【摘要】：背景新生兒缺氧缺血性腦病(Hypoxic-ischemic encephalopathy,HIE)是造成嬰幼兒神經(jīng)功能障礙的主要原因之一,患兒往往需要較長(zhǎng)時(shí)間的治療和康復(fù),家長(zhǎng)是患兒的主要照顧者,其自身因素在患兒的治療、康復(fù)過(guò)程中起到至關(guān)重要的作用。HIE患兒作為家長(zhǎng)的心理應(yīng)激事件,應(yīng)對(duì)不當(dāng)可能會(huì)出現(xiàn)焦慮、抑郁等心理問(wèn)題,嚴(yán)重者可造成心理疾患,影響患兒的治療與照顧質(zhì)量。目的探討HIE恢復(fù)期患兒家長(zhǎng)焦慮、抑郁狀況并分析其影響因素,以期為進(jìn)一步制定護(hù)理干預(yù)措施、消除患兒家長(zhǎng)負(fù)性情緒、改善心理狀況、提高患兒及家長(zhǎng)的生活質(zhì)量提供參考。方法選取2014年10月~2015年10月河南省四所三級(jí)綜合醫(yī)院小兒康復(fù)科的196名HIE恢復(fù)期患兒家長(zhǎng)作為研究對(duì)象,利用一般資料調(diào)查表、醫(yī)院焦慮抑郁量表、中文版家庭親密度與適應(yīng)性量表、社會(huì)支持評(píng)定量表對(duì)其焦慮抑郁情緒、家庭功能、社會(huì)支持狀況進(jìn)行調(diào)查,并利用SPSS19.0軟件對(duì)數(shù)據(jù)進(jìn)行描述性統(tǒng)計(jì)分析、t檢驗(yàn)、方差分析、Pearson相關(guān)分析和多元線(xiàn)性回歸分析。結(jié)果1.HIE恢復(fù)期患兒家長(zhǎng)焦慮情緒得分為9.43±3.62,抑郁情緒得分為9.19±3.83,約70%存在不同程度的焦慮、抑郁傾向,其中約40%肯定存在焦慮、抑郁情緒。2.單因素分析顯示,不同學(xué)歷、職業(yè)、與家人關(guān)系、性格特征、居住地、對(duì)疾病了解程度、自我感覺(jué)壓力以及照顧不同月齡、HIE程度、康復(fù)療程患兒的家長(zhǎng)在焦慮情緒得分上差異有統(tǒng)計(jì)學(xué)意義(P0.05);不同學(xué)歷、居住地、自我感覺(jué)壓力、費(fèi)用支付方式以及照顧不同月齡、HIE程度、康復(fù)療程患兒的家長(zhǎng)在抑郁情緒得分上差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.在家庭功能方面,家庭實(shí)際親密度與國(guó)內(nèi)常模相比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),理想親密度、親密度不滿(mǎn)意度、適應(yīng)性不滿(mǎn)意度高于常模,實(shí)際適應(yīng)性、理想適應(yīng)性低于常模(P0.05)。焦慮、抑郁情緒得分均與家庭實(shí)際親密度、實(shí)際適應(yīng)性呈負(fù)相關(guān),均與親密度不滿(mǎn)意度、適應(yīng)性不滿(mǎn)意度呈正相關(guān)(P0.05)。4.在社會(huì)支持方面,社會(huì)支持總分及各維度得分均高于國(guó)內(nèi)常模(P0.05)。社會(huì)支持水平為中等或高等水平,其中中等水平者占79.1%,高水平者占20.9%。焦慮、抑郁情緒得分均與社會(huì)支持總分、客觀支持得分、主觀支持得分、社會(huì)支持利用度呈負(fù)相關(guān)(P0.05)。5.回歸分析顯示,自我感覺(jué)壓力、客觀支持得分、HIE程度、社會(huì)支持利用度、性格特征、居住地、親密度不滿(mǎn)意度均進(jìn)入了以焦慮情緒得分為因變量的回歸方程,共同有效解釋39.5%的變異量(P0.05);自我感覺(jué)壓力、客觀支持得分、社會(huì)支持利用度、康復(fù)療程均進(jìn)入了以抑郁情緒得分為因變量的回歸方程,共同有效解釋36.1%的變異量(P0.05)。其中,客觀支持得分、社會(huì)支持利用度均為患兒家長(zhǎng)焦慮、抑郁情緒得分的負(fù)性影響因素。結(jié)論1.HIE恢復(fù)期患兒家長(zhǎng)的情緒狀態(tài)不容樂(lè)觀,焦慮、抑郁情緒得分處于較高水平。一般人口社會(huì)學(xué)資料中,自我感覺(jué)壓力、性格特征、居住地、HIE程度、康復(fù)療程是患兒家長(zhǎng)焦慮、抑郁情緒的主要影響因素。2.HIE恢復(fù)期患兒家長(zhǎng)家庭功能狀況有待改善。家庭功能狀況越好,越不容易出現(xiàn)焦慮、抑郁情緒。家庭親密度不滿(mǎn)意度是影響焦慮水平的重要因素。3.HIE恢復(fù)期患兒家長(zhǎng)社會(huì)支持呈中等水平。得到的社會(huì)支持越多,焦慮、抑郁水平就越低。客觀支持、社會(huì)支持利用度是患兒家長(zhǎng)重要的保護(hù)性因素。
[Abstract]:Background Hypoxic-ischemic encephalopathy (HIE) is one of the main causes of neurological impairment in infants and young children. Children often need long-term treatment and rehabilitation. Parents are the main caregivers of children. Their own factors play an important role in the treatment and rehabilitation of children with HIE. Children as parents of psychological stress events, coping improperly may appear anxiety, depression and other psychological problems, serious can cause psychological disorders, affecting the quality of treatment and care of children. Methods 196 parents of HIE convalescent children in the Department of pediatric rehabilitation in four tertiary general hospitals of Henan Province from October 2014 to October 2015 were selected as the subjects. General data questionnaire, Hospital Anxiety and depression scale and Chinese version of family intimacy were used. The scores of anxiety and depression, family function and social support were investigated with the Adaptability Scale, Social Support Rating Scale and SPSS19.0 software. The data were analyzed by descriptive statistical analysis, t test, variance analysis, Pearson correlation analysis and multiple linear regression analysis. Results 1. The scores of anxiety and depression of parents of HIE convalescent children were 9.43 (+). 