跨理论模型在慢性阻塞性肺疾病患者肺康复锻炼干预中的应用研究

发布时间：2018-04-05 20:00

本文选题：跨理论模型　切入点：肺康复锻炼　出处：《宁夏医科大学》2017年硕士论文

【摘要】：目的调查、分析慢性阻塞性肺疾病(COPD)患者肺康复锻炼和生活质量现状及影响因素;分析生活质量与呼吸困难程度、运动耐力、肺功能的相关性;探讨跨理论模型在COPD患者肺康复锻炼干预中的应用效果;寻求科学、有效的适合COPD患者的肺康复锻炼干预方案,为改善COPD患者肺康复锻炼行为提供一定的理论指导和参考依据。方法在宁夏人民医院呼吸科电子病例系统中,便利抽取2015年1月~12月就诊的符合纳入标准的COPD患者98例,随机分为试验组和对照组各49例。于2016年3月~11月实施干预,给予试验组患者跨理论模型指导的肺康复锻炼干预,给予对照组患者常规肺康复锻炼干预。于干预前、干预3、6、9个月时评估两组患者的肺康复锻炼行为改变阶段、肺康复锻炼频率、慢性阻塞性肺疾病生活质量测评量表(CAT)评分、呼吸困难程度(MMRC)评分、运动耐力(6MWD)、肺功能(FEV1/FVC、FEV1%pred),比较两种干预方式的效果。结果1.本研究纳入并完成干预的COPD患者共94例,男性58例(61.7%),女性36例(38.3%);平均年龄(68.94±10.76)岁;平均病程(14.45±6.41)年;1年内因COPD加重住院平均次数(2.55±1.12)次。2.CAT平均得分(24.00±7.44)分;MMRC平均得分(2.81±1.08)分;6MWD平均距离(330.24±69.98)米;FEV1/FVC均值为(55.74±10.11)%,FEV1%pred均值为(54.68±10.20)%。3.干预前COPD患者肺康复锻炼行为改变阶段以意向阶段人数最多,所占比例为46.8%,准备阶段人数最少,所占比例为7.40%。4.急性加重住院次数,肺康复锻炼知识掌握情况,肺康复锻炼实施情况影响COPD患者生活质量(P0.05)。5.CAT评分与MMRC评分呈正相关(r=0.937,P0.05),与6MWD(r=-0.981,P0.05)、FEV1/FVC(r=-0.933,P0.05)、FEV1%pred(r=-0.933,P0.05)呈负相关。6.干预前两组COPD患者人口学特征、临床基本资料、肺康复锻炼行为改变阶段、CAT评分、MMRC评分、6MWD、FEV1/FVC、FEV1%pred组间比较,差异均无统计学意义(P0.05)。7.干预结束时试验组患者肺康复锻炼行为阶段的改变优于对照组(P0.05),且锻炼频率明显高于对照组(P0.05)。8.干预6、9个月时试验组患者呼吸困难程度低于对照组(P0.05),且生活质量、运动耐力均优于对照组(P0.05)。9.干预9个月时试验组患者肺功能优于对照组,FEV1/FVC、FEV1%pred均高于对照组(P0.05)。结论1.急性加重住院次数,肺康复锻炼知识掌握情况与锻炼实施情况均可影响COPD患者生活质量。2.生活质量(CAT评分)与呼吸困难程度(MMRC评分)、运动耐力(6MWD)、肺功(FEV1/FVC、FEV1%pred)具有相关性,监测以上几组指标可综合反映COPD患者生活质量。3.跨理论模型指导的干预能更好地提高COPD患者肺康复锻炼行为的依从性。4.跨理论模型指导的肺康复锻炼干预可有效缓解COPD患者呼吸困难症状,提高运动耐力,增强肺功能,改善生活质量。
[Abstract]:Objective to investigate the status quo and influencing factors of pulmonary rehabilitation and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD), and to analyze the correlation between QOL and dyspnea, exercise endurance and pulmonary function.To explore the application effect of transtheoretical model in the intervention of lung rehabilitation exercise in patients with COPD, to seek a scientific and effective scheme of lung rehabilitation exercise intervention for COPD patients, and to provide certain theoretical guidance and reference basis for improving the pulmonary rehabilitation exercise behavior of COPD patients.Methods from January to December 2015, 98 patients with COPD who met the inclusion criteria were randomly divided into two groups: experimental group (n = 49) and control group (n = 49) in the electronic case system of respiratory department of Ningxia people's Hospital.The intervention was carried out from March to November 2016. The patients in the experimental group were given the intervention of lung rehabilitation exercise under the guidance of the cross-theoretical model, and the patients in the control group were given routine pulmonary rehabilitation exercise intervention.Before intervention, 6 months and 9 months after intervention, the changes of pulmonary rehabilitation behavior, the frequency of pulmonary rehabilitation exercise, the scale of chronic obstructive pulmonary disease quality of life (CAT), the degree of dyspnea and the score of MMRC were evaluated.The effects of two intervention methods were compared with FEV1 / FVCFEV1 / FEV1 predder.Result 1.In this study, 94 patients with COPD were enrolled and completed the intervention, 58 males and 36 females, with an average age of 68.94 卤10.76 years old, and 36 female patients with a mean age of 68.94 卤10.76 years.Before intervention, the number of patients with COPD in the stage of pulmonary rehabilitation exercise behavior change was the most, the proportion was 46.8%, the number of patients in the preparatory stage was the least, the proportion was 7.40.4.Before intervention, there were no significant differences in demographic characteristics, clinical data, cat scores and MMRC scores between the two groups before intervention in COPD patients with FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1pred group. There was no significant difference between the two groups.At the end of intervention, the changes of pulmonary rehabilitation exercise behavior in the experimental group were better than those in the control group (P 0.05), and the exercise frequency was significantly higher than that in the control group.The degree of dyspnea in the test group was lower than that in the control group at 6 and 9 months, and the quality of life and exercise endurance were better than those in the control group.After 9 months of intervention, the pulmonary function in the trial group was better than that in the control group (FEV1 / FVC+ FEV1 / FEV1), which was higher than that in the control group (P0.05).Conclusion 1.The times of acute exacerbation of hospitalization, the knowledge of pulmonary rehabilitation exercise and the implementation of exercise can all affect the quality of life of patients with COPD.The cat score of quality of life (cat) was correlated with the degree of dyspnea and MMRC score, exercise endurance and FEV1 / FV1 / FEV1 / pred. The quality of life of patients with COPD could be comprehensively reflected by monitoring the above indexes.The intervention guided by cross-theoretical model can improve the compliance of pulmonary rehabilitation exercise behavior in patients with COPD. 4.The intervention of pulmonary rehabilitation exercise under the guidance of cross-theoretical model can effectively alleviate the dyspnea symptoms, improve exercise endurance, enhance lung function and improve the quality of life in patients with COPD.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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