军队离退休干部慢性阻塞性肺疾病稳定期自我管理水平及影响因素分析

Self-management Level and Influencing Factors of Stable Period of Chronic Obstructive Pulmonary Disease in Retired Military Officers

目的了解军队离退休老干部慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者稳定期自我管理水平现状并分析影响因素,探索改善其自我管理水平的有效途径。方法采用便利抽样法选取于2019-03/2019-05月湖北省3个军队离退休老干部休养所和2个军休中心的138例COPD稳定期患者进行问卷调查,调查工具包括个人一般资料调查表、COPD患者自我管理量表。采用多因素Logistic回归分析影响老干部自我管理水平的危险因素。结果除症状管理因子外,离退休COPD老干部自我管理总分与各维度均分在一般水平(3分)以上,表明离退休COPD老干部自我管理水平中等;除日常生活维度外,不同婚姻状况其余各维度之间的比较有统计学差异(P<0.01或0.05);不同居住情况、不同经济负担COPD患者在症状管理、日常生活和情绪管理3个维度之间的比较有统计学差异(P<0.01或0.05);在症状管理、情绪管理和自我效能3个维度,学历越高的老干部得分越高(P均<0.01);离退休前不同职业者、医疗费用90%报销的老干部,除症状管理维度外,其余各维度得分均高于其他患者(P<0.05或0.01);家庭关系好的老干部日常生活和自我效能维度好于家庭关系一般的老干部(P<0.01或0.05);从不吸烟老干部各维度得分均高于其余两组,在症状管理、信息管理及自我效能3个维度的比较有统计学差异(P均<0.01);有无呼吸困难的患者在日常生活及情绪管理维度之间的比较有统计学差异(P均<0.01);活动能力下降、有无家族史患者除情绪管理维度外,其余各维度的比较有统计学差异(P<0.01或0.05);不同疾病分级及合并其它疾病的患者各维度之间的比较有统计学差异(P<0.01或0.05);有无使用吸入剂、家庭氧疗各维度之间的比较无统计学差异(P>0.05)。多元线性回归分析结果显示:支付方式、经济负担、家庭关系、平均住院天数、家庭氧疗、家族史、合并其他疾病是其重要影响因素。结论军队离退休干部COPD的自我管理状况有待改善,干休所及军休中心应尽快制定针对性护理措施,提升老干部自我管理能力,改善其健康结局。

Objective To understand the influencing factors of the current situation of self-management level of veteran cadres in the stable period of chronic obstructive pulmonary disease(COPD),and explore its effective ways to improve the self-management level.Methods A convenient sampling method was used to select 138 patients with stable COPD from 3 military retired cadres and 2 military rest centers in Hubei province from March 2019 to May 2019. And the survey tools included general survey of personal data and COPD patient self-management scale.Multivariate logistic regression was used to analyze the risk factors affecting the self-management level of veteran cadres.Results Except for symptom management factors, the COPD veteran cadres’ self-management scores and dimensions were all above the general level(3 points), indicating that the self-management level of retired COPD cadres was moderate.Except for the dimension of daily life,the other dimensions of different marital status were significantly different(P<0.01 or 0.05).The living conditions and economic burden variables were significantly different in the three dimensions of symptom management, daily life and emotional management(P<0.01 or 0.05). In the three dimensions of symptom management, emotional management and self-efficacy,the higher the score of the veteran cadres with higher education(all P<0.01).The veteran cadres of different workers before retiring and the veteran cadres who reimbursed 90% of medical expenses, except for the symptom management dimension, scored higher than the other patients(P<0.05 or 0.01). The dimensions of daily life and self-efficacy of the veteran cadres with good family relationship scored higher than veteran cadres with a general family relationship(P<0.01 or 0.05).The scores of the never-smoking veteran cadres in all dimensions were higher than those in the other two groups,there were significantly different in symptom management,information management and self-efficacy(all P<0.01). Except for the emotional management dimension,there were significantly different in the other dimensions of patients with or without decreased activity ability and family history(P<0.01 or 0.05). There were significantly different among the dimensions of patients with different disease grades, and other diseases(P<0.01 or 0.05).There was no significant difference in the dimensions of patients with inhalation or home oxygen therapy(P>0.05).Multiple linear regression results showed that payment mode,financial burden,family relationship,average length of hospital stay,family oxygen therapy,family history,and other comlications were important factors.Conclusion The self-management of veteran cadres with COPD needs to be improved.Nursing measures should be developed as soon as possible for the rest homes and military rest centers to improve the self-management of veteran cadres and improve their health outcomes.