本文選題：斜視 + 生存質(zhì)量　； 參考：《第三軍醫(yī)大學(xué)》2015年博士論文

【摘要】：斜視給患者外觀、視功能、心理社會(huì)、個(gè)人發(fā)展和家庭和諧等多方面造成不良影響,導(dǎo)致生存質(zhì)量下降。因此,如何有效地消除斜視的不良影響和改善患者生存質(zhì)量是臨床實(shí)踐和科學(xué)研究中重點(diǎn)關(guān)注的內(nèi)容。斜視手術(shù)被認(rèn)為是改善外觀和視功能、提升生存質(zhì)量的重要和有效手段,但目前仍存在三個(gè)問(wèn)題:①患者術(shù)后仍面臨并發(fā)癥和二次手術(shù)的風(fēng)險(xiǎn),不利于生存質(zhì)量長(zhǎng)期、穩(wěn)定的改善;②已有研究表明斜視手術(shù)并不能完全解決患者在長(zhǎng)期患病過(guò)程中形成的自卑內(nèi)向性格和不良自我認(rèn)知;③缺乏適合我國(guó)斜視人群的生存質(zhì)量測(cè)量工具。上述問(wèn)題一定程度制約了我國(guó)斜視患者生存質(zhì)量的全面提升和遠(yuǎn)期預(yù)后,以及對(duì)成人斜視患者生存質(zhì)量的研究。因此本研究旨研究我國(guó)文化背景下成人斜視患者生存質(zhì)量現(xiàn)狀、特點(diǎn)及影響因素,在此基礎(chǔ)上研制成人斜視患者生存質(zhì)量測(cè)量工具,以及手術(shù)治療患者的綜合護(hù)理干預(yù)方案,為提高成人斜視患者手術(shù)后生成質(zhì)量提供依據(jù)。第一部分:成人斜視患者生存質(zhì)量現(xiàn)狀及影響因素調(diào)查研究一、目的:了解我國(guó)成人斜視患者生存質(zhì)量現(xiàn)狀、特點(diǎn)及影響因素。二、方法:采用質(zhì)性與量性相結(jié)合的方法學(xué)。①對(duì)29例符合研究納入排除標(biāo)準(zhǔn)的成人斜視患者,按照事先擬定的訪談提綱,進(jìn)行一對(duì)一半結(jié)構(gòu)式深入訪談,詳細(xì)了解斜視患者的生存質(zhì)量體驗(yàn)。對(duì)訪談進(jìn)行錄音并轉(zhuǎn)錄成文本,經(jīng)反復(fù)分析、對(duì)比和歸納,提煉出我國(guó)成人斜視人群生存質(zhì)量的內(nèi)涵及特點(diǎn);②在訪談基礎(chǔ)上,編制《成人斜視患者生存質(zhì)量調(diào)查問(wèn)卷》,并選取437例成人斜視患者進(jìn)行橫斷面調(diào)查,探索成人斜視患者生存質(zhì)量現(xiàn)狀及影響因素。三、結(jié)果:①深入訪談共提取6個(gè)關(guān)于斜視患者生存質(zhì)量體驗(yàn)的主題:軀體活動(dòng)障礙、成長(zhǎng)發(fā)展受限、疾病受到歧視、消極情緒明顯、各種支持缺乏和社會(huì)交往障礙。斜視生存質(zhì)量相關(guān)需求有:改善外觀和視功能、解決婚戀問(wèn)題、獲得經(jīng)濟(jì)和信息支持、避免術(shù)后并發(fā)癥和復(fù)發(fā)。②編制的《成人斜視患者生存質(zhì)量調(diào)查問(wèn)卷》共65個(gè)條目,分三部分:斜視癥狀(10條目)、斜視生存質(zhì)量體驗(yàn)(45條目)、阻礙因素和需求(10條目)。前兩部分采用Likert-5級(jí)評(píng)分,第三部分以是非評(píng)分。其中“斜視生存質(zhì)量體驗(yàn)”又分為5個(gè)維度:軀體活動(dòng)(8條目)、心理情感(8條目)、社會(huì)交往(8條目)、應(yīng)對(duì)方式(15條目)和幸福感(6條目)。③斜視癥狀發(fā)生明顯,常見(jiàn)的有:視物模糊,依靠單眼視物,視疲勞和斜視加重。④與軀體活動(dòng)和社會(huì)交往條目相比,情緒體驗(yàn)、應(yīng)對(duì)方式和幸福感條目的表現(xiàn)更為嚴(yán)重。⑤延誤患者就醫(yī)的因素有:不知道斜視可以治療、就診意識(shí)不足、擔(dān)心把眼睛治瞎和當(dāng)?shù)蒯t(yī)療條件落后。⑥斜視生存質(zhì)量水平受到性別、學(xué)歷、地區(qū)因素的影響。四、結(jié)論:斜視癥狀表現(xiàn)明顯,不僅對(duì)患者視功能造成影響,也對(duì)其軀體活動(dòng)、社會(huì)交往、情緒體驗(yàn)造成影響。成人斜視患者生存質(zhì)量受斜視癥狀、人口學(xué)特征、疾病認(rèn)知和社會(huì)環(huán)境因素的影響。第二部分:成人斜視患者生存質(zhì)量測(cè)量工具的研究一、目的:研制成人斜視患者生存質(zhì)量測(cè)量工具,評(píng)價(jià)成人斜視患者生存質(zhì)量。二、方法:①漢化英文版成人斜視量表(adultstrabismusquestionnaire,as-20),并應(yīng)用于255例成人斜視患者,并進(jìn)行信效度檢驗(yàn)和rasch模型檢驗(yàn)。②在第一部分研究的基礎(chǔ)上,通過(guò)德?tīng)柗茖＜液?形成《成人斜視患者生存質(zhì)量量表》,并應(yīng)用于242例成人斜視患者,進(jìn)行信效度檢驗(yàn)和rasch模型檢驗(yàn)。三、結(jié)果:①中文版as-20有較高的信度,量表總cronbachα系數(shù)為0.908,心理社會(huì)維度和功能維度的α系數(shù)分別為0.913和0.808。但功能維度的結(jié)構(gòu)不太理想,從2個(gè)維度測(cè)量生存質(zhì)量,與本研究顯示的多維度影響生存質(zhì)量不吻合,條目選項(xiàng)的likert-5級(jí)評(píng)分不合理,需要整合為4級(jí)。②研制的《成人斜視患者生存質(zhì)量量表》共20個(gè)條目,分為4個(gè)維度:軀體活動(dòng)(4條目)、心理情感(5條目)、社會(huì)交往(5條目)和應(yīng)對(duì)方式(6條目)。量表有較高的信度,總cronbachα系數(shù)為0.923,軀體活動(dòng)、社會(huì)交往、心理情感和應(yīng)對(duì)方式各維度的α系數(shù)分別為0.716、0.765、0.884和0.758。量表與rasch模型的擬合度良好,各維度結(jié)構(gòu)、條目選項(xiàng)的likert-5級(jí)評(píng)分合理,條目項(xiàng)設(shè)置合理,各維度的個(gè)體和條目分離信度好,在0.80~0.98之間。四、結(jié)論:漢化英文版成人斜視患者量表(adultstrabismusquestionnaire,as-20)用于中國(guó)成人斜視患者測(cè)量顯示不理想。課題組研制的《成人斜視患者生存質(zhì)量量表》具有較好的信效度,條目選項(xiàng)設(shè)置合理,可以作為成人斜視生存質(zhì)量的有效評(píng)估工具。第三部分:成人斜視患者生存質(zhì)量護(hù)理干預(yù)研究一、目的:構(gòu)建成人斜視患者生存質(zhì)量綜合護(hù)理干預(yù)方案。二、方法:①在深入訪談和橫斷面調(diào)查的基礎(chǔ)上,結(jié)合文獻(xiàn)分析和相關(guān)理論,構(gòu)建改善成人斜視手術(shù)患者生存質(zhì)量的綜合護(hù)理干預(yù)方案。②采用對(duì)照試驗(yàn)方法,按納入排除標(biāo)準(zhǔn),選擇手術(shù)治療成人斜視患者,干預(yù)組共53例(納入55例,其中失訪2例);對(duì)照組共42例(納入54例,其中失訪12例)。