成人斜视患者生存质量现状及护理干预研究

发布时间：2018-06-28 11:41

本文选题：斜视 + 生存质量　；参考：《第三军医大学》2015年博士论文

【摘要】：斜视给患者外观、视功能、心理社会、个人发展和家庭和谐等多方面造成不良影响,导致生存质量下降。因此,如何有效地消除斜视的不良影响和改善患者生存质量是临床实践和科学研究中重点关注的内容。斜视手术被认为是改善外观和视功能、提升生存质量的重要和有效手段,但目前仍存在三个问题:①患者术后仍面临并发症和二次手术的风险,不利于生存质量长期、稳定的改善;②已有研究表明斜视手术并不能完全解决患者在长期患病过程中形成的自卑内向性格和不良自我认知;③缺乏适合我国斜视人群的生存质量测量工具。上述问题一定程度制约了我国斜视患者生存质量的全面提升和远期预后,以及对成人斜视患者生存质量的研究。因此本研究旨研究我国文化背景下成人斜视患者生存质量现状、特点及影响因素,在此基础上研制成人斜视患者生存质量测量工具,以及手术治疗患者的综合护理干预方案,为提高成人斜视患者手术后生成质量提供依据。第一部分:成人斜视患者生存质量现状及影响因素调查研究一、目的:了解我国成人斜视患者生存质量现状、特点及影响因素。二、方法:采用质性与量性相结合的方法学。①对29例符合研究纳入排除标准的成人斜视患者,按照事先拟定的访谈提纲,进行一对一半结构式深入访谈,详细了解斜视患者的生存质量体验。对访谈进行录音并转录成文本,经反复分析、对比和归纳,提炼出我国成人斜视人群生存质量的内涵及特点;②在访谈基础上,编制《成人斜视患者生存质量调查问卷》,并选取437例成人斜视患者进行横断面调查,探索成人斜视患者生存质量现状及影响因素。三、结果:①深入访谈共提取6个关于斜视患者生存质量体验的主题:躯体活动障碍、成长发展受限、疾病受到歧视、消极情绪明显、各种支持缺乏和社会交往障碍。斜视生存质量相关需求有:改善外观和视功能、解决婚恋问题、获得经济和信息支持、避免术后并发症和复发。②编制的《成人斜视患者生存质量调查问卷》共65个条目,分三部分:斜视症状(10条目)、斜视生存质量体验(45条目)、阻碍因素和需求(10条目)。前两部分采用Likert-5级评分,第三部分以是非评分。其中“斜视生存质量体验”又分为5个维度:躯体活动(8条目)、心理情感(8条目)、社会交往(8条目)、应对方式(15条目)和幸福感(6条目)。③斜视症状发生明显,常见的有:视物模糊,依靠单眼视物,视疲劳和斜视加重。④与躯体活动和社会交往条目相比,情绪体验、应对方式和幸福感条目的表现更为严重。⑤延误患者就医的因素有:不知道斜视可以治疗、就诊意识不足、担心把眼睛治瞎和当地医疗条件落后。⑥斜视生存质量水平受到性别、学历、地区因素的影响。四、结论:斜视症状表现明显,不仅对患者视功能造成影响,也对其躯体活动、社会交往、情绪体验造成影响。成人斜视患者生存质量受斜视症状、人口学特征、疾病认知和社会环境因素的影响。第二部分:成人斜视患者生存质量测量工具的研究一、目的:研制成人斜视患者生存质量测量工具,评价成人斜视患者生存质量。二、方法:①汉化英文版成人斜视量表(adultstrabismusquestionnaire,as-20),并应用于255例成人斜视患者,并进行信效度检验和rasch模型检验。②在第一部分研究的基础上,通过德尔菲专家函询,形成《成人斜视患者生存质量量表》,并应用于242例成人斜视患者,进行信效度检验和rasch模型检验。三、结果:①中文版as-20有较高的信度,量表总cronbachα系数为0.908,心理社会维度和功能维度的α系数分别为0.913和0.808。但功能维度的结构不太理想,从2个维度测量生存质量,与本研究显示的多维度影响生存质量不吻合,条目选项的likert-5级评分不合理,需要整合为4级。②研制的《成人斜视患者生存质量量表》共20个条目,分为4个维度:躯体活动(4条目)、心理情感(5条目)、社会交往(5条目)和应对方式(6条目)。量表有较高的信度,总cronbachα系数为0.923,躯体活动、社会交往、心理情感和应对方式各维度的α系数分别为0.716、0.765、0.884和0.758。量表与rasch模型的拟合度良好,各维度结构、条目选项的likert-5级评分合理,条目项设置合理,各维度的个体和条目分离信度好,在0.80~0.98之间。四、结论:汉化英文版成人斜视患者量表(adultstrabismusquestionnaire,as-20)用于中国成人斜视患者测量显示不理想。课题组研制的《成人斜视患者生存质量量表》具有较好的信效度,条目选项设置合理,可以作为成人斜视生存质量的有效评估工具。第三部分:成人斜视患者生存质量护理干预研究一、目的:构建成人斜视患者生存质量综合护理干预方案。二、方法:①在深入访谈和横断面调查的基础上,结合文献分析和相关理论,构建改善成人斜视手术患者生存质量的综合护理干预方案。②采用对照试验方法,按纳入排除标准,选择手术治疗成人斜视患者,干预组共53例(纳入55例,其中失访2例);对照组共42例(纳入54例,其中失访12例)。对照组实施常规手术护理干预,干预组在常规手术护理基础上进行综合护理干预。采用《成人斜视患者生存质量量表》于术前、术后1、2、3、4周(干预组在干预前)分别采集数据进行效果评价。三、结果:①在总量表和躯体活动维度上,干预组与对照组在术前及术后1、2、3周的得分无明显差异;干预组在术后第4周的得分明显高于对照组(P0.05)。②在心理情感和社会交往维度上,干预组与对照组在术前及术后1、2周的得分无明显差异;干预组在术后第3、4周的得分明显高于对照组(P0.05或P0.01)。③在应对方式维度上,干预组与对照组在术前、术后第1、2、3、4周的得分都无明显差异。④干预组自术后第3周起,总量表和各维度的得分较术前明显提高;对照组只有在术后第4周的总量表、心理情感和躯体活动维度得分上才明显高于术前,其余维度术前术后均无显著差异。四、结论:综合护理干预方案可作为手术干预的有效补充措施,促进斜视生存质量的全方面提高。在手术后第4周,斜视患者在心理情感和社会交往方面的改善效果最为明显。
[Abstract]:Strabismus causes adverse effects on patients' appearance, visual function, psychosocial, personal development and family harmony, resulting in a decline in the quality of life. Therefore, how to effectively eliminate the adverse effects of strabismus and improve the quality of life of patients is a key concern in clinical practice and scientific research. Strabismus surgery is considered to improve the appearance and appearance of the patients. The important and effective means to improve the quality of life can be seen, but there are still three problems: (1) the patients still face complications and two operation risks, which are not conducive to the long-term and stable improvement of the quality of life; 2. The previous study shows that the strabismus surgery can not completely solve the inferiority introverted character formed in the process of long-term illness. There is a lack of quality measurement tools suitable for the population of strabismus in China. These problems restrict the overall improvement of the quality of life and the long-term prognosis of the Chinese strabismus, as well as the study of the quality of life for the adult strabismus, so this study aims to study the survival quality of the adult strabismus patients in our country. In order to improve the quality of adult strabismus patients after operation, the