心导管介入治疗术后患儿照顾者负担影响因素探讨

Study on the burden and influential factors of caregiver in pediatric cardiac catheterization

目的心导管介入治疗方法复杂,费用高昂,给患儿及其照顾者带来沉重的心理及经济负担。本研究旨在探讨心导管介入治疗术后患儿照顾者负担及其影响因素。方法选取2015-06-01-2017-08-31在河南省儿童医院接受心导管介入治疗术患儿的102位照顾者进行问卷调查。调查工具为自制一般资料调查表,包括患儿信息及主要照顾着信息共11个条目;及Zarlt照顾者负担量表,包括角色负担与个人负担2个维度共22个条目,每个条目0~4分,得分越高照顾者负担越重。单因素分析计数资料采用t或F检验,多因素分析采用Logistic回归。结果 102位主要照顾者,Zarlt照顾者负担量表得分43~76分,平均得分(57.02±2.17)分;中度负担63位(61.76%),重度负担39位(38.24%)。单因素分析结果显示,患儿年龄、照顾者文化程度、职业、医疗费用支付方式、自付医疗费用占家庭收入比例及每天照顾患儿时间为主要影响因素,均P<0.05。多因素Logistic分析结果显示,患儿年龄:1~6岁(OR=0.598,95%CI为0.433~0.827,P=0.002),7~14岁(OR=0.596,95%CI为0.437~0.812,P<0.001);照顾者文化程度:高中或中专(OR=1.645,95%CI为1.193~2.270,P=0.001),大专及以上(OR=1.370,95%CI为1.104~1.700,P=0.007);自付医疗费用占家庭收入比例:20%~40%(OR=1.388,95%CI为1.099~1.752,P=0.031),>40%(OR=1.665,95%CI为1.121~2.473,P=0.043);每天照顾患儿时间:8~12h(OR=1.476,95%CI为1.132~1.923,P=0.015),>12h(OR=1.581,95%CI为1.142~2.188,P=0.021)均为照顾者负担的独立影响因素。结论心导管介入治疗术后患儿照顾者负担主要受患儿年龄、照顾者文化程度、自付医疗费用占家庭收入比例及每天照顾患儿时间影响,护理人员应从以上方面入手给予照顾者更多的人文关怀与专业指导以降低照顾者负担。

OBJECTIVE The interventional treatment of cardiac catheterization is complicated and costly.It brings a heavy psychological and economic burden to children and their caregivers.Therefore,the burden of caregivers and their influencing factors in patients undergoing cardiac catheterization intervention are explored.METHODS Convenient sampling method was used to select 102 caregivers whose child underwent cardiac catheterization in children’s hospital affiliated to Zhengzhou university from June 1,2015 to August 31,2017 to conduct questionnaire survey.The survey tools consisted of self-made general information questionnaires(including 11 items for children’s information and primary care information)and Zarlt’s caregiver burden scale(including 22 items in the two dimensions of role burden and personal burden,each item with 0-4 points,the higher the score,the heavier the burden on the caregiver).The t test or Ftest was used for univariate analysis,and Logistic regression was used for multivariate analysis.RESULTS The Zarlt caregiver burden scores of 102 primary caregivers scored 43 to 76 points,with an average of(57.02±2.17)points,63 moderate burdens,accounting for 61.76%,and 39 heavy burdens,accounting for 38.24%.The results of single-factor analysis showed that the age of children,the education level of caregivers,occupations,payment of medical expenses,the proportion of self-paid medical expenses as a percentage of household income,and the time of daily care of children were the main influencing factors(all P<0.05).Logistic analysis showed that the age of children [1-6 years old(OR=0.598,95%CI:0.433-0.827,P=0.002),7-14 years old(OR=0.596,95%CI:0.437-0.812,P<0.001)],caregiver education level[high school or technical secondary school(OR=1.645,95%CI:1.193-2.270,P=0.001),≥junior college(OR=1.370,95%CI:1.104-1.700,P=0.007)],self-paid medical expenses as a proportion of household income[20%-40%(OR=1.388,95%CI:1.099-1.752,P=0.031),>40%(OR=1.665,95%CI:1.121-2.473,P=0.043)],taking care of children every day[8-12 h(OR=1.476,95%CI:1.132-1.923,P=0.015),>12 h(OR=1.581,95%CI:1.142-2.188,P=0.021)]were independent influencing factors for the caregiver’s burden.CONCLUSIONS The burden of caregivers in patients with cardiac catheterization is mainly due to the age and education level of children,the proportion of household medical expenses to family income,and the time spent daily for children.Nursing staff should give caregivers more humanistic care and professional guidance from the above aspects to reduce the burden on caregivers.