【摘要】：目的:了解冠心病、腦卒中住院患者生命質(zhì)量總體水平及其軀體、心理、社會和疾病特異性四個領(lǐng)域方面的生命質(zhì)量水平。比較不同特征患者生命質(zhì)量,分析其影響因素,探討不同特征患者生命質(zhì)量存在差異的原因。通過患者住院前后生命質(zhì)量的對比,評價系統(tǒng)治療對患者生命質(zhì)量改善的有效性。旨在為進(jìn)一步提高患者生命質(zhì)量,選擇合適的健康教育干預(yù)方案,改善醫(yī)療衛(wèi)生服務(wù)提供參考。方法:本研究依據(jù)醫(yī)院級別進(jìn)行分層,在某市隨機抽取兩家二級醫(yī)院和兩家三級醫(yī)院,于2015年6-12月期間在四所醫(yī)院的心血管內(nèi)科、胸外科、神經(jīng)內(nèi)科、神經(jīng)外科選擇符合納入標(biāo)準(zhǔn)的冠心病患者290例、腦卒中患者310例,共600例住院患者作為調(diào)查對象。分別在患者入院和出院時,采用萬崇華等人研制的冠心病患者生命質(zhì)量量表(QLICD—CHD V1.0)、腦卒中患者生命質(zhì)量量表(QLICD—ST V2.0)對第一診斷為冠心病、腦卒中的患者住院前后的生命質(zhì)量進(jìn)行調(diào)查。通過EPIDATE3.l建立數(shù)據(jù)庫進(jìn)行數(shù)據(jù)錄入,使用EXCEL、SPSS 21.0對數(shù)據(jù)進(jìn)行統(tǒng)計分析。結(jié)果:1.冠心病患者生命質(zhì)量得分為65.09±14.76,腦卒中患者生命質(zhì)量得分為49.83±8.05,冠心病患者生命質(zhì)量高于腦卒中患者,二者間差異具有統(tǒng)計學(xué)意義(t=15.761,P0.01)。在四個領(lǐng)域方面,冠心病患者心理功能得分最高,軀體功能得分最低。腦卒中患者社會功能得分最高,心理功能得分最低。2.生命質(zhì)量的影響因素分析發(fā)現(xiàn),冠心病患者中,男性的生命質(zhì)量高于女性,差異具有統(tǒng)計學(xué)意義(t=2.729,P0.01);中年患者高于老年患者高于青年患者,差異具有統(tǒng)計學(xué)意義(F=15.868,P0.01);有配偶患者高于無配偶患者,差異具有統(tǒng)計學(xué)意義(t=2.004,P0.05);不同工作狀態(tài)患者的生命質(zhì)量不同,表現(xiàn)為在職人員和離退休人員均高于無業(yè)人員且差異具有統(tǒng)計學(xué)意義(F=28.504,P0.01);文化程度越高,生命質(zhì)量越高且差異具有統(tǒng)計學(xué)意義(F=31.986,P0.01);經(jīng)濟狀況越好生命質(zhì)量越高且差異具有統(tǒng)計學(xué)意義(F=33.320,P0.01);不同支付方式患者的生命質(zhì)量不同,城鎮(zhèn)醫(yī)保支付的患者生命質(zhì)量高于農(nóng)合患者高于商業(yè)醫(yī)療保險患者高于自費患者,差異具有統(tǒng)計學(xué)意義(F=72.131,P0.01);病程不同生命質(zhì)量有差異,表現(xiàn)為病程短的患者生命質(zhì)量較高,且差異具有統(tǒng)計學(xué)意義(F=28.706,P0.01);無合并癥患者生命質(zhì)量高于有合并癥患者,且合并癥越少患者生命質(zhì)量越高,差異具有統(tǒng)計學(xué)意義(F=17.231,P0.01)。但是多因素分析發(fā)現(xiàn)影響冠心病患者生命質(zhì)量的主要因素包括婚姻狀況、文化程度、工作狀態(tài)、病程、合并癥。腦卒中患者中,不同年齡段患者生命質(zhì)量不同,表現(xiàn)為青年患者高于中年患者高于老年患者,差異具有統(tǒng)計學(xué)意義(F=99.568,P0.01);不同婚姻狀況、工作狀態(tài)、文化程度、經(jīng)濟狀況、醫(yī)療費用支付方式、病程、合并癥的變化趨勢與冠心病患者相同且差異均具有統(tǒng)計學(xué)意義(P0.05)。多因素分析發(fā)現(xiàn)影響腦卒中生命質(zhì)量的因素包括年齡、婚姻狀況、文化程度、工作狀態(tài)、經(jīng)濟狀況、醫(yī)療費用支付方式、病程。3.入院前后的比較研究發(fā)現(xiàn),冠心病患者出院時生命質(zhì)量(67.97±13.99)高于入院時(65.09±14.76)且差異具有統(tǒng)計學(xué)意義(t=25.312,P0.01)。腦卒中患者出院時生命質(zhì)量(59.92±10.30)高于入院時(49.83±8.05),差異同樣具有統(tǒng)計學(xué)意義(t=34.721,P0.01)。表明冠心病和腦卒中患者經(jīng)在院系統(tǒng)治療后生命質(zhì)量均有所提高。4.不同級別醫(yī)院患者出院時生命質(zhì)量均高于入院時,但是生命質(zhì)量提升幅度不同,經(jīng)比較發(fā)現(xiàn),冠心病患者在三級醫(yī)院住院治療后生命質(zhì)量提升幅度明顯高于二級醫(yī)院,差異具有統(tǒng)計學(xué)意義(t=-5.418,P0.01)。腦卒中患者在三級醫(yī)院住院治療后生命質(zhì)量提升幅度低于二級醫(yī)院,差異具有統(tǒng)計學(xué)意義(t=13.986,P0.01)。結(jié)論:1.冠心病患者生命質(zhì)量處于中等水平,腦卒中患者生命質(zhì)量水平偏低。冠心病和腦卒中住院患者生命質(zhì)量均低于我國普通人群常模,說明患病對人群生命質(zhì)量有影響。2.影響冠心病患者生命質(zhì)量的因素主要包括婚姻狀況、文化程度、工作狀態(tài)、病程;影響腦卒中患者生命質(zhì)量的主要因素包括年齡、婚姻狀況、工作狀態(tài)、文化程度、經(jīng)濟狀況、醫(yī)療費用支付方式、病程。3.對比住院前后患者的生命質(zhì)量,發(fā)現(xiàn)系統(tǒng)治療能夠提高患者的生命質(zhì)量。
[Abstract]:Objective: To investigate the overall quality of life (QOL) of inpatients with coronary heart disease (CHD) and stroke and its physical, psychological, social and disease-specific quality of life (QOL). The purpose of this study was to provide references for further improving the quality of life of patients, choosing appropriate health education intervention programs and improving medical and health services. From June to December, 2015, 290 patients with coronary heart disease and 310 patients with stroke were selected from cardiovascular, thoracic, neurological and neurosurgical departments of four hospitals. A total of 600 inpatients were enrolled in the study. QLICD-CHD V1.0 and Stroke Quality of Life Scale (QLICD-ST V2.0) were used to investigate the quality of life of patients with coronary heart disease and stroke before and after hospitalization. There was a significant difference between the two groups (t = 15.761, P 0.01). In four areas, the score of psychological function was the highest in patients with coronary heart disease, and the score of physical function was the lowest. The physical function score was the lowest. 