甘肃省慢型克山病患者自我管理治疗效果评价及影响因素分析

Evaluation of self-management treatment effect and analysis of influencing factors in patients with chronic Keshan disease in Gansu Province

目的评价甘肃省慢型克山病患者自我管理治疗效果。方法2018年3-6月,选择甘肃省7个克山病病区县院外自我管理治疗的243例慢型克山病患者作为调查对象,收集其一般人口学资料和临床资料。同时,对调查对象进行为期6个月的自我管理治疗,采用自我管理量表评价治疗前及治疗6个月时患者自我管理行为,分值越高表示患者的自我管理行为越好。采用多元线性回归分析进行自我管理量表影响因素分析。结果剔除信息不完整数据,本次调查共纳入158例慢型克山病患者,其中男性96例、女性62例。与自我管理治疗前比较,自我管理治疗6个月时患者心功能分级和劳动能力均明显改善(Z=-4.685、-5.934,P均<0.05);心胸比较低(0.61±0.08比0.63±0.09,t=5.175,P<0.05);心脏彩超指标中,左室射血分数(LVEF)和左室短轴缩短率(LVFS)均较高(0.41±0.11比0.36±0.07,0.21±0.07比0.18±0.05,t=-6.504、-5.391,P均<0.05);自我管理量表总分较高[(53.86±9.29)分比(51.46±10.50)分,t=-3.696,P<0.05]。患者服药依从性与心功能分级疗效呈正相关(r=0.243,P<0.05)。多元线性回归分析显示,文化程度、心功能分级疗效是慢型克山病患者自我管理量表的影响因素(t=2.466、2.635,P均<0.05)。结论自我管理治疗可改善慢型克山病患者心脏功能,提高患者自我管理行为能力。

Objective To evaluate the effect of self-management treatment for patients with chronic Keshan disease in Gansu Province.Methods From March to June 2018,243 patients with chronic Keshan disease who were treated by self-management treatment outside the hospital in 7 Keshan disease counties in Gansu Province were selected as the survey subjects,and their general demographic and clinical data were collected.At the same time,the survey subjects were given a 6-month self-management treatment,and the self-management scale was used to evaluate the patients'self-management behavior before treatment and 6 months after treatment.The higher the score,the better the patients'self-management behavior.The influencing factors of self-management scale were analyzed by multiple linear regression analysis.Results Excluding incomplete data,a total of 158 patients with chronic Keshan disease were included in this survey,including 96 males and 62 females.Compared with patients before self-management treatment,the patients'cardiac function classification and work ability improved significantly after 6 months of self-management treatment(Z=-4.685,-5.934,P<0.05);cardiothoracic ratio decreased(0.61±0.08 vs 0.63±0.09,t=5.175,P<0.05);in the cardiac color Doppler ultrasound indexes,left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)were increased(0.41±0.11 vs 0.36±0.07,0.21±0.07 vs 0.18±0.05,t=-6.504,-5.391,P<0.05);the total score of the self-management scale was increased[(53.86±9.29)scores vs(51.46±10.50)scores,t=-3.696,P<0.05].Further analysis of the efficacy of the patients'cardiac function classification showed that the patients'medication compliance was positively correlated with the efficacy of the cardiac function classification(r=0.243,P<0.05).The result of multiple linear regression analysis showed that education level and efficacy of the cardiac function classification were influencing factors of the self-management scale for patients with chronic Keshan disease(t=2.466,2.635,P<0.05).Conclusion The self-management treatment for patients with chronic Keshan disease can effectively improve heart function and improve self-management behavior.