某市冠心

发布时间：2018-08-25 17:50

【摘要】：目的:了解冠心病、脑卒中住院患者生命质量总体水平及其躯体、心理、社会和疾病特异性四个领域方面的生命质量水平。比较不同特征患者生命质量,分析其影响因素,探讨不同特征患者生命质量存在差异的原因。通过患者住院前后生命质量的对比,评价系统治疗对患者生命质量改善的有效性。旨在为进一步提高患者生命质量,选择合适的健康教育干预方案,改善医疗卫生服务提供参考。方法:本研究依据医院级别进行分层,在某市随机抽取两家二级医院和两家三级医院,于2015年6-12月期间在四所医院的心血管内科、胸外科、神经内科、神经外科选择符合纳入标准的冠心病患者290例、脑卒中患者310例,共600例住院患者作为调查对象。分别在患者入院和出院时,采用万崇华等人研制的冠心病患者生命质量量表(QLICD—CHD V1.0)、脑卒中患者生命质量量表(QLICD—ST V2.0)对第一诊断为冠心病、脑卒中的患者住院前后的生命质量进行调查。通过EPIDATE3.l建立数据库进行数据录入,使用EXCEL、SPSS 21.0对数据进行统计分析。结果:1.冠心病患者生命质量得分为65.09±14.76,脑卒中患者生命质量得分为49.83±8.05,冠心病患者生命质量高于脑卒中患者,二者间差异具有统计学意义(t=15.761,P0.01)。在四个领域方面,冠心病患者心理功能得分最高,躯体功能得分最低。脑卒中患者社会功能得分最高,心理功能得分最低。2.生命质量的影响因素分析发现,冠心病患者中,男性的生命质量高于女性,差异具有统计学意义(t=2.729,P0.01);中年患者高于老年患者高于青年患者,差异具有统计学意义(F=15.868,P0.01);有配偶患者高于无配偶患者,差异具有统计学意义(t=2.004,P0.05);不同工作状态患者的生命质量不同,表现为在职人员和离退休人员均高于无业人员且差异具有统计学意义(F=28.504,P0.01);文化程度越高,生命质量越高且差异具有统计学意义(F=31.986,P0.01);经济状况越好生命质量越高且差异具有统计学意义(F=33.320,P0.01);不同支付方式患者的生命质量不同,城镇医保支付的患者生命质量高于农合患者高于商业医疗保险患者高于自费患者,差异具有统计学意义(F=72.131,P0.01);病程不同生命质量有差异,表现为病程短的患者生命质量较高,且差异具有统计学意义(F=28.706,P0.01);无合并症患者生命质量高于有合并症患者,且合并症越少患者生命质量越高,差异具有统计学意义(F=17.231,P0.01)。但是多因素分析发现影响冠心病患者生命质量的主要因素包括婚姻状况、文化程度、工作状态、病程、合并症。脑卒中患者中,不同年龄段患者生命质量不同,表现为青年患者高于中年患者高于老年患者,差异具有统计学意义(F=99.568,P0.01);不同婚姻状况、工作状态、文化程度、经济状况、医疗费用支付方式、病程、合并症的变化趋势与冠心病患者相同且差异均具有统计学意义(P0.05)。多因素分析发现影响脑卒中生命质量的因素包括年龄、婚姻状况、文化程度、工作状态、经济状况、医疗费用支付方式、病程。3.入院前后的比较研究发现,冠心病患者出院时生命质量(67.97±13.99)高于入院时(65.09±14.76)且差异具有统计学意义(t=25.312,P0.01)。脑卒中患者出院时生命质量(59.92±10.30)高于入院时(49.83±8.05),差异同样具有统计学意义(t=34.721,P0.01)。表明冠心病和脑卒中患者经在院系统治疗后生命质量均有所提高。4.不同级别医院患者出院时生命质量均高于入院时,但是生命质量提升幅度不同,经比较发现,冠心病患者在三级医院住院治疗后生命质量提升幅度明显高于二级医院,差异具有统计学意义(t=-5.418,P0.01)。脑卒中患者在三级医院住院治疗后生命质量提升幅度低于二级医院,差异具有统计学意义(t=13.986,P0.01)。结论:1.冠心病患者生命质量处于中等水平,脑卒中患者生命质量水平偏低。冠心病和脑卒中住院患者生命质量均低于我国普通人群常模,说明患病对人群生命质量有影响。2.影响冠心病患者生命质量的因素主要包括婚姻状况、文化程度、工作状态、病程;影响脑卒中患者生命质量的主要因素包括年龄、婚姻状况、工作状态、文化程度、经济状况、医疗费用支付方式、病程。3.对比住院前后患者的生命质量,发现系统治疗能够提高患者的生命质量。
[Abstract]:Objective: To investigate the overall quality of life (QOL) of inpatients with coronary heart disease (CHD) and stroke and its physical, psychological, social and disease-specific quality of life (QOL). The purpose of this study was to provide references for further improving the quality of life of patients, choosing appropriate health education intervention programs and improving medical and health services. From June to December, 2015, 290 patients with coronary heart disease and 310 patients with stroke were selected from cardiovascular, thoracic, neurological and neurosurgical departments of four hospitals. A total of 600 inpatients were enrolled in the study. QLICD-CHD V1.0 and Stroke Quality of Life Scale (QLICD-ST V2.0) were used to investigate the quality of life of patients with coronary heart disease and stroke before and after hospitalization. There was a significant difference between the two groups (t = 15.761, P 0.01). In four areas, the score of psychological function was the highest in patients with coronary heart disease, and the score of physical function was the lowest. The physical function score was the lowest. 2. The analysis of the influencing factors of the quality of life showed that the quality of life in male patients with coronary heart disease was higher than that in female patients, the difference was statistically significant (t = 2.729, P 0.01); that in middle-aged patients was higher than that in elderly patients was higher than that in young patients, the difference was statistically significant (F = 15.868, P 0.01); that in patients with spouse was higher than that in patients without spouse, the difference was statistically significant. There was statistical significance (t = 2.004, P 0.05); the quality of life of patients in different working conditions was different, the performance of the in-service and retired workers were higher than the unemployed