社会资本与脑卒中患者生活质量关系研究

发布时间：2017-12-27 12:11

  本文关键词：社会资本与脑卒中患者生活质量关系研究　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 社会资本 脑卒中 患者 生活质量

【摘要】：背景:脑卒中又称脑血管意外,是一种发病急促的脑血液循环障碍性疾病,存在明显的高发病率、高死亡率、高致残率现象,已成为严重影响人类健康的慢性病之一。脑卒中多发于老年人群,特别是60岁以上老年人群,已经属于一种常见病,一旦发病通常会给家庭和社会带来沉重的经济压力和照料负担。研究发现,2010年全球新发脑卒中病人约1690万、存活脑卒中病人约3300万、因脑卒中导致的死亡约590万。资料显示,我国每年有150万~200万新发脑卒中的病例,每年死于脑血管病的约150万人,现存脑血管病患者约700万人;在存活的脑卒中患者中,75%~80%会留有不同程度的残疾,其中重度残疾超过40%,有30%左右可能在2至5年内复发。脑卒中后由于疾病因素、肢体残疾、经济及照料负担等原因,会导致患者产生焦虑、抑郁、人际关系不和谐、日常生活活动能力和生活质量下降等一系列问题。近年来,社会资本理论逐渐成为健康领域学术研究的热点,在国外医学领域,学者们做了大量社会资本对健康影响的研究。目前,社会资本核心要素与脑卒中的关系研究已经为国内外学者所开展。这些研究显示:较高水平的社会参与、社会支持对脑卒中有积极的作用,主要体现在降低脑卒中发生的风险,提高脑卒中发生后的生活质量和日常生活活动能力,改善康复的效果。所以,社会资本在脑卒中的防治和康复等过程中具有积极的作用。目的:通过调查了解脑卒中患者的社会资本现况、生活质量现况;分析脑卒中患者生活质量的影响因素,探索社会资本与生活质量关系;通过对脑卒中患者社会资本与生活质量关系研究,进而从社会资本角度探索提高脑卒中患者生活质量的核心要素和关键措施。方法:本研究在文献系统复习和专家咨询研讨的基础上,研制出脑卒中患者社会资本与生活质量关系研究的方案和现场调查量表;于2014年8月-10月,通过多阶段随机抽样法,在安徽省阜阳市、合肥市和铜陵市三地各抽取1个县和1个区开展调查。资料收集整理完成后,使用Epi Data3.1软件录入数据并建立数据库,采用SPSS18.0软件进行统计学分析。计量资料使用均数±标准差/中位数±四分位间距表示,其中正态分布资料采用方差分析/t检验进行比较,非正态分布资料采用非参数检验进行比较;计数资料使用率或构成比比较,采用卡方检验或Fisher确切概率法进行比较;影响因素采用多元线性回归进行分析;相关性分析采用Spearman相关性系数;社会资本量表使用信效度检验方法。结果:(1)本次研究共调查了脑卒中患者420人,收回问卷402份,有效问卷390份,有效应答率为92.9%。(2)社会资本量表信效度:整个量表的Cronbach‘sα系数为0.882,结构效度上,提取出6个主成分,总共可以解释75.547%的总变异。(3)脑卒中患者社会资本现况:脑卒中患者和家人/亲戚联系比较密切的有307人(78.8%),和朋友联系比较密切有202人(51.8%),认识周边大部分邻居的有316人(81.0%),和邻居交往比较密切的有125人(32.0%);个人支持方面,在遇到困难时脑卒中患者会得到较多精神支持的有323人(82.8%),会得到较多经济支持的有329人(84.4%);组织/非正式团体支持方面,在遇到困难时脑卒中患者会得到较多精神支持的有121人(31%),会得到较多经济支持的有119人(30.5%);脑卒中患者对家人/亲戚、朋友、邻居、医生和社居委/村委会人员的信任程度较高,分别为342人(87.7%)、304人(77.9%)、310人(79.4%)、315人(80.7%)和299人(76.6%);脑卒中患者多数会帮忙家人/亲戚的有278人(71.3%),多数会帮忙邻居的有245人(62.8%),多数会帮忙朋友的有241人(61.8%),多数会帮忙陌生人的有130人(33.3%);脑卒中患者觉得所在地方关系比较融洽和很融洽的分别为172人(44.1%)和101人(25.9%),本人关心社区/村较多的脑卒中患者为194人(49.7%),认为其它人关心社区/村较多的脑卒中患者为204人(52.3%),对搬离现在的社区/村较为不舍的脑卒中患者为228人(58.5%)。(4)脑卒中患者生活质量现状及影响因素:本次调查的脑卒中患者生活质量总分换算得分为526.92±168.56分,换算均分为65.86±21.07分;各维度得分换算后由高到低排序依次为交流、ADL/IADL、记忆与思维、手功能、移动能力、情绪、参与和力量。生活质量的影响因素主要有:年龄(B=-0.736,P=0.018),每周锻炼身体(B=20.541,P0.001),脑卒中类型(B=21.314,P=0.003),服药情况(B=-21.920,P=0.003)。(5)脑卒中患者社会资本与生活质量的关系:社会联系(B=20.937,P0.001)、互惠(B=21.750,P0.001)、凝聚力与归属感(B=18.487,P0.001)对生活质量有影响,社会联系、互惠、凝聚力与归属感水平越高,脑卒中患者生活质量越好。社会支持、信任对脑卒中患者生活质量暂无影响。(6)社会资本与生活质量维度的相关性:社会联系、凝聚力与归属感与生活质量的8个维度均呈正相关,互惠与生活质量中的情绪、交流、ADL/IADL、移动能力、手功能、参与6个维度呈正相关。结论:(1)本研究使用的社会资本量表信效度良好,达到了研究要求的标准。(2)脑卒中患者社会联系程度较高,大多数脑卒中患者与家人/亲戚联系密切;个人支持水平明显高于组织/非正式团体支持水平,但个人支持来源单一;信任程度普遍较高;除对陌生人外,互惠程度都较高,对家人/亲戚的互惠程度最高;凝聚力与归属感水平一般。(3)脑卒中患者生活质量的影响因素主要有:年龄、每周锻炼身体状况、脑卒中类型和服药情况。(4)社会联系、互惠、凝聚力与归属感对脑卒中患者生活质量有积极作用,且与生活质量的多个维度存在相关性。建议:(1)加强社会联系,促进社会支持,让脑卒中患者获取更多与外界沟通交流的机会以及支持和帮助,进而全面提高生活质量;(2)提高互惠、凝聚力与归属感水平,增强脑卒中患者的集体感和责任感,发挥个人在集体中的作用,促进康复的信心和积极性,以争取早日康复;(3)注重发挥中观社会资本作用,确保资源在各机构间流动共享,从而使社会资本效益最大化;(4)积极开发宏观社会资本,通过对资本的整合和分配,为提高脑卒中患者生活质量开拓新的出路。
[Abstract]:Background: stroke, also known as cerebrovascular accident, is a rapidly occurring disorder of cerebral blood circulation disorder. It has obvious high incidence rate, high mortality rate and high disability rate. It has become one of the chronic diseases which seriously affect human health. Stroke often occurs in the elderly population, especially the elderly over 60 years old. It has been a common disease. Once it happens, it will bring heavy economic pressure and care burden to families and society. The study found that about 16 million 900 thousand of the global stroke patients in 2010, about 33 million of the patients who survived the stroke, and about 5 million 900 thousand of the