quality measurement tools of adult strabismus and the comprehensive nursing intervention program for patients with surgical treatment are provided to improve the quality of adult strabismus after operation. The quality of life, characteristics and influencing factors of Chinese adult strabismus. Two, methods: the methods of combining qualitative and quantitative methods were used. (1) 29 cases of adult strabismus patients who were in accordance with the exclusion criteria of the study, according to the proposed interview outline, carried out one to half of the structural in-depth interviews to understand the quality of life of the strabismus patients in detail. Experience. The interview was recorded and transcribed into text. After repeated analysis, comparison and induction, the quality of life of the Chinese adult strabismus was extracted. On the basis of the interview, the questionnaire for the quality of life of the patients with adult strabismus was compiled, and 437 cases of adult strabismus were selected to carry out a cross-sectional survey to explore the life of the adult strabismus. Three. Results: (1) a total of 6 topics on the quality of life experience of strabismus patients: somatization disorder, limited growth and development, discrimination of disease, negative emotion, lack of support and social communication barriers. The related needs of the quality of strabismus survival: improvement of appearance and visual function, solution Marriage and love problems, obtain economic and information support, avoid postoperative complications and recurrence. (2) a total of 65 items of quality of life questionnaire for adult strabismus, divided into three parts: strabismus symptoms (10 items), strabismus quality of life experience (45 items), hindrance factors and requirements (10 items). The first two parts are Likert-5 grade, third part There were 5 dimensions of the "strabismus quality experience": physical activity (8 items), psychological emotion (8 entries), social interaction (8 entries), coping style (15 entries) and happiness (6 items). (3) contiguant symptoms of strabismus, such as blurred visual substance, monocular vision, visual fatigue and strabismus aggravation. The social contact items, emotional experience, coping style and happiness stripe were more serious. 5. The factors that delayed the patient's medical treatment were: not knowing the strabismus treatment, the lack of awareness, the fear of blindness and the local medical conditions. 6. The impact of the quality of strabismus on the quality of life, education, regional factors. Four, conclusion The symptoms of strabismus are obvious, which not only affect the visual function of the patients, but also affect their physical activity, social interaction and emotional experience. The quality of life of the adult strabismus is affected by the symptoms of strabismus, demographic characteristics, disease cognition and social environment factors. The second part: a study of the measurement tools for the quality of life of the adult strabismus patients. To develop a quality of life measurement tool for adult strabismus patients and evaluate the quality of life of the adult strabismus. Two, methods: (1) adultstrabismusquestionnaire (as-20) in the Chinese English version of adult strabismus (as-20), and applied to the patients with adult strabismus, and the reliability and validity test and the Rasch model test. Delphy experts formed a questionnaire for the quality of life of the patients with adult strabismus, and applied to 242 cases of adult strabismus. The reliability and validity test and Rasch model test. Three. Results: (1) the Chinese version of as-20 has high reliability, the total Cronbach alpha coefficient of the scale is 0.908, the alpha coefficient of the psychosocial dimension and the functional dimension is 0.913 and 0.808., respectively. The structure of the functional dimension is not ideal. Measuring the