慢性心力衰竭患者及其主要照顾者心力衰竭相关知识现状及影响因素研究

Current Status and Influencing Factors of Heart Failure-related Knowledge in Patients with Chronic Heart Failure and Their Primary Caregivers

背景慢性心力衰竭(CHF)患者病死率和再入院率较高,治疗效果常欠佳。既往研究常关注CHF的药物治疗,对CHF的综合管理关注较少,有关CHF患者及其主要照顾者心力衰竭相关知识现状及影响因素的研究则更为少见。目的分析CHF患者及其主要照顾者心力衰竭相关知识现状,并分析其影响因素。方法选取2017年12月—2018年6月于大理大学第一附属医院老年病科、心内科住院治疗的CHF患者61例及其主要照顾者61例为调查对象。采用结构式问卷调查法,调查内容分为CHF患者部分〔包括患者一般资料问卷、心力衰竭相关知识测试问卷(HFKT)、心力衰竭自我护理指数量表(SCHFI)〕及主要照顾者部分〔包括主要照顾者一般资料问卷、HFKT、心力衰竭自我护理指数贡献量表(CC-SCHFI)〕。CHF患者及其主要照顾者HFKT总分的影响因素分析采用多元线性逐步回归分析。结果CHF患者HFKT总分实际得分和条目均分分别为(5.3±2.2)、(0.4±0.2)分。多元线性逐步回归分析结果显示:CHF患者的文化程度(β=-2.149,t=-2.460)、基础病因(β=-0.244,t=-2.224)、纽约心脏病协会(NYHA)分级(β=1.204,t=2.706)、SCHFI总分(β=0.123,t=6.583)是其HFKT总分的影响因素(P<0.05)。主要照顾者HFKT总分实际得分和条目均分分别为(5.5±2.6)、(0.4±0.2)分。多元线性逐步回归分析结果显示:主要照顾者的文化程度(β=1.015,t=4.031)、每天照顾时间(β=1.106,t=2.334)、自觉健康状况(β=0.996,t=2.059)、CC-SCHFI总分(β=0.119,t=5.123)是其HFKT总分的影响因素(P<0.05)。CHF患者服药知识得分、病理知识得分、HFKT总分分别与主要照顾者服药知识得分、病理知识得分、症状管理得分、行为管理得分、HFKT总分呈正相关(P<0.05);CHF患者症状管理得分与主要照顾者服药知识得分、症状管理得分、HFKT总分呈正相关(P<0.05);CHF患者饮食选择得分与主要照顾者症状管理得分呈负相关(P<0.05);CHF患者行为管理得分与主要照顾者服药知识得分、病理知识得分、行为管理得分、HFKT总分呈正相关(P<0.05)。结论CHF患者及其主要照顾者心力衰竭相关知识水平普遍偏低,且二者存在重要依存关系;CHF患者的文化程度、基础病因、NYHA分级、自我护理能力是其心力衰竭相关知识水平的影响因素,而主要照顾者的文化程度、每天照顾时间、自觉健康状况、自我护理贡献能力是其心力衰竭相关知识水平的影响因素。

Background The mortality and readmission rate of patients with chronic heart failure(CHF)are high,and the therapeutic effect is often poor.Previous studies often pay attention to the drug treatment of CHF but pay less attention to the comprehensive management of CHF,and the research on the current status and influencing factors of heart failure-related knowledge in patients with CHF and their primary caregivers is even less.Objective To analyze the current status and influencing factors of heart failure-related knowledge in patients with CHF and their primary caregivers.Methods A total of 61 CHF patients and 61 primary caregivers were enrolled from the Department of Geriatrics and Department of Cardiology of the First Affiliated Hospital of Dali University from December 2017 to June 2018.The participants were investigated by structured questionnaires.The CHF patients were investigated using the general questionnaire,Heart Failure Knowledge Test(HFKT),and Self-Care of Heart Failure Index(SCHFI).The primary caregivers were surveyed using the general questionnaire,HFKT,Caregiver Contribution to Self-Care of Heart Failure Index(CC-SCHFI).The influencing factors of HFKT total score of CHF patients and their primary caregivers were analyzed by multiple linear stepwise regression analyses.Results The actual total score and average item score of HFKT in patients with CHF were(5.3±2.2)and(0.4±0.2),respectively.The results of multiple linear stepwise regression analysis showed that the educational level(β=-2.149,t=-2.460),primary etiology(β=-0.244,t=-2.224),NYHA classification(β=1.204,t=2.706),and SCHFI total score(β=0.123,t=6.583)were the influencing factors of HFKT total score in patients with CHF(P<0.05).The actual total score and average item score of HFKT of the primary caregivers were(5.5±2.6)and(0.4±0.2),respectively.The results of multiple linear stepwise regression analysis showed that the education level(β=1.015,t=4.031),daily care time(β=1.106,t=2.334),perceived health status(β=0.996,t=2.059),and CC-SCHFI total score(β=0.119,t=5.123)were the influencing factors of HFKT total score in primary caregivers(P<0.05).CHF patients'medication knowledge score,pathology knowledge score,and HFKT total score were positively correlated with the primary caregiver's medication knowledge score,pathology knowledge score,symptom management score,behavior management score,and HFKT total score,respectively(P<0.05).The symptom management score of CHF patients was positively correlated with the primary caregiver's medication knowledge score,symptom management score,and HFKT total score,respectively(P<0.05).The dietary choice score of CHF patients was negatively correlated with the symptom management score of the primary caregiver(P<0.05).The scores of behavior management of CHF patients were positively correlated with the scores of medication knowledge,pathology,behavior management,and HFKT total scores of primary caregivers,respectively(P<0.05).Conclusion The level of heart failure related knowledge in patients with CHF and their primary caregivers is generally low,and there is a critical dependent relationship between them.The education level,primary etiology,NYHA classification,and self-nursing ability of CHF patients are the influencing factors of their heart failure related knowledge,while the education level,daily care time,perceived health status,and self-nursing contribution ability are the influencing factors of heart failure related knowledge in primary caregivers.