心力衰竭患者家庭运动行为的影响因素分析及干预研究

发布时间：2018-01-14 12:43

本文关键词：心力衰竭患者家庭运动行为的影响因素分析及干预研究　出处：《南京医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景心力衰竭简称心衰,为各种心脏疾病的严重和终末阶段,发病率高,是当今最重要的心血管病之一。近年来尽管新型药物与介入治疗取得较好效果,但总体预后仍不理想。运动康复作为改善心衰预后的有效途径,2013美国心脏病学会基金会/美国心脏协会心力衰竭管理指南将其列为IA类推荐。心力衰竭患者运动的有效性已得到证实,然而,若患者不坚持运动,效果将不再持续。国外有研究显示,尽管组织良好,资源充足,努力优化运动依从性,但只有约400%的干预组患者短期内实现了运动目标。2014慢性稳定性心力衰竭运动康复中国专家共识指出心功能分级Ⅰ～Ⅲ级的稳定性心衰患者均应考虑接受运动康复,然而我国多数心衰患者出院后与医院终止了联系,极少有患者实现运动目标。如何改善心衰患者运动行为成为亟待解决的问题。研究目的1.本研究旨在通过对心衰患者进行调查及随访,从运动形式、频率、时间、强度四个方面了解心衰患者家庭运动行为现状,探讨心衰患者运动行为的影响因素。2.依据心衰患者运动行为的影响因素,结合国内外研究成果,制定提高心衰患者运动依从性的干预措施,探讨该措施对心衰患者家庭运动行为及生活质量、心理状况的影响。研究方法第一阶段描述性研究:采用便利抽样方法,调查南京医科大学第一附属医院心血管内科2015年11月至2016年4月心血管科住院心衰患者137例,包括住院心衰患者一般资料、心衰疾病特征、运动自我效能、社会支持、出院后家庭运动行为,分别以家庭运动形式、频率、时间和强度为因变量,单因素分析和相关性性分析中有统计学差异的变量为自变量,运用SPSS19.0统计分析心力衰竭患者家庭运动行为的影响因素。第二阶段类实验性研究:将2016年6～7月住院符合纳入标准的40例患者作为对照组,9～10月38例患者作为干预组。对照组进行常规健康教育,干预组在常规教育的基础上,针对患者运动自我效能进行干预,包括住院期间的个性化运动自我效能干预和出院后的随访与指导。嘱患者出院后记录运动日志(包括运动形式、频率、时间和强度等),分别评估患者入组时和出院后4个月的运动自我效能、焦虑抑郁情绪和生活质量。采用SPSS19.0对完成随访的71例患者(对照组37例,干预组34例)资料进行统计分析,评价运动自我效能干预对心力衰竭患者家庭运动行为、生活质量及心理状况的影响。研究结果:1.运动自我效能与家庭运动行为现状:心衰患者运动自我效能总分为32.80±9.33分。进行有氧运动118例(86.1%),有氧联合抗阻运动19例(13.9%);运动频率3.23±0.80次/周;时间为27.50±7.91分钟/天;强度为自感劳累分级(RPE)11.38±1.296。2.家庭运动行为的影响因素:X2分析结果显示,不同年龄、文化程度、合并症数目的患者运动形式差异有统计学意义(P0.05),t检验结果显示不同社会支持程度的患者运动形式差异有统计学意义(P0.05)。t检验、方差分析结果显示,不同婚姻、心功能、合并症数目的患者运动频率差异有统计学意义(P㩳0.05),不同文化程度、心功能、合并症数目的患者运动时间差异有统计学意义(P0.05),不同性别、婚姻、心功能、合并症数目的患者运动强度差异有统计学意义(P0.05)。相关分析显示,运动频率(次/周)、时间(分钟/次)、强度(RPE)与运动自我效能均存在正相关(r值分别为0.539、0.607和0.562),运动频率、时间、强度与年龄均存在负相关(r值分别为-0.350、-0.229和-0.377),运动频率、时间、强度与社会支持均存在正相关(r值分别为0.281、0.562和0.221)。多元线性回归分析显示,运动频率的影响因素为运动自我效能、心功能、合并症数目,运动时间的影响因素为运动自我效能、社会支持、心功能、年龄、合并症数目,运动强度的影响因素为运动自我效能和合并症数目。3.运动自我效能干预效果:采用运动自我效能干预4个月后,干预组运动频率、时间、强度和运动自我效能得分显著优于对照组(P0.05),而运动形式差异无统计学意义;并且干预后两组患者抑郁和生活质量评分差异有统计学意义(P0.05)。研究结论:1.心衰患者运动自我效能处于中等偏下水平,心衰患者家庭运动行为不理想,运动自我效能是其主要影响因素。在设计和实施康复护理时,应重视提高患者的运动自我效能,综合考虑社会支持、年龄、心功能状态及合并症等因素对运动行为的影响。2.运动自我效能干预能有效提高心力衰竭患者的运动自我效能水平,改善家庭运动行为,此外,运动可改善患者心理状态及生活质量。
[Abstract]:On the background of heart failure CHF, for a variety of heart disease and severe end stage, high incidence of cardiovascular disease is the most important one. In recent years, although new drugs and interventional therapy has a good effect, but the overall prognosis is still not ideal. As an effective way to improve the rehabilitation prognosis of heart failure, 2013 of the American Heart Association Disease Foundation / American Heart Association guidelines for heart failure management will be listed as a class IA recommendation. The effectiveness of exercise in patients with heart failure has been confirmed, however, if patients do not adhere to the movement, the effect will no longer continue. Overseas studies have shown that although the organization is good, adequate resources, efforts to optimize the exercise compliance, but only about 400% patients in the intervention group in the short term to achieve a consensus China expert.2014 moving target motion rehabilitation that stable chronic congestive heart failure heart function grade I ~ III level stability heart failure patients Be given rehabilitation, but the majority of our patients with heart failure after termination of hospital contact, few patients realize the moving target. How to improve the behavior of patients with heart failure has become a problem to be solved. Objective: 1. the aim of this study is to through the investigation and follow-up of patients with heart failure, the movement form, frequency, time, four a strength to understand the current situation of family sports behaviors of patients with heart failure, to evaluate the effect of patients with heart failure behavior factors on.2. in patients with heart failure behavior, combined with the research achievements at home and abroad, making exercise adherence interventions in patients with heart failure and to explore the measures of family sports behavior and quality of life in patients with heart failure, affecting mental health. Study on the first stage of a descriptive research method: using convenience sampling method, investigation department of Cardiology the First Affiliated Hospital of Nanjing Medical University in 2015 1 From January to April 2016, 137 cases of hospitalized patients with heart failure and cardiovascular hospitalization, including general data of patients with heart failure, heart failure symptoms, exercise self-efficacy, social support, family sports behavior after discharge, respectively, with the family movement form, frequency, time