应用5A和5R策略对肺结核门诊病人进行戒烟干预的实施效果分析

发布时间：2018-01-14 10:34

本文关键词：应用5A和5R策略对肺结核门诊病人进行戒烟干预的实施效果分析　出处：《安徽医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：通过在县级结核病门诊项目针对吸烟的肺结核患者进行戒烟劝导，了解吸烟的肺结核患者对戒烟的态度、信心，评价戒烟干预效果，为建立有效的、可实施的结核病戒烟劝导模式提供依据。方法：在肺结核项目门诊，对于前来就诊的肺结核患者进行登记，了解烟草使用情况，对于戒烟的态度，意愿。由医生应用5A和5R戒烟干预法对吸烟患者实施戒烟宣传干预；在发放肺结核治疗卡同时发放戒烟干预卡；记录戒烟信心、动机分值，在第2、5、6个月复诊时，再次对患者进行戒烟宣传并记录烟草使用状况，对戒烟的信心、动机进行评分。治疗结束后在12个月时进行电话随访；了解患者烟草使用状况，对戒烟的信心、动机进行评分，收集5次随访信息建立Epidata数据库，利用SPSS软件对数据进行分析，评价项目门诊医生劝导戒烟的效果。结果：项目实施一年，共计登记肺结核患者491名，其中有302名吸烟患者，首次登记表示愿意戒烟者292人，四次随访失访人数为0、8、5、7，失访率分别为0.0%、2.6%、1.7%和2.3%。可随访到的患者第2个月、第5个月、半年后以及一年后的戒烟率分别为32.1%、30.6%、27.9%和18.0%；第5个月、半年、一年的连续3个月戒烟成功率分别为4.1%、5.0%和3.7%，治疗的6个月期间复吸率为37.5%；治疗后6个月期间复吸率为77.1%采用非参数检验中的Friedman法对五次戒烟动机和信心进行比较，得出五次动机得分不全相等，x2=405.524，P=0.000；五次信心得分也不全相等，，x2=390.893，P=0.000。进一步两两比较用编秩后的LSD法，得出：戒烟动机的比较中，第6个月和第12个月比较的P值为0.019，其余P值均为0.000，说明五次动机得分都各不相等，动机分值呈下降趋势；信心的比较中，P均为0.000，说明每次信心得分都各不相等，信心分值呈下降趋势。结论：由医生用5A和5R策略对吸烟者进行戒烟劝导，在国内的戒烟门诊干预研究中取得了一定成效，但应用在结核病门诊，针对结核病人进行在国内还没有研究结果，通过本次项目的实施，结果表示：在结核病人接受督导治疗的同时，给予戒烟宣传、劝导的措施是可行的，在进一步的推广研究中，在调动患者戒烟的主动性和积极性、增加干预的次数以及争取患者家庭的支持等方面来加强，从而提高戒烟成功率并维持长期效果。
[Abstract]:Objective: Through the county-level tuberculosis outpatient program for smoking tuberculosis patients smoking cessation persuasion, to understand the smoking pulmonary tuberculosis patients' attitude, confidence, evaluation of smoking cessation intervention effect, in order to establish an effective. The feasible smoking cessation and persuasion model of tuberculosis can provide the basis. Methods: In the tuberculosis project outpatient clinic, to come to visit the tuberculosis patient to carry on the registration, understands the tobacco use situation, regarding the smoking cessation attitude. Willingness. The doctors applied 5A and 5R smoking cessation intervention method to smoking cessation patients to give up smoking propaganda intervention; Issuing tuberculosis treatment cards at the same time as smoking cessation intervention cards; Record smoking cessation confidence, motivation score, at the 2nd month, 6 months, the patients again to quit smoking publicity and record the status of tobacco use, confidence in smoking cessation. Motivation score. Telephone follow-up at 12 months after treatment. To understand the status of tobacco use in patients, to score the confidence and motivation of quitting smoking, to collect 5 follow-up information to set up the Epidata database, and to analyze the data by SPSS software. To evaluate the effect of exhortation of outpatient doctor on smoking cessation. Results: A total of 491 pulmonary tuberculosis patients were registered in one year, of which 302 were smokers, 292 were first registered to quit smoking, and the number of missing visits at four follow-up visits was 0 / 8 / 5 / 7. The rates of missing visit were 0.02.6and 2.30.The smoking cessation rate was 32.6% in the second month, the fifth month, the half year and one year after the follow-up. 27.9% and 18.0; The success rate of quitting smoking for the fifth month, half a year and one year for 3 consecutive months was 4.1% and 3.7%, respectively, and the relapse rate was 37.5% during the 6 months of treatment. The relapse rate of 77.1% months after treatment was compared with the five smoking cessation motivation and confidence by Friedman method in non-parametric test. The results showed that the scores of the five motivations were not equal. X2 + 405.524 Pu 0.000; The confidence score of five times was not equal to that of x2n390.893P0.000.A further comparison was made by using the rank LSD method to obtain the following conclusions: the comparison of smoking cessation motivation. At the 6th and 12th months, the P value was 0.019, and the other P values were 0.000, which indicated that the scores of five times of motivation were not equal, and the scores of motivation showed a downward trend. The confidence scores were 0.000, indicating that each confidence score was not equal, and the confidence score showed a downward trend. Conclusion: Doctors used 5A and 5R strategies to persuade smokers to give up smoking, and some results were achieved in the study of smoking cessation outpatient intervention in China, but it was used in tuberculosis outpatient clinic. There are no research results in China for TB patients, through the implementation of this project, the results show that: while TB patients receive supervision treatment, give smoking cessation publicity, persuasive measures is feasible. In the further popularizing research, we should arouse the initiative and enthusiasm of patients to quit smoking, increase the times of intervention and win the support of patients' families, so as to improve the success rate of smoking cessation and maintain the long-term effect.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R521;R163

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