對(duì)照組實(shí)施常規(guī)手術(shù)護(hù)理干預(yù),干預(yù)組在常規(guī)手術(shù)護(hù)理基礎(chǔ)上進(jìn)行綜合護(hù)理干預(yù)。采用《成人斜視患者生存質(zhì)量量表》于術(shù)前、術(shù)后1、2、3、4周(干預(yù)組在干預(yù)前)分別采集數(shù)據(jù)進(jìn)行效果評(píng)價(jià)。三、結(jié)果:①在總量表和軀體活動(dòng)維度上,干預(yù)組與對(duì)照組在術(shù)前及術(shù)后1、2、3周的得分無(wú)明顯差異;干預(yù)組在術(shù)后第4周的得分明顯高于對(duì)照組(P0.05)。②在心理情感和社會(huì)交往維度上,干預(yù)組與對(duì)照組在術(shù)前及術(shù)后1、2周的得分無(wú)明顯差異;干預(yù)組在術(shù)后第3、4周的得分明顯高于對(duì)照組(P0.05或P0.01)。③在應(yīng)對(duì)方式維度上,干預(yù)組與對(duì)照組在術(shù)前、術(shù)后第1、2、3、4周的得分都無(wú)明顯差異。④干預(yù)組自術(shù)后第3周起,總量表和各維度的得分較術(shù)前明顯提高;對(duì)照組只有在術(shù)后第4周的總量表、心理情感和軀體活動(dòng)維度得分上才明顯高于術(shù)前,其余維度術(shù)前術(shù)后均無(wú)顯著差異。四、結(jié)論:綜合護(hù)理干預(yù)方案可作為手術(shù)干預(yù)的有效補(bǔ)充措施,促進(jìn)斜視生存質(zhì)量的全方面提高。在手術(shù)后第4周,斜視患者在心理情感和社會(huì)交往方面的改善效果最為明顯。
[Abstract]:Strabismus causes adverse effects on patients' appearance, visual function, psychosocial, personal development and family harmony, resulting in a decline in the quality of life. Therefore, how to effectively eliminate the adverse effects of strabismus and improve the quality of life of patients is a key concern in clinical practice and scientific research. Strabismus surgery is considered to improve the appearance and appearance of the patients. The important and effective means to improve the quality of life can be seen, but there are still three problems: (1) the patients still face complications and two operation risks, which are not conducive to the long-term and stable improvement of the quality of life; 2. The previous study shows that the strabismus surgery can not completely solve the inferiority introverted character formed in the process of long-term illness. There is a lack of quality measurement tools suitable for the population of strabismus in China. These problems restrict the overall improvement of the quality of life and the long-term prognosis of the Chinese strabismus, as well as the study of the quality of life for the adult strabismus, so this study aims to study the survival quality of the adult strabismus patients in our country. In order to improve the quality of adult strabismus patients after operation, the quality measurement tools of adult strabismus and the comprehensive nursing intervention program for patients with surgical treatment are provided to improve the quality of adult strabismus after operation. The quality of life, characteristics and influencing factors of Chinese adult strabismus. Two, methods: the methods of combining qualitative and quantitative methods were used. (1) 29 cases of adult strabismus patients who were in accordance with the exclusion criteria of the study, according to the proposed interview outline, carried out one to half of the structural in-depth interviews to understand the quality of life of the strabismus patients in detail. Experience. The interview was recorded and transcribed into text. After repeated analysis, comparison and induction, the quality of life of the Chinese adult strabismus was extracted. On the basis of the interview, the questionnaire for the quality of life of the patients with adult strabismus was compiled, and 437 cases of adult strabismus were selected to carry out a cross-sectional survey to explore the life of the adult strabismus. Three. Results: (1) a total of 6 topics on the quality of life experience of strabismus patients: somatization disorder, limited