and intensity as the dependent variable, single factor analysis and correlation analysis of statistically significant variables independent variables and factors influencing the use of SPSS19.0 statistical analysis of family sports behavior of patients with heart failure. In the second stage of experimental study: 6 2016 to July were 40 patients met the inclusion criteria were as the control group, 38 patients from 9 to October as the intervention group. The control group was given routine health education, intervention group on the basis of conventional education on the intervention in patients exercise self-efficacy, including personalized exercise self-efficacy intervention during hospitalization and post discharge follow-up and guidance. The patients after discharge The log record movement (including the movement form, frequency, time and intensity, etc.) were assessed at baseline and after 4 months of exercise self-efficacy, anxiety, depression and quality of life. The SPSS19.0 of 71 patients with complete follow-up (37 cases in the control group, 34 cases in the intervention group) statistical analysis evaluation, exercise self-efficacy intervention on family exercise in patients with heart failure, affecting the quality of life and psychological status. Results: 1. of exercise self-efficacy and family sports behavior: exercise self-efficacy in patients with heart failure score was 32.80 + 9.33. Aerobic exercise in 118 cases (86.1%), aerobic combined resistance exercise in 19 cases (13.9%); the movement frequency 3.23 + 0.80 times per week; time is 27.50 + 7.91 minutes / day; strength rating of perceived exertion (RPE) factor 11.38 + 1.296.2. family sports behavior: the results of X2 analysis showed that different age, education level, and There are significant differences in the form of exercise in patients with complications of the number (P0.05), t test results show that the support of patients with different social movement form difference was statistically significant (P0.05).T test, variance analysis results showed that the heart function of different marriage, the difference was statistically significant number of complications in patients with motor frequency (P? 0.05) heart function, different cultural degree, and there was statistical significance in patients with exercise number of time difference (P0.05), different gender, marriage, heart function, different exercise intensity in patients with the number of patients with statistical significance (P0.05). The correlation analysis shows that the movement frequency (times / week), time (minutes / time), strength (RPE) and exercise self-efficacy is positively correlated (r = 0.539,0.607 and 0.562), exercise frequency, time, intensity and age were negatively correlated (r = -0.350, -0.229 and -0.377), exercise frequency, time, intensity and agency For there was a positive correlation (r = 0.281,0.562 and 0.221). Multiple linear regression analysis showed that the factors affecting exercise frequency for exercise self-efficacy, heart function, number of complications, factors affecting the exercise time for exercise self-efficacy, social support, cardiac function, age, number of complications, the factors affecting exercise the intensity of exercise self efficacy and complications of the number of.3. exercise self-efficacy intervention by exercise self-efficacy after 4 months of intervention, the intervention group exercise frequency, time, intensity and exercise self-efficacy score was significantly better than the control group (P0.05), but no significant differences in the form of exercise; there were significant differences between the two groups of patients with depression and the quality of life score and after intervention (P0.05). Conclusions: 1. patients with heart failure and exercise self-efficacy at a moderate level, family sports behavior in patients with heart failure is not ideal, exercise self-efficacy Are the main influencing factors. In the design and implementation of rehabilitation nursing, should pay attention to improve patients' self-efficacy, considering social support, age, heart function and complications and other factors on exercise behavior of.2. exercise self-efficacy intervention can effectively improve heart failure in patients with exercise self-efficacy level, improve family in addition, exercise behavior, exercise can improve the psychological state and life quality of patients.

【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.2

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