quality of life from 2 dimensions is not consistent with the multidimensional impact of the quality of life shown in this study. The likert-5 grade of the entry options is not reasonable and needs to be integrated into grade 4. (2) the quality of life scale of the patients with adult strabismus was developed in a total of 20 items, which are divided into 4 dimensions: physical activity (4 entries) and psychological feelings. Sense (5 items), social interaction (5 entries) and coping style (6 items). The scale has high reliability, the total Cronbach alpha coefficient is 0.923, the alpha coefficients of body activity, social interaction, psychological emotion and coping style are 0.716,0.765,0.884 and 0.758. scale and Rasch model, respectively, each dimension structure, and the likert-5 of entry options The grade is reasonable, the item item is set reasonable, the individual and item of each dimension have good separation reliability, between 0.80~0.98. Four. Conclusion: adultstrabismusquestionnaire (as-20) for Chinese adult strabismus (as-20) is not ideal for Chinese adult strabismus. With good reliability and validity, the selection of item options is reasonable and can be used as an effective assessment tool for the quality of life of adult strabismus. The third part: Study on the quality of life nursing intervention for adult strabismus patients. Objective: to construct a comprehensive nursing intervention program for the quality of life of adult strabismus patients. (two) methods: (1) on the basis of in-depth interview and cross-sectional survey, Combined with literature analysis and related theories, a comprehensive nursing intervention scheme was constructed to improve the quality of survival of the patients with adult strabismus surgery. (2) 53 cases (including 55 cases, of which 2 cases were lost) in the intervention group were selected by the control test, and 42 cases in the control group (including 54 cases, of which 12 cases were lost). The group carried out routine nursing intervention, and the intervention group carried out comprehensive nursing intervention on the basis of routine surgical nursing. The quality of life of the patients with adult strabismus was evaluated before the operation and 1,2,3,4 weeks after the operation (before intervention group). Three. Results: (1) the intervention group and the body activity dimension, the intervention group and the opposite group. There was no significant difference in scores between preoperative and postoperative 1,2,3 weeks, and the score of intervention group in fourth weeks after operation was significantly higher than that of control group (P0.05). (2) there was no significant difference between the intervention group and the control group before and after the operation in the control group (P0.05). The score of the intervention group was significantly higher than that of the control group (P0.05 or 1,2 weeks after the operation (P0.05). P0.01). In the coping style dimension, there was no significant difference between the intervention group and the control group before the operation and the 1,2,3,4 week after the operation. (4) the score of the total scale and the dimensions of the intervention group increased obviously from the third weeks after the operation. The control group was only significantly higher than the total amount of mental emotion and physical activity in the fourth week after the operation. Before operation, there was no significant difference between the other dimensions before and after operation. Four. Conclusion: the comprehensive nursing intervention scheme can be used as an effective supplementary measure to improve the quality of the strabismus. Fourth weeks after the operation, the improvement effect of the patients with strabismus in the aspects of psychological emotion and social communication is the most obvious.
【学位授予单位】：第三军医大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R473.77

【参考文献】