2. The analysis of the influencing factors of the quality of life showed that the quality of life in male patients with coronary heart disease was higher than that in female patients, the difference was statistically significant (t = 2.729, P 0.01); that in middle-aged patients was higher than that in elderly patients was higher than that in young patients, the difference was statistically significant (F = 15.868, P 0.01); that in patients with spouse was higher than that in patients without spouse, the difference was statistically significant. There was statistical significance (t = 2.004, P 0.05); the quality of life of patients in different working conditions was different, the performance of the in-service and retired workers were higher than the unemployed and the difference was statistically significant (F = 28.504, P 0.01); the higher the education level, the higher the quality of life and the difference was statistically significant (F = 31.986, P 0.01); the better the economic situation, the better the quality of life; The higher the quantity was and the difference was statistically significant (F = 33.320, P 0.01); the quality of life of patients with different payment methods was different; the quality of life of patients with urban medical insurance payment was higher than that of patients with agricultural cooperative medical insurance and patients with commercial medical insurance and higher than that of patients with self-financed medical insurance, the difference was statistically significant (F = 72.131, P 0.01); the quality of life of patients with different course of disease was different, which was manifested as disease. The quality of life of patients with short duration was higher and the difference was statistically significant (F = 28.706, P 0.01); the quality of life of patients without complications was higher than that of patients with complications, and the quality of life of patients with fewer complications was higher, the difference was statistically significant (F = 17.231, P 0.01). However, multivariate analysis found that the main factors affecting the quality of life of patients with coronary heart disease were found. The quality of life of stroke patients in different age groups was higher in young patients than in middle-aged patients than in elderly patients, the difference was statistically significant (F = 99.568, P 0.01); different marital status, working status, educational level, economic status, medical expenses payment. Multivariate analysis found that the factors affecting the quality of life of stroke patients included age, marital status, educational level, working status, economic status, medical expenses payment methods, course of disease. 3. The comparative study before and after admission found that coronary heart disease The quality of life at discharge was higher than that at admission (67.97 + 13.99) and the difference was statistically significant (t = 25.312, P 0.01). The quality of life at discharge (59.92 + 10.30) of stroke patients was higher than that at admission (49.83 + 8.05), and the difference was also statistically significant (t = 34.721, P 0.01). After treatment, the quality of life of patients in different levels of hospitals was higher than that at admission, but the improvement of quality of life was different. By comparison, the improvement of quality of life in patients with coronary heart disease after hospitalization in tertiary hospitals was significantly higher than that in secondary hospitals, the difference was statistically significant (t = - 5.418, P 0.01). The quality of life of stroke patients after hospitalization in tertiary hospital was lower than that in secondary hospital, the difference was statistically significant (t = 13.986, P 0.01). Conclusion: 1. The quality of life of patients with coronary heart disease was in the middle level, and the quality of life of patients with stroke was on the low side. The main factors affecting the quality of life of patients with coronary heart disease include marital status, educational level, working status, course of illness; the main factors affecting the quality of life of stroke patients include age, marital status, working status, educational level, economic status, mode of payment for medical expenses, course of illness. Compared with the quality of life of patients before and after hospitalization, it is found that systematic treatment can improve the quality of life of patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R197.323

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