and the difference was statistically significant (F = 28.504, P 0.01); the higher the education level, the higher the quality of life and the difference was statistically significant (F = 31.986, P 0.01); the better the economic situation, the better the quality of life; The higher the quantity was and the difference was statistically significant (F = 33.320, P 0.01); the quality of life of patients with different payment methods was different; the quality of life of patients with urban medical insurance payment was higher than that of patients with agricultural cooperative medical insurance and patients with commercial medical insurance and higher than that of patients with self-financed medical insurance, the difference was statistically significant (F = 72.131, P 0.01); the quality of life of patients with different course of disease was different, which was manifested as disease. The quality of life of patients with short duration was higher and the difference was statistically significant (F = 28.706, P 0.01); the quality of life of patients without complications was higher than that of patients with complications, and the quality of life of patients with fewer complications was higher, the difference was statistically significant (F = 17.231, P 0.01). However, multivariate analysis found that the main factors affecting the quality of life of patients with coronary heart disease were found. The quality of life of stroke patients in different age groups was higher in young patients than in middle-aged patients than in elderly patients, the difference was statistically significant (F = 99.568, P 0.01); different marital status, working status, educational level, economic status, medical expenses payment. Multivariate analysis found that the factors affecting the quality of life of stroke patients included age, marital status, educational level, working status, economic status, medical expenses payment methods, course of disease. 3. The comparative study before and after admission found that coronary heart disease The quality of life at discharge was higher than that at admission (67.97 + 13.99) and the difference was statistically significant (t = 25.312, P 0.01). The quality of life at discharge (59.92 + 10.30) of stroke patients was higher than that at admission (49.83 + 8.05), and the difference was also statistically significant (t = 34.721, P 0.01). After treatment, the quality of life of patients in different levels of hospitals was higher than that at admission, but the improvement of quality of life was different. By comparison, the improvement of quality of life in patients with coronary heart disease after hospitalization in tertiary hospitals was significantly higher than that in secondary hospitals, the difference was statistically significant (t = - 5.418, P 0.01). The quality of life of stroke patients after hospitalization in tertiary hospital was lower than that in secondary hospital, the difference was statistically significant (t = 13.986, P 0.01). Conclusion: 1. The quality of life of patients with coronary heart disease was in the middle level, and the quality of life of patients with stroke was on the low side. The main factors affecting the quality of life of patients with coronary heart disease include marital status, educational level, working status, course of illness; the main factors affecting the quality of life of stroke patients include age, marital status, working status, educational level, economic status, mode of payment for medical expenses, course of illness. Compared with the quality of life of patients before and after hospitalization, it is found that systematic treatment can improve the quality of life of patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.323

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