deaths caused by stroke. Statistics show that there are 1 million 500 thousand ~200 million new cases of stroke patients in our country every year, every year about 1 million 500 thousand people died of cerebrovascular disease, cerebral vascular disease in patients with existing about 7 million people; in stroke patients survived, 75%~80% will have a different degree of disability, severe disability among more than 40%, there are about 30% possible recurrence 2 to 5 years. Due to disease factors, limb disability, economic burden and caregiving burden, a series of problems such as anxiety, depression, interpersonal disharmony, activity of daily living and quality of life decline after stroke. In recent years, social capital theory has gradually become the focus of academic research in the field of health. In the field of foreign medicine, scholars have done a lot of research on the impact of social capital on health. At present, the research on the relationship between the core elements of social capital and the stroke has been carried out by scholars at home and abroad. These studies show that: a higher level of social participation and social support has a positive effect on stroke, mainly in reducing the risk of stroke, improving the quality of life and activities of daily living after stroke, and improving the effect of rehabilitation. Therefore, social capital plays a positive role in the prevention and rehabilitation of stroke. Objective: to understand the status of quality of life in patients with stroke, social capital through investigation; analysis of factors affecting the quality of life in stroke patients, to explore the relationship between social capital and the quality of life of patients with stroke; the relationship between social capital and quality of life, and then explore the core elements and the key measures to improve the quality of life of patients with stroke from society capital view. Methods: Based on literature review and expert consultation system research, developed the scheme and field survey scale of stroke patients to study the relationship between social capital and quality of life; in August 2014 -10 months, by multi stage random sampling method, carry out the investigation in the Anhui city of Fuyang Province, from Hefei city and Tongling City, three 1 counties and 1 districts. After the data collection was completed, Epi Data3.1 software was used to record data and set up a database, and SPSS18.0 software was used for statistical analysis. Measurement data using standard deviation / median + four spacing, the normal distribution of data using analysis of variance /t test compared to the non normal distribution data were compared using non parametric test; count data use rate or composition, were compared using chi square test or Fisher exact probability method; influence the factors using multiple linear regression analysis; correlation analysis using Spearman correlation coefficient; social capital scale test methods for reliability and validity. Results: (1) a total of 420 stroke patients were investigated, 402 questionnaires were collected, 390 questionnaires were valid, and the response rate was 92.9%. (2) social capital scale reliability and validity: the Cronbach s alpha coefficient of the whole scale is 0.882, and 6 principal components can be extracted from structural validity, which can explain 75.547% of the total variance. (3)鑴戝崚涓�鎮ｈ�呯ぞ浼氳祫鏈�鐜板啠�

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