食管支架置入术后院外并发胃食管反流的影响因素及依从性分析

发布时间：2018-02-21 18:54

本文关键词： 食管支架置入术胃食管反流依从性　出处：《新乡医学院》2014年硕士论文　论文类型：学位论文

【摘要】：背景食管支架置入术(Esophageal Stent Implantation, ESI)是治疗食管癌性狭窄的有效手段之一,能够显著改善患者的生存质量。术后自我护理和患者的依从性交互影响ESI的治疗效果,而胃食管反流是受这一交互作用影响最显著的术后并发症。众所周知,缺乏医护人员监督指导的院外患者,自我护理是术后护理的薄弱环节,依从性同样也较差。因此,研究院外胃食管反流发生的影响因素,分析院外患者的依从性,是有效降低术后并发胃食管反流的前提和基础,值得医护人员的重视。目的分析ESI患者院外并发胃食管反流的影响因素,评估患者的依从性,分析影响患者依从性的相关因素。方法 1.病例设计：收集符合标准的食管中下段癌患者,入院当天即纳入本研究,院内围手术期综合护理,常规出院1月后复诊。 2.问卷调查：采用当面调查的方式,用RDQ量表、ESI术后患者自我护理情况调查表、ESI术后患者依从性调查表、ESI术后患者依从性影响因素调查表、Zung焦虑自评量表对患者进行随访和调查。 3.胃食管反流的影响因素和术后依从性分析：运用SPSS19.0软件的x2检验、Logistic回归分别分析胃食管反流情况与患者的自我护理情况、术后依从性等因素的关系。运用t检验对比不同社会、生理、心理特征的患者依从性,运用Pearson相关分析以及多元线性回归分析术后依从性的影响因素。检验水准a=0.05。结果 1.统计调查结果：本研究共纳入病例107例,男女比例是2.06：1。患者年龄65.60±9.560岁。107位患者术后依从性得分6-23分之间,平均14.06±4.613,符合正态性分布。 2.院外并发胃食管反流影响因素分析：低半坐卧位睡姿(OR=0.048,95%CI：0.023-0.170)、适量运动(OR=0.150,95%CI:0.045-0.539)、患者依从性(OR=0.176,95%CI:0.046-0.578)是术后并发胃食管反流的保护因素。 3.患者依从性影响因素分析：影响患者依从性的因素依次为疾病认知水平(t=2.867,P=0.005)、焦虑状况(t=-8.142,P0.001)、家庭支持情况(t=2.664,P=0.009)和性别(t=2.175,P=0.032)。疾病认知水平高、家庭支持情况好的患者依从性好。焦虑状况与依从性显著相关,焦虑程度越轻,患者的依从性越好。男性患者的依从性较差。结论 1.低半坐卧位睡姿、适量运动和良好的术后依从性是降低ESI患者术后并发胃食管反流的因素。 2.焦虑程度轻、疾病认知水平高、家庭支持情况好、女性患者的术后依从性好。
[Abstract]:Background. Esophageal Stent implantation is one of the effective methods for the treatment of esophageal carcinoma stenosis, which can significantly improve the quality of life of patients. Postoperative self-care and patient compliance interaction affect the therapeutic effect of ESI. Gastroesophageal reflux (GER) is the most significant postoperative complication affected by this interaction. It is well known that self-care is the weak link of postoperative care and compliance is also poor in patients without supervision and guidance from medical staff. The influencing factors of gastroesophageal reflux and the analysis of compliance of patients outside hospital are the premise and foundation of reducing postoperative gastroesophageal reflux effectively, and deserve the attention of medical and nursing staff. Purpose. Objective: to analyze the influencing factors of gastroesophageal reflux (GER) in patients with ESI, to evaluate the compliance of patients, and to analyze the related factors. Method. 1. Case design: the patients with middle and lower esophageal cancer who met the criteria were included in this study on admission day, comprehensive nursing care in hospital perioperative period, and routine follow-up after discharge on January. 2. Questionnaire survey: face to face survey, The self-nursing status of patients after RDQ operation was investigated by Zung anxiety Self-Rating scale (SAS). 3. Analysis of influencing factors and postoperative compliance of gastroesophageal reflux: using SPSS19.0 software x2 test logistic regression to analyze gastroesophageal reflux and self-care of patients, respectively. T test was used to compare patients' compliance with different social, physiological and psychological characteristics, Pearson correlation analysis and multiple linear regression analysis were used to analyze the influencing factors of postoperative compliance. Results. 1. Statistical investigation results: 107 cases were included in this study, the ratio of male to female was 2.06: 1.The age of the patients was 65.60 卤9.560 years old. 107 patients' compliance scores ranged from 6 to 23 points, with an average of 14.06 卤4.613, which was consistent with the normal distribution. 2. Analysis of the influencing factors of gastroesophageal reflux in the low sitting and lying position: the protective factors of gastroesophageal reflux after operation were: the sleeping position in the low half sitting position was 0.048-0.170%, the moderate exercise was 0.15095% CI 0.045-0.539, the patient's compliance was 0.176% 95 CIW 0.046-0.578). 3. Analysis of influencing factors of patients' compliance: the influencing factors of patients' compliance were as follows: disease cognition level was 2.867% P0. 005, anxiety was t0. 842%, family support was 2. 664% P0. 009) and sex was 2. 175P0. 032. The level of disease cognition was high. The patients with good family support had good compliance. Anxiety was significantly correlated with compliance. The less anxiety, the better the compliance of patients, and the worse the compliance of male patients. Conclusion. 1. Sleeping position, moderate exercise and good postoperative compliance were the factors that decreased gastroesophageal reflux after ESI. 2. Low level of anxiety, high level of disease cognition, good family support and good postoperative compliance of female patients.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.6

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