心脏择期手术老年患者术后生活质量改善情况及影响因素分析

Quality of life and its influencing factors in elderly patients undergoing elective cardiac surgery

目的:探讨心脏择期手术老年患者术后生活质量的改善程度,并分析术后3个月患者生活质量的影响因素。方法:2019年2-9月采用便利抽样法选择山东大学齐鲁医院心外科病房进行心脏择期手术的260例老年患者,术前1 d开展问卷调查,调查工具包括患者一般资料调查表、医院焦虑抑郁量表、疾病感知量表、领悟社会支持量表、36条目简版生活质量问卷。术后3个月,通过电话随访再次完成36条目简版生活质量问卷的填写。比较患者术前、术后3个月生活质量的变化,并采用多重线性回归分析术后3个月生活质量的影响因素。结果:术前共纳入260例老年心脏择期手术患者,术前生活质量总分、生理健康维度和心理健康维度得分分别为(43.30±9.10)、(43.76±9.39)、(42.85±12.04)分。术后3个月随访获取研究对象215例,生活质量总分、生理健康维度和心理健康维度得分分别为(67.64±15.85)、(68.53±11.87)、(66.75±21.39)分;与术前比较差异均有统计学意义( P<0.01)。多重回归分析结果显示,心脏择期手术老年患者术后3个月生活质量的影响因素为年龄、ICU滞留时间、住院时间、术前抑郁、正性疾病感知、社会支持( P<0.05),共同解释术后3个月生活质量68.9%的变异量。 结论:心脏择期手术老年患者术后3个月生活质量的生理健康和心理健康维度均能得到改善。医护人员可以为心脏择期手术老年患者提供充足的疾病相关信息和社会支持,开展术前筛查,实施有针对性的干预,减轻患者术前消极心理,缩短住院时间,进一步改善其术后生活质量。

Objective To explore the improvement degree of quality of life of elderly patients after elective cardiac surgery,and analyze its influencing factors three months after surgery.Methods From February to September 2019,260 elderly patients with elective cardiac surgery in the Cardiac Surgery of Qilu Hospital of Shandong University were selected by convenient sampling.A questionnaire survey was conducted one day before the operation.The survey tools included the General Information Questionnaire,Hospital Anxiety and Depression Scale(HADS),Brief Illness Perception Questionnaire(BIPQ),Perceived Social Support Scale(PSSS),and the MOS 36-Item Short Form Health Survey(SF-36).Three months after operation,the patient completed the SF-36 through telephone follow-up.The quality of life of patients before and three months after operation was compared,and the influencing factors of the quality of life of patients three months after operation were analyzed by multiple linear regression.Results A total of 260 elderly patients undergoing elective cardiac surgery were enrolled before operation.Before operation,the total score,scores of physical health dimension and mental health dimension of quality of life were(43.30±9.10),(43.76±9.39)and(42.85±12.04)respectively.A total of 215 patients were followed up three months after operation,and the total score,physical health dimension and mental health dimension scores of quality of life were(67.64±15.85),(68.53±11.87)and(66.75±21.39)respectively,with statistical differences(P<0.01).Multiple regression analysis showed that the influencing factors of the quality of life of elderly patients with elective cardiac surgery three months after surgery were age,Intensive Care Unit residence time,hospital stay,preoperative depression,positive disease perception,and social support(P<0.05).These variables accounted for 68.9%of the variance of quality of life 3 months after surgery.Conclusions The physical and mental health dimensions of the quality of life of elderly patients with elective cardiac surgery are improved three months after surgery.Medical and nursing staff can provide sufficient disease information and social support for elderly patients undergoing elective cardiac surgery,carry out preoperative screening,implement targeted intervention,reduce patients'preoperative negative psychology,shorten hospital stay,and further improve their postoperative quality of life.