【作者】 张淑敏；

【导师】 李玉香；

【作者基本信息】 吉林大学 ， 临床医学硕士（内科学）（专业学位）， 2019， 硕士

【摘要】 目的:分析布鲁菌病患者治疗前后的生活质量,探索与其生活质量相关的影响因素,为指导临床工作、实施临床干预、评估预后提供依据。方法:本研究纳入确诊为布鲁菌病的住院患者60例,采用自制个人信息表收集患者的一般资料及临床资料,采用健康调查简表(The MOS 36-Item Short From Health Survey,SF-36)评估患者治疗前、治疗后1年、治疗后2年的生活质量,分析影响患者治疗前后生活质量的可能因素。使用SPSS l9.0软件进行数据的统计学分析。结果:本研究纳入布鲁菌病患者共60例,其中男性41例(68.3%),女性19例(31.7%),年龄:16-70岁,中位年龄为53岁,纳入的60例患者均完成治疗后1年的生活质量评估,56例患者完成治疗后2年的生活质量评估,其中1人死亡,3人失访。57例患者完成治疗后2年回访,其中痊愈49例(86.0%)、死亡1例(1.7%),布鲁菌病患者经治疗后临床症状较治疗前明显改善。治疗前患者生活质量较常模低,治疗后1年患者的生理职能、躯体疼痛、总体健康3个维度的得分低于常模,治疗后2年患者的躯体疼痛、总体健康2个维度的得分低于常模。治疗后患者的生活质量较治疗前显著提高,治疗后2年患者的生理职能、躯体疼痛、总体健康3个维度得分及总得分较治疗后1年高。对治疗前患者生活质量的单因素分析,可得出经济收入高、病程短、无乏力、无多汗、疼痛程度轻、血沉低者生活质量总得分较高,对患者治疗后2年生活质量的单因素分析,可得出经济收入高、病程短、无并发症、疼痛程度轻者生活质量总得分较高。对治疗前患者生活质量的多因素分析,可得出疼痛、乏力、血沉、饮食情况为生理功能维度的影响因素;病程为躯体疼痛维度的影响因素;年龄、经济收入为总体健康维度的影响因素;疼痛、乏力为活力维度的影响因素;疼痛、病程、经济收入为社会功能维度的影响因素;疼痛、血沉、乏力为精神健康维度的影响因素;疼痛、乏力为生活质量总得分的影响因素。对患者治疗后2年生活质量的多因素分析,可得出病程、并发症为生理功能维度的影响因素;并发症、经济收入、病程为生理职能维度的影响因素;并发症为躯体疼痛、社会功能维度的影响因素;并发症、经济收入为总体健康维度的影响因素;经济收入为活力维度的影响因素;病程、经济收入、并发症为精神健康维度的影响因素;病程、并发症、经济收入为生活质量总得分的影响因素。结论:1.布鲁菌病患者经治疗后临床症状明显改善,生活质量显著提高。2.布鲁菌病患者治疗前8个维度的生活质量均低于常模人群,经治疗后大部分维度的生活质量与常模无明显差异。3.治疗前患者生活质量各个维度的影响因素不同,乏力、疼痛可能为治疗前患者生活质量总得分的影响因素。4.治疗后2年患者生活质量各个维度的影响因素不同,病程、并发症、经济收入可能为患者远期生活质量总得分的影响因素。更多还原

【Abstract】 Objective: To analyze the quality of life of patients with brucellosis before and after treatment,explore the influencing factors related to the quality of life,providing basis for guiding clinical work,implementing clinical intervention and evaluating prognosis.Method: This study included 60 inpatients diagnosed with brucellosis.The general data and clinical data of patients were collected by self-made personal information table.The quality of life of patients before treatment,one year after treatment and two years after treatment were assessed by SF-36,and to analyze the factors affecting the quality of life of patients before and after treatment.Statistical analysis of data using SPSS l9.0 software.Result: 60 patients with brucellosis were included in this study,including 41 males(68.3%)and 19 females(31.7%),Age: 16-70 years,median age: 53.00.All 60 patients completed the quality of life assessment one year after treatment,56 patients completed the quality of life assessment two years after treatment,one of them died and three were lost to follow-up.57 patients were followed up for 2 years after treatment,49 cases(86.0%)were cured and 1 case(1.7%)died.The symptoms in patients with brucellosis after treatment were significantly improved compared with those before treatment.The quality of life of patients before treatment were lower than the norm.The scores of physical functioning,bodily pain and general health of patients one year after treatment were lower than the norm.The scores of bodily pain and general health of patients two years after treatment were lower than the norm.The quality of life of the patients after treatment were significantly improved compared with those before treatment.The scores of physical functioning,bodily pain and general health of the patients in two years after treatment were higher than that in one year after treatment.Single factor analysis of the quality of life of patients before treatment showed that the patients with high income,short course of disease,no fatigue,no hyperhidrosis,mild pain and low erythrocyte sedimentation rate had higher total score of quality of life.Single factor analysis of quality of life of patients 2 years after treatment showed that the patients with high income,short course,no complications and mild pain had higher total score of quality of life.Multivariate analysis of the quality of life of patients before treatment,we can conclude that pain,fatigue,erythrocyte sedimentation rate and dietary status were the influencing factors of physical functioning dimension;course of disease was influencing factors of bodily pain dimension;age and economic income were influencing factors of general health dimension;pain and fatigue were the influencing factors of vitality dimension;pain,course of disease and economic income were the influencing factors of social functioning dimension;pain,erythrocyte sedimentation rate and fatigue were the influencing factors of mental health dimension,pain and fatigue were the influencing factors of total score of quality of life.Multivariate analysis of quality of life of patients 2 years after treatment can conclude that course of disease and complications were the influencing factors of physical functioning dimensions;complications,economic income and course of disease were the influencing factors of role–physical dimension;complications was the influencing factors of bodily pain and social functioning dimensions;complications and economic income were the influencing factor of general health dimension;economic income was the influencing factor of vitality dimension;course of disease,economic income and complications were the influencing factors of mental health dimension;course of disease,complications and economic income were the influencing factors of total score of quality of life.Conclusion: 1.The clinical symptoms and quality of life of patients with brucellosis improved significantly after treatment.2.The quality of life of 8 dimensions of patients with brucellosis before treatment was lower than he norm group,there was no significant difference between the norm and the quality of life in most dimensions after treatment.3.The factors influencing the quality of life of patients before treatment were different,weakness and pain may be the factors influencing the total score of quality of life of patients.4.The factors influencing the quality of life of patients 2 years after treatment were different,course of disease,complications and economic income may be the factors influencing the total score of quality of life of patients 2 years after treatment.更多还原