本文關(guān)鍵詞：心力衰竭患者家庭運(yùn)動(dòng)行為的影響因素分析及干預(yù)研究　出處：《南京醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 心力衰竭 家庭 運(yùn)動(dòng)行為 運(yùn)動(dòng)自我效能 護(hù)理 運(yùn)動(dòng)康復(fù)

【摘要】：研究背景心力衰竭簡(jiǎn)稱心衰,為各種心臟疾病的嚴(yán)重和終末階段,發(fā)病率高,是當(dāng)今最重要的心血管病之一。近年來盡管新型藥物與介入治療取得較好效果,但總體預(yù)后仍不理想。運(yùn)動(dòng)康復(fù)作為改善心衰預(yù)后的有效途徑,2013美國心臟病學(xué)會(huì)基金會(huì)/美國心臟協(xié)會(huì)心力衰竭管理指南將其列為IA類推薦。心力衰竭患者運(yùn)動(dòng)的有效性已得到證實(shí),然而,若患者不堅(jiān)持運(yùn)動(dòng),效果將不再持續(xù)。國外有研究顯示,盡管組織良好,資源充足,努力優(yōu)化運(yùn)動(dòng)依從性,但只有約400%的干預(yù)組患者短期內(nèi)實(shí)現(xiàn)了運(yùn)動(dòng)目標(biāo)。2014慢性穩(wěn)定性心力衰竭運(yùn)動(dòng)康復(fù)中國專家共識(shí)指出心功能分級(jí)Ⅰ～Ⅲ級(jí)的穩(wěn)定性心衰患者均應(yīng)考慮接受運(yùn)動(dòng)康復(fù),然而我國多數(shù)心衰患者出院后與醫(yī)院終止了聯(lián)系,極少有患者實(shí)現(xiàn)運(yùn)動(dòng)目標(biāo)。如何改善心衰患者運(yùn)動(dòng)行為成為亟待解決的問題。研究目的1.本研究旨在通過對(duì)心衰患者進(jìn)行調(diào)查及隨訪,從運(yùn)動(dòng)形式、頻率、時(shí)間、強(qiáng)度四個(gè)方面了解心衰患者家庭運(yùn)動(dòng)行為現(xiàn)狀,探討心衰患者運(yùn)動(dòng)行為的影響因素。2.依據(jù)心衰患者運(yùn)動(dòng)行為的影響因素,結(jié)合國內(nèi)外研究成果,制定提高心衰患者運(yùn)動(dòng)依從性的干預(yù)措施,探討該措施對(duì)心衰患者家庭運(yùn)動(dòng)行為及生活質(zhì)量、心理狀況的影響。研究方法第一階段描述性研究:采用便利抽樣方法,調(diào)查南京醫(yī)科大學(xué)第一附屬醫(yī)院心血管內(nèi)科2015年11月至2016年4月心血管科住院心衰患者137例,包括住院心衰患者一般資料、心衰疾病特征、運(yùn)動(dòng)自我效能、社會(huì)支持、出院后家庭運(yùn)動(dòng)行為,分別以家庭運(yùn)動(dòng)形式、頻率、時(shí)間和強(qiáng)度為因變量,單因素分析和相關(guān)性性分析中有統(tǒng)計(jì)學(xué)差異的變量為自變量,運(yùn)用SPSS19.0統(tǒng)計(jì)分析心力衰竭患者家庭運(yùn)動(dòng)行為的影響因素。第二階段類實(shí)驗(yàn)性研究:將2016年6～7月住院符合納入標(biāo)準(zhǔn)的40例患者作為對(duì)照組,9～10月38例患者作為干預(yù)組。對(duì)照組進(jìn)行常規(guī)健康教育,干預(yù)組在常規(guī)教育的基礎(chǔ)上,針對(duì)患者運(yùn)動(dòng)自我效能進(jìn)行干預(yù),包括住院期間的個(gè)性化運(yùn)動(dòng)自我效能干預(yù)和出院后的隨訪與指導(dǎo)。囑患者出院后記錄運(yùn)動(dòng)日志(包括運(yùn)動(dòng)形式、頻率、時(shí)間和強(qiáng)度等),分別評(píng)估患者入組時(shí)和出院后4個(gè)月的運(yùn)動(dòng)自我效能、焦慮抑郁情緒和生活質(zhì)量。采用SPSS19.0對(duì)完成隨訪的71例患者(對(duì)照組37例,干預(yù)組34例)資料進(jìn)行統(tǒng)計(jì)分析,評(píng)價(jià)運(yùn)動(dòng)自我效能干預(yù)對(duì)心力衰竭患者家庭運(yùn)動(dòng)行為、生活質(zhì)量及心理狀況的影響。研究結(jié)果:1.運(yùn)動(dòng)自我效能與家庭運(yùn)動(dòng)行為現(xiàn)狀:心衰患者運(yùn)動(dòng)自我效能總分為32.80±9.33分。進(jìn)行有氧運(yùn)動(dòng)118例(86.1%),有氧聯(lián)合抗阻運(yùn)動(dòng)19例(13.9%);運(yùn)動(dòng)頻率3.23±0.80次/周;時(shí)間為27.50±7.91分鐘/天;強(qiáng)度為自感勞累分級(jí)(RPE)11.38±1.296。2.家庭運(yùn)動(dòng)行為的影響因素:X2分析結(jié)果顯示,不同年齡、文化程度、合并癥數(shù)目的患者運(yùn)動(dòng)形式差異有統(tǒng)計(jì)學(xué)意義(P0.05),t檢驗(yàn)結(jié)果顯示不同社會(huì)支持程度的患者運(yùn)動(dòng)形式差異有統(tǒng)計(jì)學(xué)意義(P0.05)。t檢驗(yàn)、方差分析結(jié)果顯示,不同婚姻、心功能、合并癥數(shù)目的患者運(yùn)動(dòng)頻率差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05),不同文化程度、心功能、合并癥數(shù)目的患者運(yùn)動(dòng)時(shí)間差異有統(tǒng)計(jì)學(xué)意義(P0.05),不同性別、婚姻、心功能、合并癥數(shù)目的患者運(yùn)動(dòng)強(qiáng)度差異有統(tǒng)計(jì)學(xué)意義(P0.05)。相關(guān)分析顯示,運(yùn)動(dòng)頻率(次/周)、時(shí)間(分鐘/次)、強(qiáng)度(RPE)與運(yùn)動(dòng)自我效能均存在正相關(guān)(r值分別為0.539、0.607和0.562),運(yùn)動(dòng)頻率、時(shí)間、強(qiáng)度與年齡均存在負(fù)相關(guān)(r值分別為-0.350、-0.229和-0.377),運(yùn)動(dòng)頻率、時(shí)間、強(qiáng)度與社會(huì)支持均存在正相關(guān)(r值分別為0.281、0.562和0.221)。多元線性回歸分析顯示,運(yùn)動(dòng)頻率的影響因素為運(yùn)動(dòng)自我效能、心功能、合并癥數(shù)目,運(yùn)動(dòng)時(shí)間的影響因素為運(yùn)動(dòng)自我效能、社會(huì)支持、心功能、年齡、合并癥數(shù)目,運(yùn)動(dòng)強(qiáng)度的影響因素為運(yùn)動(dòng)自我效能和合并癥數(shù)目。3.運(yùn)動(dòng)自我效能干預(yù)效果:采用運(yùn)動(dòng)自我效能干預(yù)4個(gè)月后,干預(yù)組運(yùn)動(dòng)頻率、時(shí)間、強(qiáng)度和運(yùn)動(dòng)自我效能得分顯著優(yōu)于對(duì)照組(P0.05),而運(yùn)動(dòng)形式差異無統(tǒng)計(jì)學(xué)意義;并且干預(yù)后兩組患者抑郁和生活質(zhì)量評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05)。研究結(jié)論:1.心衰患者運(yùn)動(dòng)自我效能處于中等偏下水平,心衰患者家庭運(yùn)動(dòng)行為不理想,運(yùn)動(dòng)自我效能是其主要影響因素。在設(shè)計(jì)和實(shí)施康復(fù)護(hù)理時(shí),應(yīng)重視提高患者的運(yùn)動(dòng)自我效能,綜合考慮社會(huì)支持、年齡、心功能狀態(tài)及合并癥等因素對(duì)運(yùn)動(dòng)行為的影響。2.運(yùn)動(dòng)自我效能干預(yù)能有效提高心力衰竭患者的運(yùn)動(dòng)自我效能水平,改善家庭運(yùn)動(dòng)行為,此外,運(yùn)動(dòng)可改善患者心理狀態(tài)及生活質(zhì)量。
