本文關(guān)鍵詞：社會(huì)資本與腦卒中患者生活質(zhì)量關(guān)系研究　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 社會(huì)資本 腦卒中 患者 生活質(zhì)量

【摘要】：背景:腦卒中又稱(chēng)腦血管意外,是一種發(fā)病急促的腦血液循環(huán)障礙性疾病,存在明顯的高發(fā)病率、高死亡率、高致殘率現(xiàn)象,已成為嚴(yán)重影響人類(lèi)健康的慢性病之一。腦卒中多發(fā)于老年人群,特別是60歲以上老年人群,已經(jīng)屬于一種常見(jiàn)病,一旦發(fā)病通常會(huì)給家庭和社會(huì)帶來(lái)沉重的經(jīng)濟(jì)壓力和照料負(fù)擔(dān)。研究發(fā)現(xiàn),2010年全球新發(fā)腦卒中病人約1690萬(wàn)、存活腦卒中病人約3300萬(wàn)、因腦卒中導(dǎo)致的死亡約590萬(wàn)。資料顯示,我國(guó)每年有150萬(wàn)~200萬(wàn)新發(fā)腦卒中的病例,每年死于腦血管病的約150萬(wàn)人,現(xiàn)存腦血管病患者約700萬(wàn)人;在存活的腦卒中患者中,75%~80%會(huì)留有不同程度的殘疾,其中重度殘疾超過(guò)40%,有30%左右可能在2至5年內(nèi)復(fù)發(fā)。腦卒中后由于疾病因素、肢體殘疾、經(jīng)濟(jì)及照料負(fù)擔(dān)等原因,會(huì)導(dǎo)致患者產(chǎn)生焦慮、抑郁、人際關(guān)系不和諧、日常生活活動(dòng)能力和生活質(zhì)量下降等一系列問(wèn)題。近年來(lái),社會(huì)資本理論逐漸成為健康領(lǐng)域?qū)W術(shù)研究的熱點(diǎn),在國(guó)外醫(yī)學(xué)領(lǐng)域,學(xué)者們做了大量社會(huì)資本對(duì)健康影響的研究。目前,社會(huì)資本核心要素與腦卒中的關(guān)系研究已經(jīng)為國(guó)內(nèi)外學(xué)者所開(kāi)展。這些研究顯示:較高水平的社會(huì)參與、社會(huì)支持對(duì)腦卒中有積極的作用,主要體現(xiàn)在降低腦卒中發(fā)生的風(fēng)險(xiǎn),提高腦卒中發(fā)生后的生活質(zhì)量和日常生活活動(dòng)能力,改善康復(fù)的效果。所以,社會(huì)資本在腦卒中的防治和康復(fù)等過(guò)程中具有積極的作用。目的:通過(guò)調(diào)查了解腦卒中患者的社會(huì)資本現(xiàn)況、生活質(zhì)量現(xiàn)況;分析腦卒中患者生活質(zhì)量的影響因素,探索社會(huì)資本與生活質(zhì)量關(guān)系;通過(guò)對(duì)腦卒中患者社會(huì)資本與生活質(zhì)量關(guān)系研究,進(jìn)而從社會(huì)資本角度探索提高腦卒中患者生活質(zhì)量的核心要素和關(guān)鍵措施。方法:本研究在文獻(xiàn)系統(tǒng)復(fù)習(xí)和專(zhuān)家咨詢(xún)研討的基礎(chǔ)上,研制出腦卒中患者社會(huì)資本與生活質(zhì)量關(guān)系研究的方案和現(xiàn)場(chǎng)調(diào)查量表;于2014年8月-10月,通過(guò)多階段隨機(jī)抽樣法,在安徽省阜陽(yáng)市、合肥市和銅陵市三地各抽取1個(gè)縣和1個(gè)區(qū)開(kāi)展調(diào)查。資料收集整理完成后,使用Epi Data3.1軟件錄入數(shù)據(jù)并建立數(shù)據(jù)庫(kù),采用SPSS18.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。計(jì)量資料使用均數(shù)±標(biāo)準(zhǔn)差/中位數(shù)±四分位間距表示,其中正態(tài)分布資料采用方差分析/t檢驗(yàn)進(jìn)行比較,非正態(tài)分布資料采用非參數(shù)檢驗(yàn)進(jìn)行比較;計(jì)數(shù)資料使用率或構(gòu)成比比較,采用卡方檢驗(yàn)或Fisher確切概率法進(jìn)行比較;影響因素采用多元線(xiàn)性回歸進(jìn)行分析;相關(guān)性分析采用Spearman相關(guān)性系數(shù);社會(huì)資本量表使用信效度檢驗(yàn)方法。結(jié)果:(1)本次研究共調(diào)查了腦卒中患者420人,收回問(wèn)卷402份,有效問(wèn)卷390份,有效應(yīng)答率為92.9%。(2)社會(huì)資本量表信效度:整個(gè)量表的Cronbach‘sα系數(shù)為0.882,結(jié)構(gòu)效度上,提取出6個(gè)主成分,總共可以解釋75.547%的總變異。(3)腦卒中患者社會(huì)資本現(xiàn)況:腦卒中患者和家人/親戚聯(lián)系比較密切的有307人(78.8%),和朋友聯(lián)系比較密切有202人(51.8%),認(rèn)識(shí)周邊大部分鄰居的有316人(81.0%),和鄰居交往比較密切的有125人(32.0%);個(gè)人支持方面,在遇到困難時(shí)腦卒中患者會(huì)得到較多精神支持的有323人(82.8%),會(huì)得到較多經(jīng)濟(jì)支持的有329人(84.4%);組織/非正式團(tuán)體支持方面,在遇到困難時(shí)腦卒中患者會(huì)得到較多精神支持的有121人(31%),會(huì)得到較多經(jīng)濟(jì)支持的有119人(30.5%);腦卒中患者對(duì)家人/親戚、朋友、鄰居、醫(yī)生和社居委/村委會(huì)人員的信任程度較高,分別為342人(87.7%)、304人(77.9%)、310人(79.4%)、315人(80.7%)和299人(76.6%);腦卒中患者多數(shù)會(huì)幫忙家人/親戚的有278人(71.3%),多數(shù)會(huì)幫忙鄰居的有245人(62.8%),多數(shù)會(huì)幫忙朋友的有241人(61.8%),多數(shù)會(huì)幫忙陌生人的有130人(33.3%);腦卒中患者覺(jué)得所在地方關(guān)系比較融洽和很融洽的分別為172人(44.1%)和101人(25.9%),本人關(guān)心社區(qū)/村較多的腦卒中患者為194人(49.7%),認(rèn)為其它人關(guān)心社區(qū)/村較多的腦卒中患者為204人(52.3%),對(duì)搬離現(xiàn)在的社區(qū)/村較為不舍的腦卒中患者為228人(58.5%)。