本文選題：跨理論模型　切入點：肺康復(fù)鍛煉　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的調(diào)查、分析慢性阻塞性肺疾病(COPD)患者肺康復(fù)鍛煉和生活質(zhì)量現(xiàn)狀及影響因素;分析生活質(zhì)量與呼吸困難程度、運動耐力、肺功能的相關(guān)性;探討跨理論模型在COPD患者肺康復(fù)鍛煉干預(yù)中的應(yīng)用效果;尋求科學(xué)、有效的適合COPD患者的肺康復(fù)鍛煉干預(yù)方案,為改善COPD患者肺康復(fù)鍛煉行為提供一定的理論指導(dǎo)和參考依據(jù)。方法在寧夏人民醫(yī)院呼吸科電子病例系統(tǒng)中,便利抽取2015年1月~12月就診的符合納入標準的COPD患者98例,隨機分為試驗組和對照組各49例。于2016年3月~11月實施干預(yù),給予試驗組患者跨理論模型指導(dǎo)的肺康復(fù)鍛煉干預(yù),給予對照組患者常規(guī)肺康復(fù)鍛煉干預(yù)。于干預(yù)前、干預(yù)3、6、9個月時評估兩組患者的肺康復(fù)鍛煉行為改變階段、肺康復(fù)鍛煉頻率、慢性阻塞性肺疾病生活質(zhì)量測評量表(CAT)評分、呼吸困難程度(MMRC)評分、運動耐力(6MWD)、肺功能(FEV1/FVC、FEV1%pred),比較兩種干預(yù)方式的效果。結(jié)果1.本研究納入并完成干預(yù)的COPD患者共94例,男性58例(61.7%),女性36例(38.3%);平均年齡(68.94±10.76)歲;平均病程(14.45±6.41)年;1年內(nèi)因COPD加重住院平均次數(shù)(2.55±1.12)次。2.CAT平均得分(24.00±7.44)分;MMRC平均得分(2.81±1.08)分;6MWD平均距離(330.24±69.98)米;FEV1/FVC均值為(55.74±10.11)%,FEV1%pred均值為(54.68±10.20)%。3.干預(yù)前COPD患者肺康復(fù)鍛煉行為改變階段以意向階段人數(shù)最多,所占比例為46.8%,準備階段人數(shù)最少,所占比例為7.40%。4.急性加重住院次數(shù),肺康復(fù)鍛煉知識掌握情況,肺康復(fù)鍛煉實施情況影響COPD患者生活質(zhì)量(P0.05)。5.CAT評分與MMRC評分呈正相關(guān)(r=0.937,P0.05),與6MWD(r=-0.981,P0.05)、FEV1/FVC(r=-0.933,P0.05)、FEV1%pred(r=-0.933,P0.05)呈負相關(guān)。6.干預(yù)前兩組COPD患者人口學(xué)特征、臨床基本資料、肺康復(fù)鍛煉行為改變階段、CAT評分、MMRC評分、6MWD、FEV1/FVC、FEV1%pred組間比較,差異均無統(tǒng)計學(xué)意義(P0.05)。7.干預(yù)結(jié)束時試驗組患者肺康復(fù)鍛煉行為階段的改變優(yōu)于對照組(P0.05),且鍛煉頻率明顯高于對照組(P0.05)。8.干預(yù)6、9個月時試驗組患者呼吸困難程度低于對照組(P0.05),且生活質(zhì)量、運動耐力均優(yōu)于對照組(P0.05)。9.干預(yù)9個月時試驗組患者肺功能優(yōu)于對照組,FEV1/FVC、FEV1%pred均高于對照組(P0.05)。結(jié)論1.急性加重住院次數(shù),肺康復(fù)鍛煉知識掌握情況與鍛煉實施情況均可影響COPD患者生活質(zhì)量。2.生活質(zhì)量(CAT評分)與呼吸困難程度(MMRC評分)、運動耐力(6MWD)、肺功(FEV1/FVC、FEV1%pred)具有相關(guān)性,監(jiān)測以上幾組指標可綜合反映COPD患者生活質(zhì)量。3.跨理論模型指導(dǎo)的干預(yù)能更好地提高COPD患者肺康復(fù)鍛煉行為的依從性。4.跨理論模型指導(dǎo)的肺康復(fù)鍛煉干預(yù)可有效緩解COPD患者呼吸困難癥狀,提高運動耐力,增強肺功能,改善生活質(zhì)量。
[Abstract]:Objective to investigate the status quo and influencing factors of pulmonary rehabilitation and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD), and to analyze the correlation between QOL and dyspnea, exercise endurance and pulmonary function.To explore the application effect of transtheoretical model in the intervention of lung rehabilitation exercise in patients with COPD, to seek a scientific and effective scheme of lung rehabilitation exercise intervention for COPD patients, and to provide certain theoretical guidance and reference basis for improving the pulmonary rehabilitation exercise behavior of COPD patients.Methods from January to December 2015, 98 patients with COPD who met the inclusion criteria were randomly divided into two groups: experimental group (n = 49) and control group (n = 49) in the electronic case system of respiratory department of Ningxia people's Hospital.The intervention was carried out from March to November 2016. The patients in the experimental group were given the intervention of lung rehabilitation exercise under the guidance of the cross-theoretical model, and the patients in the control group were given routine pulmonary rehabilitation exercise intervention.Before intervention, 6 months and 9 months after intervention, the changes of pulmonary rehabilitation behavior, the frequency of pulmonary rehabilitation exercise, the scale of chronic obstructive pulmonary disease quality of life (CAT), the degree of dyspnea and the score of MMRC were evaluated.The effects of two intervention methods were compared with FEV1 / FVCFEV1 / FEV1 predder.Result 1.In this study, 94 patients with COPD were enrolled and completed the intervention, 58 males and 36 females, with an average age of 68.94 鹵10.76 years old, and 36 female patients with a mean age of 68.94 鹵10.76 years.Before intervention, the number of patients with COPD in the stage of pulmonary rehabilitation exercise behavior change was the most, the proportion was 46.8%, the number of patients in the preparatory stage was the least, the proportion was 7.40.4.Before intervention, there were no significant differences in demographic characteristics, clinical data, cat scores and MMRC scores between the two groups before intervention in COPD patients with FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1 / FEV1pred group. There was no significant difference between the two groups.At the end of intervention, the changes of pulmonary rehabilitation exercise behavior in the experimental group were better than those in the control group (P 0.05), and the exercise frequency was significantly higher than that in the control group.The degree of dyspnea in the test group was lower than that in the control group at 6 and 9 months, and the quality of life and exercise endurance were better than those in the control group.After 9 months of intervention, the pulmonary function in the trial group was better than that in the control group (FEV1 / FVC+ FEV1 / FEV1), which was higher than that in the control group (P0.05).Conclusion 1.The times of acute exacerbation of hospitalization, the knowledge of pulmonary rehabilitation exercise and the implementation of exercise can all affect the quality of life of patients with COPD.The cat score of quality of life (cat) was correlated with the degree of dyspnea and MMRC score, exercise endurance and FEV1 / FV1 / FEV1 / pred. The quality of life of patients with COPD could be comprehensively reflected by monitoring the above indexes.The intervention guided by cross-theoretical model can improve the compliance of pulmonary rehabilitation exercise behavior in patients with COPD. 4.The intervention of pulmonary rehabilitation exercise under the guidance of cross-theoretical model can effectively alleviate the dyspnea symptoms, improve exercise endurance, enhance lung function and improve the quality of life in patients with COPD.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.5

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