克罗恩病患者216例生活质量影响因素及其与出院准备度、正念觉知水平的相关性

Influencing factors of quality of life in 216 patients with Crohn′s disease and their correlation with readiness for hospital discharge and mindful attention awareness

目的探讨克罗恩病患者生活质量的影响因素及其与出院准备度、正念觉知水平的相关性。方法选择2016年1月20日至2021年5月20日在山东大学齐鲁医院(青岛)消化内科住院的216例克罗恩病患者,采用自行设计的一般资料调查问卷、炎症性肠病患者生活质量问卷(IBDQ)、出院准备度量表(RHDS)、正念注意觉知量表(MAAS)、医院焦虑抑郁量表和匹兹堡睡眠质量指数量表(PSQI)对患者进行问卷调查,分析克罗恩病患者生活质量的影响因素。两组间比较采用Mann-Whitney U检验或独立样本t检验,多组间比较采用Kruskal-Wallis H检验或单因素方差分析;两变量间的相关性分析采用Pearson相关分析,多变量间的相关性分析采用多元线性回归分析。结果单因素分析结果显示,有配偶,文化程度为小学及以下,居住在城市,有睡眠障碍,存在焦虑、抑郁,以及处于重度活动期的克罗恩病患者生活质量差,IBDQ总分分别低于无配偶,初中至高中和高中以上学历,居住在乡镇和农村,无睡眠障碍,无焦虑,无抑郁,以及处于缓解期和轻、中度活动期者[(46.23±29.77)分比(117.45±42.23)分,11.00分(6.25分,30.75分)比79.00分(56.00分,113.00分)、114.00分(72.50分,157.50分),(37.12±30.67)分比(69.43±24.78)、(126.76±41.54)分,(42.67±23.18)分比(124.58±36.52)分,(50.35±27.23)分比(122.42±42.41)分,(51.97±37.29)分比(113.96±44.18)分,11.00分(6.75分,18.00分)比154.00分(135.50分,164.50分)、97.00分(79.00分,112.00分)、49.00分(36.75分,62.25分)],差异均有统计学意义(t=-14.40,H=60.56,F=117.61,t=-20.17、-15.20、-10.87,H=148.98;均P<0.001)。相关性分析结果显示,RHDS得分与IBDQ各维度得分和总分均呈正相关(r=0.646~0.781,均P<0.001);MAAS得分与IBDQ各维度得分和总分均呈正相关(r=0.331~0.382,均P<0.001)。多元线性回归分析结果显示,出院准备度、正念觉知水平、文化程度、居住地、睡眠情况、是否焦虑和疾病活动度均是克罗恩病患者生活质量的影响因素(t=4.19、5.38、2.36、2.88、2.85、3.11、-7.22,均P<0.05)。结论小学及以下文化程度、居住在城市、有睡眠障碍、存在焦虑、处于重度活动期、出院准备度低和正念觉知水平低的克罗恩病患者生活质量差,医护人员应着重关注此类患者,提高其生活质量。

Objective To explore the factors influencing the quality of life in patients with Crohn′s disease(CD)and their correlation with readiness for hospital discharge and mindful attention awareness.Methods From January 20,2016 to May 20,2021,216 patients with CD hospitalized in the Department of Gastroenterology,Qilu Hospital of Shandong University(Qingdao)were selected.Self-designed general information questionnaire,inflammatory bowel disease questionnaire(IBDQ),readiness for hospital discharge scale(RHDS),mindful attention awareness scale(MAAS),hospital anxiety and depression scale and Pittsburgh sleep quality index(PSQI)were used to conduct questionnaire surveys in patients.Factors influencing the quality of life of CD patients were analyzed.Mann-Whitney U test and independent sample t test were used for the comparison between two groups;Kruskal-Wallis H test and one-way analysis of variance were used for comparison between multiple groups;Pearson analysis was used for correlation analysis,and multiple linear regression method was used for multivariate analysis.Results The results of univariate analysis showed that the quality of life was poor in CD patients with spouse,primary school education or below,living in cities,sleep disorders,anxiety,depression,and severe activity.The total IBDQ scores were lower than those with no spouse,junior high school to senior high school and above,living in villages and towns,no sleep disorders,no anxiety,no depression,and in remission and mild to moderate activity(46.23±29.77 vs.117.45±42.23;11.00(6.25,30.75)vs.79.00(56.00,113.00)and 114.00(72.50,157.50);37.12±30.67 vs.69.43±24.78 and 126.76±41.54;42.67±23.18 vs.124.58±36.52;50.35±27.23 vs.122.42±42.41;51.97±37.29 vs.113.96±44.18;11.00(6.75,18.00)vs.154.00(135.50,164.50),97.00(79.00,112.00)and 49.00(36.75,62.25)),and the differences were statistically significant(t=-14.40,H=60.56,F=117.61,t=-20.17,-15.20 and-10.87,and H=148.98;all P<0.001).The results of correlation analysis showed that the RHDS score was positively correlated with the scores of each dimension and total scores of IBDQ(r=0.646 to 0.781,all P<0.001);the MAAS score was positively correlated with the scores of each dimension and total scores of IBDQ(r=0.331 to 0.382,all P<0.001).The results of multiple linear regression analysis demonstrated that readiness for hospital discharge,level of mindful attention awareness,education level,place of residence,sleep disorders,whether with anxiety and disease activity were the influencing factors of the quality of life of CD patients(t=4.19,5.38,2.36,2.88,2.85,3.11 and-7.22,all P<0.05).Conclusions The quality of life is poor in CD patients with primary school education or below,live in cities,sleep disorders,anxiety,severe activity,low readiness for hospital discharge and low level of mindful attention awareness.Doctors and nurses should pay attention to these patients and improve their quality of life.