(4)腦卒中患者生活質(zhì)量現(xiàn)狀及影響因素:本次調(diào)查的腦卒中患者生活質(zhì)量總分換算得分為526.92±168.56分,換算均分為65.86±21.07分;各維度得分換算后由高到低排序依次為交流、ADL/IADL、記憶與思維、手功能、移動(dòng)能力、情緒、參與和力量。生活質(zhì)量的影響因素主要有:年齡(B=-0.736,P=0.018),每周鍛煉身體(B=20.541,P0.001),腦卒中類(lèi)型(B=21.314,P=0.003),服藥情況(B=-21.920,P=0.003)。(5)腦卒中患者社會(huì)資本與生活質(zhì)量的關(guān)系:社會(huì)聯(lián)系(B=20.937,P0.001)、互惠(B=21.750,P0.001)、凝聚力與歸屬感(B=18.487,P0.001)對(duì)生活質(zhì)量有影響,社會(huì)聯(lián)系、互惠、凝聚力與歸屬感水平越高,腦卒中患者生活質(zhì)量越好。社會(huì)支持、信任對(duì)腦卒中患者生活質(zhì)量暫無(wú)影響。(6)社會(huì)資本與生活質(zhì)量維度的相關(guān)性:社會(huì)聯(lián)系、凝聚力與歸屬感與生活質(zhì)量的8個(gè)維度均呈正相關(guān),互惠與生活質(zhì)量中的情緒、交流、ADL/IADL、移動(dòng)能力、手功能、參與6個(gè)維度呈正相關(guān)。結(jié)論:(1)本研究使用的社會(huì)資本量表信效度良好,達(dá)到了研究要求的標(biāo)準(zhǔn)。(2)腦卒中患者社會(huì)聯(lián)系程度較高,大多數(shù)腦卒中患者與家人/親戚聯(lián)系密切;個(gè)人支持水平明顯高于組織/非正式團(tuán)體支持水平,但個(gè)人支持來(lái)源單一;信任程度普遍較高;除對(duì)陌生人外,互惠程度都較高,對(duì)家人/親戚的互惠程度最高;凝聚力與歸屬感水平一般。(3)腦卒中患者生活質(zhì)量的影響因素主要有:年齡、每周鍛煉身體狀況、腦卒中類(lèi)型和服藥情況。(4)社會(huì)聯(lián)系、互惠、凝聚力與歸屬感對(duì)腦卒中患者生活質(zhì)量有積極作用,且與生活質(zhì)量的多個(gè)維度存在相關(guān)性。建議:(1)加強(qiáng)社會(huì)聯(lián)系,促進(jìn)社會(huì)支持,讓腦卒中患者獲取更多與外界溝通交流的機(jī)會(huì)以及支持和幫助,進(jìn)而全面提高生活質(zhì)量;(2)提高互惠、凝聚力與歸屬感水平,增強(qiáng)腦卒中患者的集體感和責(zé)任感,發(fā)揮個(gè)人在集體中的作用,促進(jìn)康復(fù)的信心和積極性,以爭(zhēng)取早日康復(fù);(3)注重發(fā)揮中觀(guān)社會(huì)資本作用,確保資源在各機(jī)構(gòu)間流動(dòng)共享,從而使社會(huì)資本效益最大化;(4)積極開(kāi)發(fā)宏觀(guān)社會(huì)資本,通過(guò)對(duì)資本的整合和分配,為提高腦卒中患者生活質(zhì)量開(kāi)拓新的出路。
[Abstract]:Background: stroke, also known as cerebrovascular accident, is a rapidly occurring disorder of cerebral blood circulation disorder. It has obvious high incidence rate, high mortality rate and high disability rate. It has become one of the chronic diseases which seriously affect human health. Stroke often occurs in the elderly population, especially the elderly over 60 years old. It has been a common disease. Once it happens, it will bring heavy economic pressure and care burden to families and society. The study found that about 16 million 900 thousand of the global stroke patients in 2010, about 33 million of the patients who survived the stroke, and about 5 million 900 thousand of the deaths caused by stroke. Statistics show that there are 1 million 500 thousand ~200 million new cases of stroke patients in our country every year, every year about 1 million 500 thousand people died of cerebrovascular disease, cerebral vascular disease in patients with existing about 7 million people; in stroke patients survived, 75%~80% will have a different degree of disability, severe disability among more than 40%, there are about 30% possible recurrence 2 to 5 years. Due to disease factors, limb disability, economic burden and caregiving burden, a series of problems such as anxiety, depression, interpersonal disharmony, activity of daily living and quality