【作者】 张艳云；

【导师】 刘启贵；

【作者基本信息】 大连医科大学 ， 护理学， 2013， 硕士

【摘要】 目的:了解肝硬化住院患者的生活质量现状，通过探究肝硬化住院患者的医学应对方式，一般自我效能水平及领悟社会支持现状，来研究生理、心理、社会多个方面与其生活质量的相关性以及各方面之间的相互影响，为改善和提高肝硬化住院患者的生活质量寻求新的方法，并指导临床实践护理工作，为探究科学合理的临床护理干预措施提供有效的理论依据和可行性基础。方法：采用横断面相关性研究设计，通过随机抽样的方法，抽取内蒙古通辽市传染病院2012年3月-7月收治的符合本调查纳入标准的肝硬化住院患者120例，且患者均已了解此次研究的目的并愿意配合。采用问卷调查法，对入选研究对象由研究人员发放健康状况（SF-36）问卷、医学应对方式问卷(MCMQ)、领悟社会支持量表(PSSS)和一般自我效能感量表(GSES),应用统一指导语，对有疑问的问题和条目研究人员及时给予解释，问卷由研究对象独立完成，对于不能独立完成者，由研究人员采用问答形势填写问卷，问卷当场发放，当场收回，时间不超过20分钟。本次调查共发放问卷120份，有效问卷119份，有效率为98%。选用SPSS17.0、 Millitab15.0软件对调查数据进行统计分析，包括描述性分析、t检验、one-way方差分析、pearson线性相关分析及多元线性逐步回归等分析方法。结果：1.社会人口学资料显示：调查对象年龄范围为19-77岁，平均年龄为49±11岁；男性占75.6%，女性占24.4%；初中及以下（47%）、高中及以上（53%）；家庭月收入500-1500元占23.5%、1500-2500元占29.4%、2500-3500元占30.3%、3500以上占16.8%；已婚占89.8%，其他占11.2%；住院次数:1次占38.7%、2次占35.3%、2次以上占36%；生活自理情况：完全自理占64.7%、基本自理占31.1%、不能自理占4.2%；对医疗费用的承受能力:有足够承受能力占19.3%、基本能承受占46.2%、有一定困难占24.4%、困难比较大占10.1%；对疾病的了解程度：了解占34.4%、不了解占63.3%。2.(1)肝硬化生活质量水平明显低于常模，各维度比较其差异均有统计学意（p<0.001）。(2)不同生活自理能力的肝硬化住院患者生活质量的各维度中除情感职能这一维度外，其他各维度比较p值均小于0.01，各组间差异均有统计学意义。并且随着患者生活自理能力的提高，其生活质量各维度得分也逐步提高。(3)随着肝硬化患者对医疗费用承受能力的下降，其生活质量各维度得分呈逐渐下降的趋势。经方差分析，结果除“一般健康状况”这一维度外，其余各维度比较P值均小于0.05,差异有统计学意义。(4)经方差分析，肝硬化住院患者在对疾病知识不同的了解程度下，生活质量在“生理机能”和“社会功能”两个维度上差异具有统计学意义(P<0.01)。肝硬化住院患者对疾病的了解程度越差，其相应的生活质量水平越低。3.(1)肝硬化住院患者在选择医学应对方式方面，“面对”积极的应对方式和“回避”与“屈服”消极的应对方式，其得分均高于常模。经t检验，结果“回避”和“屈服”P值均小于0.001，差异有显著统计学意义。(2)肝硬化住院患者的领悟社会支持水平在中等水平，其中家庭内支持处于高水平，而家庭外支持处于中等水平。一般自我效能感处于较低水平。4.(1)肝硬化住院患者生活质量总分与“面对”呈正相关(r=0.225，P<0.05),与“回避”(r=-0.209,P<0.05)、“屈服”(r=-0.542,p<0.01)呈负相关。(2)肝硬化住院患者的生活质量总分与“外支持”(r=0.448,P<0.01)、“社会总支持”(r=0.366, P<0.01)及“自我效能”(r=0.568,P<0.01)呈正相关;其中“外支持”与生活质量中的“生理机能”、“生理智能”、“躯体疼痛”等八个维度均呈显著正相关(P<0.001)；生活质量的“社会功能”和“精神健康”维度与家庭内支持呈正相关;自我效能除“社会功能”（SF）这一维度外，和生活质量的其他维度均呈正相关关系(p<0.001)；“社会支持总分”除了“生理机能”（PF）外，与生活质量其他维度均呈正相关关系。(3)经线性逐步回归分析（stepwise）：“一般自我效能”、“生活自理能力”、“屈服”三个变量进入了回归方程，是影响肝硬化住院患者生活质量水平的最主要因素，其中“生活自理能力”的影响力最大（β=-0.364），其次是“屈服”消极的医学应对方式。结论:1.肝硬化住院患者的生活质量普遍较低。2.肝硬化住院患者多采取回避和屈服的消极应对方式。3.肝硬化住院患者的社会支持水平及一般自我效能感水平较低。4.肝硬化住院患者的生活质量与所采取的医学应对方式、个人的社会支持水平及一般自我效能水平相关。5.肝硬化住院患者的“一般自我效能”、“生活自理能力”、“屈服”为影响其生活质量的最主要因素。更多还原

