patients’ bad mood, provide important implications for further development and implementation of the precision nursing model pertinent to chronic diseases complicated with depression, and promote the rapid development of the precision nursing in health management in China.

在当今医疗资源有限的情况下，精准医疗以其高品质、高效率和高效益成为目前最具潜力的现代医疗服务模式。随着精准医疗的发展，精准理念也被引入护理领域，如护理研究者通过对复杂的症状进行深入研究，确定生物标志物与疾病症状之间的关系，继而进行症状管理等。类风湿关节炎（RA）诊疗过程中患者抑郁症的高发性和筛查的异质性，使其成为精准护理模式的适宜人群。本课题采用混合研究设计，第一阶段通过炎性细胞因子抗体芯片技术寻找适用于筛查中国RA合并抑郁症患者的血清生物标志物；第二阶段通过质性研究全面了解RA合并抑郁症患者的照护需求及需求动态发展变化规律；借助Delphi咨询法，构建基于症状管理理论的RA合并抑郁症精准护理模式；第三阶段通过随机对照试验和质性研究进行模式干预的效果评价。研究结果可以改善患者的不良情绪，为今后开展慢性病合并抑郁症的精准护理积累有益经验，为精准护理在我国慢性病健康管理中的应用提供新思路。

在当今医疗资源有限的情况下，精准医疗以其高品质、高效率和高效益成为目前最具潜力的现代医疗服务模式。随着精准医疗的发展，精准理念也被引入护理领域，如护理研究者通过对复杂的症状进行深入研究，确定生物标志物与疾病症状之间的关系，继而进行症状管理等。类风湿关节炎（RA）诊疗过程中患者抑郁症的高发性和筛查的异质性，使其成为精准护理模式的适宜人群。本研究采用混合研究设计，完成了如下研究内容：①RA抑郁症状的发生现状和影响因素分析。结果共纳入230例RA患者，抑郁症状发生率为29.1%，教育水平、躯体功能、生活质量-活力维度评分等是RA抑郁症状发生的独立危险因素。②通过定量炎症因子抗体芯片技术寻找RA患者抑郁症状的血清生物标志物。结果发现，RA抑郁者较非抑郁者在血清IL-6R, MCP-1, MIP-1d, RANTES, TIMP-1水平之间具有显著差异。ROC曲线分析显示，MCP-1有望成为RA抑郁症状的血清生物标志物。③通过质性研究和互联网大数据分析全面了解RA患者的抑郁症状照护需求体验和发生发展规律。结果显示，RA抑郁症状患者存在生理需求、安全需求、情感和社交需求、尊重、自我实现、信息需求等6个需求感知类别。④基于循证遴选和总结RA患者抑郁症状非药物干预的最佳证据。结果共纳入16篇文献，总结17条最佳证据，包括抑郁症状筛查与评估、疾病管理、心理干预、认知行为疗法、功能锻炼、太极、患者教育等。⑤借助专家小组会议法构建基于症状管理理论的RA患者抑郁症状精准护理模式。结果显示，RA患者抑郁症状精准护理模块最终确立为一级指标6个，二级指标23个，三级指标56个。⑥采用类实验研究对RA患者实施干预，结果表明，精准护理模式干预能够改善RA患者的焦虑、抑郁症状。研究结果可以为今后开展慢性病合并抑郁症状的精准护理积累有益经验，为精准护理在我国慢性病健康管理中的应用提供新思路。

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