体外循环心脏瓣膜手术患者疾病不确定感状况及影响因素

The current status and influential factors of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass

目的 调查体外循环心脏瓣膜手术患者疾病不确定感状况并探讨其影响因素,为制定有效干预措施提供参考.方法 采用自行设计的患者一般资料问卷、Mishel疾病不确定感量表、Connor-Davidson韧性量表、医学应对方式问卷对广东省4所“三甲”医院心血管外科的208例体外循环心脏瓣膜手术患者分别在术前1d、出院前1d进行调查.结果 体外循环心脏瓣膜手术患者术前1d疾病不确定感的总体均分为（99.09±11.41）分,92.3％的患者疾病不确定感水平处于中等.出院前1d疾病不确定感的总体均分为（90.33±10.32）分,91.8％的患者疾病不确定感水平处于中等.年龄、心脏瓣膜病类型、心脏瓣膜手术次数、乐观及屈服对疾病不确定感水平有显著正向影响,家庭平均月收入、自强、心理韧性总分及面对应对方式对患者疾病不确定感水平有显著负向影响.结论 体外循环心脏瓣膜手术患者疾病不确定感水平处于中等,年龄、家庭平均月收入、心脏瓣膜病类型、心脏瓣膜手术次数、心理韧性与应对方式是疾病不确定感水平的主要影响因素.

Objective To investigate the current status of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass and analyze its influential factor,and provide reference for effective intervention.Methods A total of 208 cardiac valvular surgery patients with cardiopulmonary bypass were recruited from 4 cardiovascular surgery in Guangdong and were investigated with the self-designed questionnaire,Mishel Uncertainty in Illness Scale （MUIS）,Connor-Davidson Resilience Scale （CD-RISC）,Medical Coping Modes Questionnaire （MCMQ）,in the preoperative day and the day before discharge.The data were analyzed by single-factor and multiple-factor analysis.Results The average score of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass was 99.09±11.41,and 92.3％ of patients got a moderate uncertainty in illness level in the preoperative day.The average score of uncertainty in illness in the patients was 90.33± 10.32,and 91.8％ of patients got a moderate uncertainty in illness level in the day before discharge.Multiple linear regression indicated that,age,cardiac valvular disease types,number of cardiac valvular surgery,optimism and yield were the protective factors of uncertainty in illness level.Average monthly household income,self-improvement,scores of resilience and confront coping were the risk factors of uncertainty in illness level.Conclusion The level of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass is moderate.Age,average monthly household income,cardiac valvular disease types,number of cardiac valvular surgery,resilience and coping style are factors influencing uncertainty in illness level of patients.