[Abstract]:On the background of heart failure CHF, for a variety of heart disease and severe end stage, high incidence of cardiovascular disease is the most important one. In recent years, although new drugs and interventional therapy has a good effect, but the overall prognosis is still not ideal. As an effective way to improve the rehabilitation prognosis of heart failure, 2013 of the American Heart Association Disease Foundation / American Heart Association guidelines for heart failure management will be listed as a class IA recommendation. The effectiveness of exercise in patients with heart failure has been confirmed, however, if patients do not adhere to the movement, the effect will no longer continue. Overseas studies have shown that although the organization is good, adequate resources, efforts to optimize the exercise compliance, but only about 400% patients in the intervention group in the short term to achieve a consensus China expert.2014 moving target motion rehabilitation that stable chronic congestive heart failure heart function grade I ~ III level stability heart failure patients Be given rehabilitation, but the majority of our patients with heart failure after termination of hospital contact, few patients realize the moving target. How to improve the behavior of patients with heart failure has become a problem to be solved. Objective: 1. the aim of this study is to through the investigation and follow-up of patients with heart failure, the movement form, frequency, time, four a strength to understand the current situation of family sports behaviors of patients with heart failure, to evaluate the effect of patients with heart failure behavior factors on.2. in patients with heart failure behavior, combined with the research achievements at home and abroad, making exercise adherence interventions in patients with heart failure and to explore the measures of family sports behavior and quality of life in patients with heart failure, affecting mental health. Study on the first stage of a descriptive research method: using convenience sampling method, investigation department of Cardiology the First Affiliated Hospital of Nanjing Medical University in 2015 1 From January to April 2016, 137 cases of hospitalized patients with heart failure and cardiovascular hospitalization, including general data of patients with heart failure, heart failure symptoms, exercise self-efficacy, social support, family sports behavior after discharge, respectively, with the family movement form, frequency, time and intensity as the dependent variable, single factor analysis and correlation analysis of statistically significant variables independent variables and factors influencing the use of SPSS19.0 statistical analysis of family sports behavior of patients with heart failure. In the second stage of experimental study: 6 2016 to July were 40 patients met the inclusion criteria were as the control group, 38 patients from 9 to October as the intervention group. The control group was given routine health education, intervention group on the basis of conventional education on the intervention in patients exercise self-efficacy, including personalized exercise self-efficacy intervention during hospitalization and post discharge follow-up and guidance. The patients after discharge The log record movement (including the movement form, frequency, time and intensity, etc.) were assessed at baseline and after 4 months of exercise self-efficacy, anxiety, depression