老年慢性心力衰竭患者乐观应对和社会支持及营养评价与生命质量的关系分析

Analysis of the relationship between optimistic coping style,social support,nutrition evaluation and quality of life in elderly patients with chronic heart failure

目的分析老年慢性心力衰竭患者乐观应对、社会支持以及营养评价与生命质量的关系。方法采用一般情况调查表、中文版Jalowiec应对量表、社会支持评定量表、心衰特异性微型营养评价工具以及明尼苏达心功能不全生命质量量表分别对312例老年慢性心力衰竭患者的一般状况、应对方式、社会支持、营养状况以及生命质量进行调查。结果本研究中312例慢性心力衰竭患者平均年龄(73.63±6.81)岁,患者的生命质量得分为(40.80±11.94)分;方差分析或t检验结果显示年龄越高(t=5.400)、文化程度越高(F=2.147)、家庭人均月收入越高(F=6.302)、心功能分级越低(F=9.530)的患者生命质量得分越高,差异均有统计学意义(P<0.05);婚姻状态中,未婚患者MLHFQ得分最高,差异均有统计学意义(F=4.141,P<0.05)。多元线性回归分析结果显示心功能分级(β=-0.159,P<0.001)、乐观-应对方式(β=0.144,P<0.01)以及营养评价(β=0.417,P<0.001)是患者生命质量的影响因素。经中介分析结果显示患者营养评价在乐观-应对与生命质量的影响中发挥了部分中介效应,中介效应值为0.063,占总效应的31.99%。结论老年慢性心力衰竭患者生命质量处于较低水平,其心功能分级、乐观-应对方式及营养评价是其重要的影响因素。医护人员应制定针对性护理干预措施,在注重患者营养状况的同时,也应提高患者乐观应对的水平,以期提高患者生命质量。

Objective To analyzes the relationship between optimistic coping style,social support,nutrition evaluation and the quality of life of elderly patients with chronic heart failure(CHF).Methods The general condition,coping style,social support,nutritional status and quality of life of 312 elderly patients with chronic heart failure were investigated by the general situation questionnaire,the Chinese version of the Jalowiec coping scale,Social Support Rating Scale,and Mini-Nutrition Assessment Special for Heart Failure and Heart Failure and Minnesota Living with Heart Failure Questionnaire(MLHFQ).Results The average age of the 312 CHF patients in this study was(73.63±6.81)years old,and the quality of life scores was(40.80±11.94).The results of analysis of variance or t-test showed that the higher the age(t=5.400),the higher the education level(F=2.147),higher per capita monthly income(F=6.302),and lower cardiac function classification(F=9.530)have higher quality of life scores,and the differences are statistically significant(P<0.05).Among marital status,unmarried patients had the highest MLHFQ scores,and the differences were statistically significant(F=4.141,P<0.05).The results of multiple linear regression analysis showed that cardiac function classification(β=-0.159,P<0.001),optimism-coping style(β=0.144,P<0.01)and nutritional evaluation(β=0.417,P<0.001)were influencing factors of the life quality.The results of the mediation analysis showed that the nutritional evaluation of patients played a part of the mediation effect in the impact of optimism-coping and quality of life,with a mediation effect value of 0.063,accounting for 31.99%of the total effect.Conclusion The quality of life of elderly patients with CHF is at a low level,and the cardiac function classification,optimistic-coping style and nutritional evaluation are important influencing factors.Medical staff should formulate targeted nursing intervention measures,pay attention to the nutritional status and improve patients’optimistic coping level,to improve patients’quality of life.