【Abstract】 Objective:To investigate of the quality of life of hospitalized patients with hepaticcirrhosis status quo; to explore medical coping style, level of general self-efficacy andsocial support for the status quo in patients with hepatic cirrhosis, to study theinteraction to all aspects and correlation between all aspects as well as the quality of lifein hospitalized patients with hepatic cirrhosis; in order to improve seeking new waysand improve the quality of life of patients with hepatic cirrhosis, and guide clinical careand nursing and provide a theoretical basis to explore the science of nursinginterventions.Methods：Using descriptive design，and stochastic sampling method,120HepaticCirrhosis Patients were sampled from Inner Mongolia Tongliao City hospital forinfectious diseases. And patients have to understand the purpose of the study and arewilling to cooperate. The questionnaire survey of selected study released by researchersof health status (SF-36) questionnaire, medical Ways of Coping Questionnaire(MCMQ), Perceived Social Support Scale (PSSS) and general self-efficacy scale(GSES).To apply Unified guidance language, the researchers given timely explain todoubted entries and questions. The questionnaire completed independently byresearchers,to those they can not be independently fill out the questionnaire used byresearchers Answers situation to recover on the spot.120questionnaires weredistributed,119valid questionnaires, the effective rate of98%.Data were analyzed bydescriptive analysis, t-test, variance analysis, Pearson correlation analysis and multiplestepwise regression analysis using SPSS17.0、Millitab15.0statistical software.Results:1.Social demographic informed: Survey cases age ranged19-77years,mean age49±11years. Accounted for75.6percent of men, women accounted for24.4percent. Education: junior high school below47percent, high school above53percent,Households with a monthly income of500-1500yuan accounted for23.5percent, 1500-2500yuan in29.4percent,2500-3500yuan in30.3percent, More than3500accounted for16.8percent; married accounted for89.8percent, other11.2percent;frequency of hospitalization: one time in38.7percent, two time in35.3percent,accounting for36percent of the more than2times; daily living: completely take care ofthemselves in64.7percent, basic self-care accounted for31.1percent,4.2percent can nottake care of themselves; affordability of health care costs: affordability accounted for19.3percent, basic can withstand46.2percent, there are certain difficulties accountedfor24.4percent, difficulties are accounted for10.1the%; understanding of the disease:Understanding accounted for34.4percent,63.3percent do not understand.2.(1) The hospitalized patients with hepatic cirrhosis’s level of quality of life wassignificantly lower than the norm, the difference in the scores of SF-36was statisticallysignificant（P<0.05）.(2) The patients with hepatic cirrhosis in Different living skills, the difference inthe scores of the quality of life in addition to emotional functions, the other dimensionp-value less than0.01, there were significant differences among the groups. And withpatients living skills to improve, their quality of life scores also gradually increase.(3) With withstand a decline in the ability of patients with hepatic cirrhosis of themedical costs, quality of life scores showed a decreasing trend. Variance analysis, theresults of this dimension in addition to the general health status, the remainingdimension P values were less than0.05, the difference was statistically significant.(4) Hepatic Cirrhosis patients with different level of understanding of the diseaseknowledge, the quality of life of each dimension in two dimensions on the physiologicalfunction and social function difference was statistically significant (P <0.01) by analysisof variance. Patients with cirrhosis is worse, the level of understanding of the diseaseand its corresponding lower quality level.3.(1) Hepatic Cirrhosis patients compared with the national norm, Coping styles toscore are All higher than national norm, yield and evasive way are statisticallysignificant.(2) The level of perceived social support of patients with hepatic cirrhosis in themiddle level, where family support at a high level and outside the family support in themiddle level. Self-efficacy in a low level.4.(1) the Score of quality of life to hepatic Cirrhosis patients positively correlatedwith Faced coping style(r=0.225,P=0.014), and negatively correlated withavoided(r=-0.209,P<0.05) and yielded coping styles(r=-0.542,p<0.01). (2)The Score of quality of life to hepatic Cirrhosis patients positively correlatedwith "Outside family support","social support and "self-efficacy";(3)Multiple stepwise regression analysis of quality of life of patients with hepaticCirrhosis:"Self-efficacy"、"living skills "and " yielded coping styles "have significantinfluence to the QOL of the patients with hepatic Cirrhosis.Conclusions:1. The quality of life of patients with hepatic cirrhosis is generally low;2. The hepatic cirrhosis patients more take avoided and yielded negative copingstyle;3. Lower levels in patients with hepatic cirrhosis of the level of social support andself-efficacy;4. The quality of life of patients with hepatic cirrhosis correlated with the medicalcoping style, an individual’s level of social support and self-efficacy levels;5."Self-efficacy"、"living skills "and " yielded coping styles "have significantinfluence to the quality of life of patients with hepatic Cirrhosis.更多还原