of life decline after stroke. In recent years, social capital theory has gradually become the focus of academic research in the field of health. In the field of foreign medicine, scholars have done a lot of research on the impact of social capital on health. At present, the research on the relationship between the core elements of social capital and the stroke has been carried out by scholars at home and abroad. These studies show that: a higher level of social participation and social support has a positive effect on stroke, mainly in reducing the risk of stroke, improving the quality of life and activities of daily living after stroke, and improving the effect of rehabilitation. Therefore, social capital plays a positive role in the prevention and rehabilitation of stroke. Objective: to understand the status of quality of life in patients with stroke, social capital through investigation; analysis of factors affecting the quality of life in stroke patients, to explore the relationship between social capital and the quality of life of patients with stroke; the relationship between social capital and quality of life, and then explore the core elements and the key measures to improve the quality of life of patients with stroke from society capital view. Methods: Based on literature review and expert consultation system research, developed the scheme and field survey scale of stroke patients to study the relationship between social capital and quality of life; in August 2014 -10 months, by multi stage random sampling method, carry out the investigation in the Anhui city of Fuyang Province, from Hefei city and Tongling City, three 1 counties and 1 districts. After the data collection was completed, Epi Data3.1 software was used to record data and set up a database, and SPSS18.0 software was used for statistical analysis. Measurement data using standard deviation / median + four spacing, the normal distribution of data using analysis of variance /t test compared to the non normal distribution data were compared using non parametric test; count data use rate or composition, were compared using chi square test or Fisher exact probability method; influence the factors using multiple linear regression analysis; correlation analysis using Spearman correlation coefficient; social capital scale test methods for reliability and validity. Results: (1) a total of 420 stroke patients were investigated, 402 questionnaires were collected, 390 questionnaires were valid, and the response rate was 92.9%. (2) social capital scale reliability and validity: the Cronbach s alpha coefficient of the whole scale is 0.882, and 6 principal components can be extracted from structural validity, which can explain 75.547% of the total variance. (3)鑴戝崚涓?zhèn)ｈ�呯ぞ浼?xì)璧勬湰鐜板啠?

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