3.62, the score of depression was 9.19 + 3.83, about 70% had different degrees of anxiety and depression tendency, of which about 40% certainly had anxiety and depression. 2. Univariate analysis showed that different educational background, occupation, family relationship, personality characteristics, residence, understanding of the disease, self-perceived stress and care for different months, HIE level, rehabilitation course of treatment. Parents of children with anxiety scores were statistically significant (P 0.05); different educational background, residence, self-perceived pressure, payment methods and care for different months, HIE degree, rehabilitation course of parents of children with depression scores were statistically significant (P 0.05). 3. Family function, family actual cohesion and There was no significant difference between the domestic norms (P 0.05). Ideal intimacy, intimacy dissatisfaction, adaptability dissatisfaction were higher than the norm, actual adaptability and ideal adaptability were lower than the norm (P 0.05). The scores of anxiety and depression were negatively correlated with family actual intimacy, actual adaptability, and both were negatively correlated with intimacy dissatisfaction and adaptability dissatisfaction. The scores of social support were higher than those of domestic norm (P 0.05). The social support level was moderate or higher, of which 79.1% was moderate and 20.9% was high. The scores of anxiety and depression were all higher than those of social support, objective support and subjective support. Social support utilization was negatively correlated (P 0.05). Regression analysis showed that self-perceived stress, objective support score, HIE level, social support utilization, personality characteristics, residence, intimacy dissatisfaction entered the regression equation with anxiety score as dependent variable, and together effectively explained 39.5% of the variance (P 0.05); self-perceived stress, and intimacy dissatisfaction. Objective support score, social support utilization and rehabilitation course all entered regression equation with depression score as dependent variable, which explained 36.1% of variance (P 0.05). Among them, objective support score and social support utilization were all negative influencing factors of parents'anxiety and depression scores. Conclusion 1. Long emotional state is not optimistic, anxiety, depression scores are at a higher level. General demographic sociological data, self-perceived stress, personality characteristics, residence, HIE degree, rehabilitation course are the main factors affecting parents'anxiety and depression. 2. HIE recovery period of children's parents' family function status needs to be improved. Family cohesion dissatisfaction is an important factor affecting the level of anxiety. 3. The parents of HIE convalescent children have moderate social support. The more social support they receive, the lower the level of anxiety and depression.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R473.74

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