本文關(guān)鍵詞： 食管支架置入術(shù) 胃食管反流 依從性　出處：《新鄉(xiāng)醫(yī)學院》2014年碩士論文　論文類型：學位論文

【摘要】：背景 食管支架置入術(shù)(Esophageal Stent Implantation, ESI)是治療食管癌性狹窄的有效手段之一,能夠顯著改善患者的生存質(zhì)量。術(shù)后自我護理和患者的依從性交互影響ESI的治療效果,而胃食管反流是受這一交互作用影響最顯著的術(shù)后并發(fā)癥。眾所周知,缺乏醫(yī)護人員監(jiān)督指導的院外患者,自我護理是術(shù)后護理的薄弱環(huán)節(jié),依從性同樣也較差。因此,研究院外胃食管反流發(fā)生的影響因素,分析院外患者的依從性,是有效降低術(shù)后并發(fā)胃食管反流的前提和基礎(chǔ),值得醫(yī)護人員的重視。 目的 分析ESI患者院外并發(fā)胃食管反流的影響因素,評估患者的依從性,分析影響患者依從性的相關(guān)因素。 方法 1.病例設(shè)計：收集符合標準的食管中下段癌患者,入院當天即納入本研究,院內(nèi)圍手術(shù)期綜合護理,常規(guī)出院1月后復診。 2.問卷調(diào)查：采用當面調(diào)查的方式,用RDQ量表、ESI術(shù)后患者自我護理情況調(diào)查表、ESI術(shù)后患者依從性調(diào)查表、ESI術(shù)后患者依從性影響因素調(diào)查表、Zung焦慮自評量表對患者進行隨訪和調(diào)查。 3.胃食管反流的影響因素和術(shù)后依從性分析：運用SPSS19.0軟件的x2檢驗、Logistic回歸分別分析胃食管反流情況與患者的自我護理情況、術(shù)后依從性等因素的關(guān)系。運用t檢驗對比不同社會、生理、心理特征的患者依從性,運用Pearson相關(guān)分析以及多元線性回歸分析術(shù)后依從性的影響因素。檢驗水準a=0.05。 結(jié)果 1.統(tǒng)計調(diào)查結(jié)果：本研究共納入病例107例,男女比例是2.06：1�；颊吣挲g65.60±9.560歲。107位患者術(shù)后依從性得分6-23分之間,平均14.06±4.613,符合正態(tài)性分布。 2.院外并發(fā)胃食管反流影響因素分析：低半坐臥位睡姿(OR=0.048,95%CI：0.023-0.170)、適量運動(OR=0.150,95%CI:0.045-0.539)、患者依從性(OR=0.176,95%CI:0.046-0.578)是術(shù)后并發(fā)胃食管反流的保護因素。 3.患者依從性影響因素分析：影響患者依從性的因素依次為疾病認知水平(t=2.867,P=0.005)、焦慮狀況(t=-8.142,P0.001)、家庭支持情況(t=2.664,P=0.009)和性別(t=2.175,P=0.032)。疾病認知水平高、家庭支持情況好的患者依從性好。焦慮狀況與依從性顯著相關(guān),焦慮程度越輕,患者的依從性越好。男性患者的依從性較差。 結(jié)論 1.低半坐臥位睡姿、適量運動和良好的術(shù)后依從性是降低ESI患者術(shù)后并發(fā)胃食管反流的因素。 2.焦慮程度輕、疾病認知水平高、家庭支持情況好、女性患者的術(shù)后依從性好。
[Abstract]:Background. Esophageal Stent implantation is one of the effective methods for the treatment of esophageal carcinoma stenosis, which can significantly improve the quality of life of patients. Postoperative self-care and patient compliance interaction affect the therapeutic effect of ESI. Gastroesophageal reflux (GER) is the most significant postoperative complication affected by this interaction. It is well known that self-care is the weak link of postoperative care and compliance is also poor in patients without supervision and guidance from medical staff. The influencing factors of gastroesophageal reflux and the analysis of compliance of patients outside hospital are the premise and foundation of reducing postoperative gastroesophageal reflux effectively, and deserve the attention of medical and nursing staff. Purpose. Objective: to analyze the influencing factors of gastroesophageal reflux (GER) in patients with ESI, to evaluate the compliance of patients, and to analyze the related factors. Method. 1. Case design: the patients with middle and lower esophageal cancer who met the criteria were included in this study on admission day, comprehensive nursing care in hospital perioperative period, and routine follow-up after discharge on January. 2. Questionnaire survey: face to face survey, The self-nursing status of patients after RDQ operation was investigated by Zung anxiety Self-Rating scale (SAS). 3. Analysis of influencing factors and postoperative compliance of gastroesophageal reflux: using SPSS19.0 software x2 test logistic regression to analyze gastroesophageal reflux and self-care of patients, respectively. T test was used to compare patients' compliance with different social, physiological and psychological characteristics, Pearson correlation analysis and multiple linear regression analysis were used to analyze the influencing factors of postoperative compliance. Results. 1. Statistical investigation results: 107 cases were included in this study, the ratio of male to female was 2.06: 1.The age of the patients was 65.60 鹵9.560 years old. 107 patients' compliance scores ranged from 6 to 23 points, with an average of 14.06 鹵4.613, which was consistent with the normal distribution. 2. Analysis of the influencing factors of gastroesophageal reflux in the low sitting and lying position: the protective factors of gastroesophageal reflux after operation were: the sleeping position in the low half sitting position was 0.048-0.170%, the moderate exercise was 0.15095% CI 0.045-0.539, the patient's compliance was 0.176% 95 CIW 0.046-0.578). 3. Analysis of influencing factors of patients' compliance: the influencing factors of patients' compliance were as follows: disease cognition level was 2.867% P0. 005, anxiety was t0. 842%, family support was 2. 664% P0. 009) and sex was 2. 175P0. 032. The level of disease cognition was high. The patients with good family support had good compliance. Anxiety was significantly correlated with compliance. The less anxiety, the better the compliance of patients, and the worse the compliance of male patients. Conclusion. 1. Sleeping position, moderate exercise and good postoperative compliance were the factors that decreased gastroesophageal reflux after ESI. 2. Low level of anxiety, high level of disease cognition, good family support and good postoperative compliance of female patients.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R473.6

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