机械瓣膜置换术患者抗凝治疗依从性及生活质量调查分析

发布时间：2018-03-24 16:24

本文选题：机械瓣膜置换术　切入点：服药依从性　出处：《山东大学》2014年硕士论文

【摘要】：目的调查机械瓣膜置换术后出院患者抗凝治疗依从性及生活质量情况,探讨其服药依从性和影响生活质量的预测因素,为制定针对性的干预策略,提高其服用华法林依从性,降低抗凝并发症,提高生活质量提供理论依据,同时为推广应用于其它慢性疾病患者生活质量提高的研究,为我国卫生行政部门对这部分患者群体管理提供一定的借鉴。方法采用方便取样法,选取2011年1月至2012年2月于山东省某三级甲等大学附属医院心脏外科行机械瓣膜置换术后(MHVR)患者。研究采用电话问卷调查法,调查时间为2013年5月1日至12月31日。调查问卷由调查员根据研究对象的回答填写,内容包括五部分：一般资料问卷、中文修订版Morisky服药依从性量表-8(MMAS-8)、健康相关生活质量(SF-36)。采用SPSS17.0对资料进行录入与分析,具体包括：描述性统计分析、两独立样本的t检验、单因素方差分析以及多元线性逐步回归分析。结果电话调查共计195例患者,获得有效问卷183份,有效率为93.85%,具体结果如下： 1.MHVR术后出院患者QOL总得分(611.29±92.78),各维度得分低于一般人群； 2.MHVR术后出院患者MMAS-8总分为(7.19±0.98)分,总体处于中等水平,其中49.20%的患者服用华法林依从性水平高,中等及低依从性水平分别占37.70%和13.10%； 3.不同人口社会学和疾病特征的MHVR患者QOL得分差异有统计学意义：女性、文盲和小学、未婚、在职、饮酒、家庭人均月收入1000元、合并其它用药、发生PTPS、心功能Ⅲ级患者的QOL得分低于男性、高中及以上、已婚、无业、1000～2000元、2000～3000元及3000元、合并1种和2种其它药物、未发生PTPS、心功能Ⅰ级和Ⅱ级患者； 4.对QOL进行多元线性逐步回归分析显示,职业、PTPS、用药种数、目前心功能(与心功能Ⅱ级相比,心功能Ⅰ级患者QOL更高,心功能Ⅲ级患者QOL更低)、婚姻状况(与未婚者相比,已婚者QOL得分高)服药依从性(与依从性低的患者相比,中高等患者QOL更高)及用药种数(与未服用药物相比,服药种类越多QOL越低)、职业(科技、公务人员、服务行业人员与农民相比,得分低,无业人员得分较农民低)是MHVR术后出院患者服用华法林依从性的预测变量(R2=58.1%)。结论 1.MHVR患者生活质量下降,低于全国常模,需制定针对性的措施,不断提高患者的生活质量。 2.MHVR患者服用华法林不依从性现象不容乐观,有50.80%的患者服用华法林依从性处于中等以下水平,提高患者服用华法林依从性亟待解决,这对于患者抗凝控制和降低抗凝并发症尤为重要。 3.患者QOL与患者的性别、婚姻状况、职业、饮酒、文化程度、家庭人均月收入、合并其它用药种数、PTPS及目前的心功能等级显著相关,其中以女性、文盲、家庭人均月收入1000元、合并其它用药3种及以上、心功能Ⅲ级的患者生活质量最低。 4.心功能、婚姻状况、文化程度、PTPS、职业、合并其它用药是患者服用华法林依从性低的预测因素,同时临床医护人员应加强对心功能Ⅲ级、未婚、文盲、无业及PTPS、合并3种及以上其他种类药物等高危患者的关注。
[Abstract]:Anticoagulation treatment compliance and quality of life objective: To investigate the mechanical valve replacement after discharge, to investigate the compliance and the prediction of the impact factors of quality of life, for the development of targeted intervention strategies, improve the compliance of warfarin anticoagulation, reduce complications, and provide a theoretical basis to improve the quality of life, at the same time as the study applied to other patients with chronic diseases and improve the quality of life, for health administrative departments in China to provide a reference to this part of population management.
Methods by convenience sampling, from January 2011 to February 2012 in the Affiliated Hospital of Shandong Province three level of first-class university heart surgery after mechanical heart valve replacement (MHVR) patients. Research by telephone questionnaire, investigation time is from May 1, 2013 to December 31st. The questionnaire completed by the investigators according to the research object of the answer, the content includes five parts: general the questionnaire data, Chinese revised version of the Morisky medication adherence scale -8 (MMAS-8), health-related quality of life (SF-36). SPSS17.0 is used for data entry and analysis, including descriptive statistical analysis, two independent samples t test, one-way ANOVA and multiple linear stepwise regression analysis.
The results of a telephone survey of a total of 195 patients, 183 valid questionnaires were obtained. The efficiency is 93.85%, the main results are as follows:
The total score of 1.MHVR in patients with QOL after operation (611.29 + 92.78), the scores lower than the general population;
After 2.MHVR patients MMAS-8 score (7.19 + 0.98) points, overall in the middle level, of which 49.20% of the patients took Wafa Lin Bea from the level of high, medium and low compliance level accounted for 37.70% and 13.10%;
There are significant differences in the scores of QOL of 3. MHVR patients with different demographic and disease characteristics: female illiteracy and primary school, unmarried, working, drinking, family per capita monthly income of 1000 yuan, combined with other drugs, PTPS, cardiac function in patients with grade QOL score lower than the male, high school and above, married, unemployed. 1000~2000 yuan, 2000~3000 yuan and 3000 yuan, with 1 and 2 other drugs, without PTPS, the cardiac function of the patients with grade I and ii;
4. of the QOL multiple linear stepwise regression analysis showed that PTPS, occupation, number of drug, the heart function (compared with heart function grade QOL heart function in patients with grade III level higher, the heart function of patients with QOL (lower), marital status and unmarried than married QOL score high) compliance (compared with low compliance in patients with higher QOL and higher) number of drug (compared with not taking drugs less medication more kinds of QOL), occupation (technology, personnel, service personnel compared with farmers, low score, unemployed score than farmers low) after MHVR discharge patients taking predictive variables from the Wafa Lin Bea (R2=58.1%).
conclusion
The decline in the quality of life in patients with 1.MHVR, lower than the national norm, the need to develop targeted measures to improve the quality of life of patients.
2.MHVR patients taking warfarin non compliance is not optimistic, there is a moderate level from taking Wafa Lin Bea in 50.80% of the patients, improve the patients taking Wafa Lin Bea to be solved from this, to anticoagulation control and reducing the complications of anticoagulant is particularly important.
3. patients with QOL and patients' gender, marital status, occupation, drinking, education, family income per month, combined with other medication species significantly related to PTPS and the current level of cardiac function, of which women, illiteracy, family per capita monthly income of 1000 yuan, combined with other medication 3 and above, heart function grade the quality of life in patients with the lowest.
4. heart function, marital status, education level, occupation, PTPS, combined with other drugs is patients taking Wafa Lin Bea from the predictive factors of low, at the same time, clinical staff should strengthen the heart function grade, unmarried, unemployed and illiterate, PTPS, with 3 or more other kinds of drugs in high-risk patients.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.6

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