and quality of life. The SPSS19.0 of 71 patients with complete follow-up (37 cases in the control group, 34 cases in the intervention group) statistical analysis evaluation, exercise self-efficacy intervention on family exercise in patients with heart failure, affecting the quality of life and psychological status. Results: 1. of exercise self-efficacy and family sports behavior: exercise self-efficacy in patients with heart failure score was 32.80 + 9.33. Aerobic exercise in 118 cases (86.1%), aerobic combined resistance exercise in 19 cases (13.9%); the movement frequency 3.23 + 0.80 times per week; time is 27.50 + 7.91 minutes / day; strength rating of perceived exertion (RPE) factor 11.38 + 1.296.2. family sports behavior: the results of X2 analysis showed that different age, education level, and There are significant differences in the form of exercise in patients with complications of the number (P0.05), t test results show that the support of patients with different social movement form difference was statistically significant (P0.05).T test, variance analysis results showed that the heart function of different marriage, the difference was statistically significant number of complications in patients with motor frequency (P? 0.05) heart function, different cultural degree, and there was statistical significance in patients with exercise number of time difference (P0.05), different gender, marriage, heart function, different exercise intensity in patients with the number of patients with statistical significance (P0.05). The correlation analysis shows that the movement frequency (times / week), time (minutes / time), strength (RPE) and exercise self-efficacy is positively correlated (r = 0.539,0.607 and 0.562), exercise frequency, time, intensity and age were negatively correlated (r = -0.350, -0.229 and -0.377), exercise frequency, time, intensity and agency For there was a positive correlation (r = 0.281,0.562 and 0.221). Multiple linear regression analysis showed that the factors affecting exercise frequency for exercise self-efficacy, heart function, number of complications, factors affecting the exercise time for exercise self-efficacy, social support, cardiac function, age, number of complications, the factors affecting exercise the intensity of exercise self efficacy and complications of the number of.3. exercise self-efficacy intervention by exercise self-efficacy after 4 months of intervention, the intervention group exercise frequency, time, intensity and exercise self-efficacy score was significantly better than the control group (P0.05), but no significant differences in the form of exercise; there were significant differences between the two groups of patients with depression and the quality of life score and after intervention (P0.05). Conclusions: 1. patients with heart failure and exercise self-efficacy at a moderate level, family sports behavior in patients with heart failure is not ideal, exercise self-efficacy Are the main influencing factors. In the design and implementation of rehabilitation nursing, should pay attention to improve patients' self-efficacy, considering social support, age, heart function and complications and other factors on exercise behavior of.2. exercise self-efficacy intervention can effectively improve heart failure in patients with exercise self-efficacy level, improve family in addition, exercise behavior, exercise can improve the psychological state and life quality of patients.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.2

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