心力衰竭患者生命质量影响因素的分析与对策研究

An analysis and countermeasure study on affecting factors of quality of life in heart failure

目的研究慢性充血性心力衰竭患者生命质量的影响因素,提出和改进延长生存期、提高生活质量的措施和建议,为今后做更深层次的调查研究奠定基础。方法采用现况调查方法,应用心衰生命质量、家庭支持和综合自护能力评估量表,对心内科住院治疗的204名慢性心衰患者进行问卷调查,所得有效数据应用 SPSS 10.0软件包进行统计,影响因素的分析用 Pearson's 相关和多因素 Logistic 回归分析。结果 80.9%心衰患者生命质量处于中、低水平。差异有显著性(P<0.05),使生命质量呈下降趋势的因素有:年龄>65岁的住院心衰患者(65.2%),体力劳动者(69.1%),心功能分级的增高和心衰年限长,伴冠心病者(61.8%);尤其心肌梗死或心绞痛者;住院前不合理用药(55.9%)者;ACEI、β-受体阻滞剂使用率不足(分别占50.0%、22.5%);未及时应用非药物治疗方法早期行血流重建者(84.3%);不做运动训练者;由配偶以外的子女等提供帮助者(64.3%);家庭成员的行为和态度处于中、低水平者(90.3%);家庭人均月收入≤600元者(53.9%)和医疗费自费者(27.9%);综合自护能力处于中、低水平者(85.3%),表现为自理能力和遵医行为不良。结论影响心衰患者生命质量的因素很多,有四项对策可提高其生活质量。

Objective To study the affecting factors on the quality of life(QOL)in chronic heart failure(CHF),put forward measures and suggestions prolonging life span and improving QOL and set a good foundation for further investigations.Methods The research is a descriptive study.Dem- ographic data,medical information,Minnesota Living with Heart Failure Questionnaire,Modified Procida- no Family Support Scale,Modified HF Patients' Comprehensive Compr-care Scale were used to make a survey of 204 CHF patients in cardiac wards.Pearson's correlation analysis and multiple factor Logistic correlation aralysis were run for all valid data on the affecting factors of QOL using the SPSS 10.0 statis- tical package.Results QOL of 80.9% of the surveyed CHF patients were in the low or middle level with a notable difference(P<0.05).Factons making QOL to assume a declining trend were age over 65 years(65.2%)profession of manual labor(69.1%),higher cardiac function class and longer duration of CHF with accompanying coronary heart disease(68.1%),especially myocardial infarction or angina,un- reasonable use of medications before being hospitalized(55.9%),insufficient use of ACEI and β- block- ers(50.0% and 22.5%),early revasculariztion of infarct-related blood vessels not instituted (84.3%),non-participation in sports,support by children or others instead of spouse(64.3%),sup- port or attitude from family not wholehearted(90.3%),family income of less tha(600/month/person or payment at one's own expense(53.9% and 27.9% respectively)and comprehensive self-care ability in low or middle level(85.3%).Conclusions The factors affecting QOL of CHF patients in- clude age,occupation,cardiac function class,duation of CHF,presence of accompanying CHD(especially MI or angina),drug or non-drug therapy,exercises,family support,economical condition,payment of medical care and comprehensive self-care ability.