基于症状管理理论的急性心力衰竭患者延迟就医影响因素分析

The association between delayed medical care-seeking and symptom experience in patients with acute heart failure

目的调查急性心力衰竭患(Acute Heart Failure, AHF)者的症状体验(包括症状感知,症状评估和对症状的反应)与延迟就医的关系,探索与延迟就医相关的因素。方法共入组109例急性心力衰竭的患者,所有患者使用结构化访谈调查问卷评估症状体验评分,同时填写中文修订版控制态度量表(Control Attitudes Scale-Revised, CAS-R)和中文版心力衰竭特异性健康素养量表(Heart Failure-Specific Healthliteracy Scale),从病例记录中收集患者的健康和疾病因素包括合并症,住院前处方药物,既往AHF住院和AHF严重程度等指标。采用单因素分析考察延迟就医的可疑相关因素,采用Logistic回归分析研究影响患者及时就医的独立相关因素。结果患者从症状感知到就诊的时间为(60.5±62.4) h,中位数(四分位数间距)为36.5(12.0~93.8) h。单因素分析发现年龄、功能健康素养、感知控制、就业状况、感知症状时在家中、疲劳感和心悸等因素与延迟就医有显著相关性(P均<0.05)。多元Logistic回归分析发现只有疲劳感(OR:0.355,95%CI:-1.627^-0.467,P<0.001)和年龄(OR:0.969,95%CI:-0.058^-0.004,P=0.031)与就医延迟有关。结论疲劳感和年龄与AHF患者延迟治疗有关。症状体验的几个特征可能会促使AHF患者在症状恶化时及时寻求治疗。这提示护士、家属医护人员需要强调增加疲劳的重要性,将其视为AHF恶化的标志。同时应及时识别AHF患者的症状体验以便促使患者及时就医。

ObjectiveTo investigate the relationship between symptom experience and delayed medical care-seeking in patients with Acute Heart Failure(AHF),and to explore the factors associated with delayed medical care-seeking.MethodsA total of 109 patients with acute Heart Failure were enrolled,all of them fill in Chinese revision Control Attitudes Scale Acute Hea(CAS-R)and the Chinese version of Heart Failure in Specific health literacy Scale(Heart Failure-Specific Healthliteracy Scale),from the case records collected in the patient′s health and disease factors include complications,hospital prescription drugs before,always HF hospitalization and HF severity index,etc.Univariate analysis was used to investigate the possible factors for delayed medical treatment,and Logistic regression analysis was used to study the independent risk factors affecting patients′timely medical treatment.ResultsThe time from symptom perception to visit was(60.5±62.4)hours,and the median(interquartile interval)was 36.5(12.0~93.8)hours.Univariate analysis found that age(P<0.05),functional HL(P<0.05),perceived control(P<0.05),employment status(P<0.05),perceived symptoms at home(P<0.05),fatigue(P<0.05),palpitations(P<0.05)and other factors were significantly correlated with delayed medical treatment.Multivariate Logistic regression analysis found that only fatigue(OR:0.355,95%CI:-1.627^-0.467,P<0.001)and age(OR:0.969,95%CI:-0.058^-0.004,P=0.030)were associated with delay in seeking medical care.ConclusionFatigue and age were associated with delayed treatment in patients with AHF.Several features of symptom experience may prompt patients with AHF to seek treatment when symptoms worsen.This suggests that nurses and family members should emphasize the importance of increasing fatigue as a sign of worsening HF.At the same time,symptoms and experiences of patients with AHF should be timely identified so as to prompt patients and seek medical treatment.