分化型甲状腺癌术后行放射性碘治疗患者自我管理效能感水平及其影响因素研究

发布时间：2018-12-10 14:13

【摘要】：目的了解分化型甲状腺癌(DTC)术后行放射性碘(RAI)治疗患者自我管理效能感水平,分析探讨患者的自我管理效能感的影响因素,为临床医护工作提高患者的自我管理能力提供参考依据。方法选取363名就诊于北京市四所综合医院接受RAI治疗的分化型甲状腺癌术后患者进行问卷调查,采用自行设计的患者一般资料和疾病相关资料调查问卷、癌症患者自我管理效能感测评量表、社会支持测评问卷、综合医院焦虑和抑郁测评量表、生命质量评估问卷、医学应对问卷对患者进行调查。建立Excel数据库,通过SPSS22.0软件对数据进行统计学分析,患者的一般资料和疾病相关资料等分类变量采用独立样本t检验和ANOVA方差分析;患者的抑郁和焦虑状态、社会支持情况、生命质量和医学应对行为等连续变量采用Pearson相关分析,多元逐步回归方法解析分化型甲状腺癌术后行RAI治疗患者自我管理效能感水平的影响因素。结果1分化型甲状腺癌术后行RAI治疗患者自我管理效能感总分为(89.71±19.45)分。2单因素方差分析结果:不同婚姻状况、文化水平、照顾者、医疗费用支付类型、家庭人均月收入、性格类型、锻炼情况、知晓情况、患病时间、病理分期、淋巴结是否转移、肿瘤体积和复发危险度分层的分化型甲状腺癌术后行RAI治疗的患者自我管理效能感得分间差异具有统计学意义(P(27)0.05);躯体、角色、认知、情绪、社会等功能领域、患者总体健康状况、面对、回避、社会支持各维度与自我管理效能感均呈正相关;焦虑、抑郁、疲倦、恶心呕吐、疼痛、失眠、食欲丧失、经济困难、屈服与自我管理效能感均呈负相关。3多元逐步回归分析结果:最终有12个变量进入到回归方程式中,根据影响力度由大到小排序依次为:面对、屈服、知情、复发危险度分层、性格类型、抑郁、淋巴结是否转移、回避、病理分期、经济困难、居住区域、服碘频次;12个变量共同解释患者自我管理效能感水平总变异的72%。结论1分化型甲状腺癌术后行RAI治疗患者的自我管理效能感处于中等水平。2分化型甲状腺癌术后行RAI治疗患者自我管理效能感水平的影响因素据影响力由大到小排序依次为:面对、屈服、知情、复发危险度分层、性格类型、抑郁、淋巴结转移、回避、病理分期、经济困难、居住区域和服碘次数。积极的医学应对方式、开朗乐观的性格、减轻患者经济负担、针对性隐瞒病情有利于提高患者的自我管理效能感水平;居住区域为城市、服碘次数越少、复发危险度分层和病理分期越低的患者自我管理效能感水平相对较高。3评价甲状腺癌术后行RAI治疗患者自我管理效能感水平,参考上述因素对患者制定个体化干预措施,有助于提升患者的自我管理效能感水平,提高患者的自我管理能力。
[Abstract]:Objective to investigate the level of self-management efficacy in patients with differentiated thyroid carcinoma treated with radioactive iodine (RAI) after (DTC), and to analyze the influencing factors of self-management efficacy. To provide a reference for clinical nursing work to improve the ability of self-management of patients. Methods A total of 363 patients with differentiated thyroid carcinoma treated with RAI in four general hospitals in Beijing were investigated by questionnaire. The general data of patients and disease related data were investigated by self-designed questionnaire. The self-management efficacy scale, the social support scale, the comprehensive hospital anxiety and depression scale, the quality of life assessment questionnaire and the medical response questionnaire were investigated. The Excel database was established and the data were analyzed statistically by SPSS22.0 software. The patients' general data and disease related data were classified by independent sample t-test and ANOVA variance analysis. Continuous variables such as depression and anxiety, social support, quality of life and medical coping behavior were analyzed by Pearson correlation. Multivariate stepwise regression method was used to analyze the influencing factors of self-management efficacy in patients with differentiated thyroid carcinoma treated with RAI. Results (1) the total score of self-management efficacy was (89.71 卤19.45) in patients with differentiated thyroid carcinoma treated with RAI after operation. 2 the results of ANOVA were as follows: different marital status, educational level, caregivers, types of payment of medical expenses. Per capita monthly income, personality type, exercise, knowledge, time of illness, pathological stage, lymph node metastasis, There was significant difference in the scores of self-management efficacy between the patients who received RAI treatment after the operation of tumor volume and recurrence risk stratified differentiated thyroid carcinoma (P (27). The functional fields of body, role, cognition, emotion, society and so on, the overall health status of patients, the dimensions of face, avoidance and social support were positively correlated with the sense of self-management efficacy. Anxiety, depression, fatigue, nausea and vomiting, pain, insomnia, loss of appetite, financial difficulties, yield were negatively correlated with self-management efficacy. According to the order of influence intensity from big to small, the order is: face, yield, know, recurrence risk stratification, personality type, depression, lymph node metastasis, avoidance, pathological stage, economic difficulty, living area, iodine frequency; Twelve variables explained 72% of the total variation in the level of self-management efficacy. Conclusion (1) Self-management efficacy of patients with differentiated thyroid carcinoma treated with RAI after operation is at a moderate level. (2) the influencing factors of self-management efficacy in patients with differentiated thyroid carcinoma treated with RAI after operation are from great to The small order is: face, Yield, knowledge, recurrence risk stratification, personality type, depression, lymph node metastasis, avoidance, pathological staging, financial difficulties, living area and iodine times. Positive medical coping style, cheerful and optimistic personality, lightening the economic burden of patients, and hiding their illness will help to improve the level of self-management efficacy of patients. The patients with less iodine intake, lower recurrence risk stratification and lower pathological stage had a higher level of self-management efficacy. 3 to evaluate the self-management efficacy level of patients treated with RAI after thyroid cancer operation. It is helpful to improve the level of self-management efficacy and the ability of self-management of patients to make individualized intervention measures according to the above factors.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

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