growth and development, discrimination of disease, negative emotion, lack of support and social communication barriers. The related needs of the quality of strabismus survival: improvement of appearance and visual function, solution Marriage and love problems, obtain economic and information support, avoid postoperative complications and recurrence. (2) a total of 65 items of quality of life questionnaire for adult strabismus, divided into three parts: strabismus symptoms (10 items), strabismus quality of life experience (45 items), hindrance factors and requirements (10 items). The first two parts are Likert-5 grade, third part There were 5 dimensions of the "strabismus quality experience": physical activity (8 items), psychological emotion (8 entries), social interaction (8 entries), coping style (15 entries) and happiness (6 items). (3) contiguant symptoms of strabismus, such as blurred visual substance, monocular vision, visual fatigue and strabismus aggravation. The social contact items, emotional experience, coping style and happiness stripe were more serious. 5. The factors that delayed the patient's medical treatment were: not knowing the strabismus treatment, the lack of awareness, the fear of blindness and the local medical conditions. 6. The impact of the quality of strabismus on the quality of life, education, regional factors. Four, conclusion The symptoms of strabismus are obvious, which not only affect the visual function of the patients, but also affect their physical activity, social interaction and emotional experience. The quality of life of the adult strabismus is affected by the symptoms of strabismus, demographic characteristics, disease cognition and social environment factors. The second part: a study of the measurement tools for the quality of life of the adult strabismus patients. To develop a quality of life measurement tool for adult strabismus patients and evaluate the quality of life of the adult strabismus. Two, methods: (1) adultstrabismusquestionnaire (as-20) in the Chinese English version of adult strabismus (as-20), and applied to the patients with adult strabismus, and the reliability and validity test and the Rasch model test. Delphy experts formed a questionnaire for the quality of life of the patients with adult strabismus, and applied to 242 cases of adult strabismus. The reliability and validity test and Rasch model test. Three. Results: (1) the Chinese version of as-20 has high reliability, the total Cronbach alpha coefficient of the scale is 0.908, the alpha coefficient of the psychosocial dimension and the functional dimension is 0.913 and 0.808., respectively. The structure of the functional dimension is not ideal. Measuring the quality of life from 2 dimensions is not consistent with the multidimensional impact of the quality of life shown in this study. The likert-5 grade of the entry options is not reasonable and needs to be integrated into grade 4. (2) the quality of life scale of the patients with adult strabismus was developed in a total of 20 items, which are divided into 4 dimensions: physical activity (4 entries) and psychological feelings. Sense (5 items), social interaction (5 entries) and coping style (6 items). The scale has high reliability, the total Cronbach alpha coefficient is 0.923, the alpha coefficients of body activity, social