血友病患者心理健康状况及系统化综合关怀干预效果研究

发布时间：2018-12-14 01:04

【摘要】：目的研究血友病患者心理健康状况及其影响因素,并根据影响因素制定系统化综合关怀方案,依据其效果分析为血友病临床护理工作提供理论依据。方法选取泰安市某三甲医院登记注册的血友病患者67名,首次调查采用患者基本资料调查表收集患者的人口社会学特征和临床特征,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和心理症状自评量表(SCL-90)测量患者干预前的心理健康状况,应用SPSS 17.0软件分析患者心理健康状况与人口社会学特征及临床特征之间的相关性,找出影响血友病患者心理健康状况的因素。依据影响因素制定和落实系统化综合关怀方案,包括建立患者健康管理档案、开展凝血因子家庭实时注射指导和预防治疗、RICE(R-Rest患肢休息制动,I-Ice冰敷,C-Compression局部压迫,E-Elevation抬高患肢)出血急救知识健康教育、康复锻炼、心理疏导、提供非血源性凝血因子、社会救助等,干预12个月后再次调查67名患者的心理健康状况,分析干预前、后心理健康状况的变化,并与国内正常人群心理健康状况的常模进行比较。结果1.干预前血友病患者的心理健康状况明显低于国内正常人群的常模水平(P0.01),其中75%的患者有不同程度的焦虑,65%的患者有不同程度的抑郁,半数以上的患者有不同程度的躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性等心理症状。2.单因素分析发现文化程度越低、婚姻和工作状况越差、医疗费用不足、生活自理能力越差、病程时间越长、凝血因子缺乏越严重、出血次数越多、出血时伴感染、治疗不及时、无预防治疗、已发生关节畸形及感染输血相关感染性疾病的患者心理健康状况越差(P0.05)。3.多因素分析发现文化程度、工作状况、医疗费用、生活自理程度、病程、凝血因子缺乏程度、每年出血次数、治疗是否及时、输血相关感染性疾病、预防治疗及出血时伴感染等因素影响血友病患者的心理健康水平(P0.01)。4.实施系统化综合关怀方案后,患者存在轻度焦虑、重度焦虑、中度抑郁、躯体化症状、抑郁症状、焦虑症状、敌对症状、恐怖症状、偏执症状、精神病性症状及其他症状的病例数较干预前显著下降(P0.01),血友病患者心理健康状况得到显著改善(P0.01),但干预后的心理健康状况仍低于国内正常人群的常模水平(P0.01)。结论血友病患者心理健康水平较低,多数患者存在心理健康问题,实施好系统化综合关怀方案能够显著提高血友病患者心理健康水平。鉴于该方案初步实施效果显示血友病患者心理健康状况仍低于正常人群水平,所以系统化综合关怀措施应持续推进。
[Abstract]:Objective to study the mental health status of hemophilia patients and its influencing factors, and to establish a systematic and comprehensive care scheme according to the influencing factors, and to provide theoretical basis for clinical nursing care of hemophilia patients. Methods Sixty-seven hemophilia patients registered in a third Class A Hospital in Taian City were selected. The sociological and clinical characteristics of the patients were collected by the basic information questionnaire for the first time. The self-rating anxiety scale (SAS),) was used to collect the demographic and clinical characteristics of the patients. (SDS) and SCL-90 were used to measure the mental health status of patients before intervention. SPSS 17.0 software was used to analyze the correlation between mental health status, demographic and sociological characteristics and clinical characteristics. Find out the factors that affect the mental health of hemophilia patients. According to the influencing factors, a systematic comprehensive care program was formulated and implemented, including the establishment of patient health management files, the development of real-time family injection of coagulation factors and the prevention and treatment of rest and immobilization of the affected limbs of, RICE (R-Rest, and the application of I-Ice ice compress. First aid knowledge education, rehabilitation exercise, psychological guidance, non-blood coagulation factor, social assistance, etc. After 12 months of intervention, 67 patients' mental health status were investigated again. The changes of mental health status before and after intervention were analyzed and compared with the norm of mental health status of normal population in China. Result 1. Before intervention, the mental health status of hemophilia patients was significantly lower than the norm level of normal population in China (P0.01), 75% of the patients had different degree of anxiety, 65% of the patients had different degrees of depression. More than half of the patients had somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychosis and other psychological symptoms. 2. Univariate analysis showed that the lower the education level, the worse the marriage and work condition, the less the medical expenses, the worse the self-care ability, the longer the course of disease, the more serious the coagulation factor deficiency, the more bleeding, the more infection, the less timely treatment. Without preventive treatment, the lower the mental health status of the patients with joint malformation and transfusion related infectious diseases (P0.05). Multivariate analysis showed that education, work status, medical expenses, self-care of life, course of disease, lack of coagulation factors, bleeding times per year, timely treatment, transfusion related infectious diseases, Preventive treatment and infection during bleeding affected the mental health of hemophilia patients (P0.01). 4. There were mild anxiety, severe anxiety, moderate depression, somatization symptoms, depression symptoms, anxiety symptoms, hostility symptoms, phobic symptoms, paranoid symptoms, The number of psychotic symptoms and other symptoms decreased significantly (P0.01), and the mental health status of hemophilia patients improved significantly (P0.01). However, the mental health status after intervention was still lower than the norm level of normal population in China (P0.01). Conclusion the mental health level of hemophilia patients is low and most of them have mental health problems. The implementation of systematic and comprehensive care program can significantly improve the mental health level of hemophilia patients. In view of the preliminary effect of the program, the mental health status of hemophilia patients is still lower than that of normal population, so the systematic comprehensive care measures should be continuously promoted.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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