interaction, psychological emotion and coping style are 0.716,0.765,0.884 and 0.758. scale and Rasch model, respectively, each dimension structure, and the likert-5 of entry options The grade is reasonable, the item item is set reasonable, the individual and item of each dimension have good separation reliability, between 0.80~0.98. Four. Conclusion: adultstrabismusquestionnaire (as-20) for Chinese adult strabismus (as-20) is not ideal for Chinese adult strabismus. With good reliability and validity, the selection of item options is reasonable and can be used as an effective assessment tool for the quality of life of adult strabismus. The third part: Study on the quality of life nursing intervention for adult strabismus patients. Objective: to construct a comprehensive nursing intervention program for the quality of life of adult strabismus patients. (two) methods: (1) on the basis of in-depth interview and cross-sectional survey, Combined with literature analysis and related theories, a comprehensive nursing intervention scheme was constructed to improve the quality of survival of the patients with adult strabismus surgery. (2) 53 cases (including 55 cases, of which 2 cases were lost) in the intervention group were selected by the control test, and 42 cases in the control group (including 54 cases, of which 12 cases were lost). The group carried out routine nursing intervention, and the intervention group carried out comprehensive nursing intervention on the basis of routine surgical nursing. The quality of life of the patients with adult strabismus was evaluated before the operation and 1,2,3,4 weeks after the operation (before intervention group). Three. Results: (1) the intervention group and the body activity dimension, the intervention group and the opposite group. There was no significant difference in scores between preoperative and postoperative 1,2,3 weeks, and the score of intervention group in fourth weeks after operation was significantly higher than that of control group (P0.05). (2) there was no significant difference between the intervention group and the control group before and after the operation in the control group (P0.05). The score of the intervention group was significantly higher than that of the control group (P0.05 or 1,2 weeks after the operation (P0.05). P0.01). In the coping style dimension, there was no significant difference between the intervention group and the control group before the operation and the 1,2,3,4 week after the operation. (4) the score of the total scale and the dimensions of the intervention group increased obviously from the third weeks after the operation. The control group was only significantly higher than the total amount of mental emotion and physical activity in the fourth week after the operation. Before operation, there was no significant difference between the other dimensions before and after operation. Four. Conclusion: the comprehensive nursing intervention scheme can be used as an effective supplementary measure to improve the quality of the strabismus. Fourth weeks after the operation, the improvement effect of the patients with strabismus in the aspects of psychological emotion and social communication is the most obvious.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R473.77

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