【作者】 陈琳；

【导师】 张瑜； 袁媛； 路国涛；

【作者基本信息】 扬州大学 ， 护理（专业学位）， 2023， 硕士

【摘要】 目的1.编制高甘油三酯血症性急性胰腺炎患者认知问卷。2.探索高甘油三酯血症性急性胰腺炎患者认知水平的影响因素。3.了解高甘油三酯血症性急性胰腺炎患者康复期居家自我管理体验,为后期进行生活方式干预提供参考依据。4.依据专家函询构建并实施干预方案,初步验证干预效果,为制定相关健康管理措施提供参考。方法1.通过文献回顾确定条目池,经2轮专家函询,采用界值法筛选条目;用内在一致性信度、稳定性信度、结构效度及内容效度等方法检验信效度。2.本部分为横断面研究。在某三甲医院对康复期的高甘油三酯血症性急性胰腺炎患者进行随访;在两家三甲医院对住院患者进行问卷调查。随访组收集一般资料、认知问卷及实验室检查数据,住院组收集一般资料及认知问卷,采用多因素线性回归分析得分的影响因素。3.对随访组25名患者及2名患者家属进行质性研究,采用半结构访谈与开放式访谈相结合、一对一访谈与焦点团体相结合的方法,用主题分析法分析资料,探究患者自我管理体验。4.本部分为类实验研究。随访组共23名患者完成研究,用不平衡指数最小原则进行分组,其中干预组12人,对照组11人。于干预组开展为期1年的干预,对照组予常规宣教。分别于干预前、干预后6月及干预后12月比较两组血脂及空腹血糖水平、体脂率及去脂体重、体力活动水平、饮食中营养素供能比及疾病认知。结果1.高甘油三酯血症性急性胰腺炎患者认知问卷包括14个题项4个维度:基础知识、血脂知识、饮食知识和运动知识;满分为55分。信度检验采用内部一致性信度和重测信度来判定。总问卷的Guttman系数为0.88,4个维度的Guttman系数为0.61-0.87,间隔2周的重测信度为0.74-0.81,整体相关系数为0.75。采用专家评判法和验证性因子分析及检验内容效度和结构效度。问卷总体内容效度为0.74,各条目内容效度在0.91-1.00之间。根据前期专家函询预设维度进行验证性因子分析,拟合指标如下:X2/df:1.767,RMSEA:0.058,IFI:0.948,CFI:0.946,TLI:0.926,NFI:0.879,RFI:0.834。该问卷具有良好的信效度。同时进行难度及区分度检验。问卷的总难度为0.65,各维度难度范围为0.22-0.83;问卷的总区分度为0.36,各维度区分度为0.20-0.54。问卷鉴别性良好。因其基本满足试卷的难度及区分度,采用60%满分作为截断值,即33分为截断值。2.HTG-APKQ均值为35.90,处于及格线水平。多因素线性回归分析结果显示,得分与婚姻状况、低密度脂蛋白水平、餐后2小时血糖水平、红肉、肥肉及内脏摄入频率及体重相关(P<0.05);其中低密度脂蛋白、餐后2小时血糖及红肉、肥肉及内脏摄入频率与得分负相关。3.质性研究共访谈25名患者及2名家属,分析资料后生成如下5个主题:遗憾、不确定感、矛盾、应对方式及获益。患者在经历痛苦的挣扎后,最终达到比较稳定的应对状态。4.干预前基线各组数据均衡可比(P<0.05),分析干预后两组重复测量方差分析及t检验结果如下所示。4.1血脂及空腹血糖不存在组间效应、测量次数效应及交互效应(P>0.05);干预组后测血糖低于基线,对照组后测血糖高于基线(P<0.001)。4.2疾病认知总分及血脂知识维度存在交互效应(P<0.05),中测大于前测。总分不存在组间效应(P>0.05),血脂知识维度存在组间效应(P<0.05),干预组大于对照组(P<0.05)。4.3体脂率组别效应及交互效应不显著(P<0.05),测量次数效应显著(P<0.05),后测高于中测;干预组后测值及中测值均低于对照组(P<0.05)。去脂体重不存在组别效应、测量次数效应及交互效应(P>0.05)。4.4体力活动强度值不存在组别效应、测量次数效应及交互效应(P<0.05),后测时干预组体力活动强度值高于对照组(P<0.05)。4.5营养素供能比中,蛋白质供能比无组间效应、测量次数效应及交互效应(P>0.05);脂肪供能比存在交互效应(P<0.05),不存在组间效应及测量次数效应(P>0.05);碳水供能比存在测量次数效应及交互效应(P<0.05),前测高于中测。后测时干预组碳水供能比低于对照组,中测及后测时干预组脂肪供能比高于对照组(P<0.05)。4.6卡方检验结果示,中测时干预组体力活动等级为高者比例大于对照组,干预组体力活动等级为中者比例低于对照组(P<0.05)。t检验结果示,干预组复发率低于对照组(P<0.05)。结论1.HTG-AP患者认知问卷具有良好信效度,各指标均基本符合测量学标准,可应用于患者群体。2.HTG-AP患者总体认知水平处于及格线水平。患者行为与疾病认知有一定相关性,应注重出院后康复期的健康教育。3.HTG-AP患者出院后康复期仍需进行较为严格的生活方式管理,但缺乏相关知识及指导且难以坚持;应当加强资源支持协助患者提升生活管理能力。4.以营养学为主的生活方式干预能有效提高患者认知水平,优化患者饮食结构,并能改善部分客观指标,降低复发率。更多还原

【Abstract】 Aims1.To develop a cognitive questionnaire of patients with hypertriglyceridemia-induced acute pancreatitis.2.To explore the influencing factors of cognitive level in patients with hypertriglyceridemia-induced acute pancreatitis.3.To understand the self-management experience of patients with hypertriglyceridemia-induced acute pancreatitis at home during the convalescent period,which is the later stage to provide reference for lifestyle intervention.4.Conduct and construct and implement intervention programs,and preliminarily verify intervention effects,as follows formulate relevant health management measures to provide reference.Methods1.The first draft was determined through two rounds of expert letter consultation,and the final draft was determined by reliability and validity test,difficulty and differentiation.2.Follow-up of convalescent patients with hypertriglyceridemia-induced acute pancreatitis in a tertiary hospital;In-patient questionnaires were conducted at two Grade III hospitals.General information,cognitive questionnaire and laboratory test data were collected in the follow-up group,and general information and cognitive questionnaire were collected in the hospitalization group,and the influencing factors of score were analyzed.3.A descriptive study was conducted on patients in the follow-up group.The methods of semi-structured interview and open interview,one-to-one interview and focus group orientation were adopted to analyze data by subject analysis method.and explore patients’ self-management experience.4.Construct intervention plan and conduct 1-year health behavior improvement on the intervention group;The control group received routine education.The levels of blood lipid and fasting blood glucose,body fat percentage and weight without fat,physical activity level,nutrient energy ratio in diet and disease cognition were compared between the two groups at baseline,6 months and 12 months after intervention,respectively.Results1.The cognitive questionnaire for patients with hypertriglyceridemia-inducedacute pancreatitis included 14 questions and 4 dimensions:basic knowledge,knowledge of blood lipids,diet knowledge and exercise knowledge;The full score is 55.The reliability test is determined by internal consistency reliability and retest reliability.The Guttman coefficient of the total questionnaire was 0.872,the Guttman coefficient of the four dimensions was 0.605-0.872,the retest reliability of 2 weeks interval was 0.736-0.813,and the overall correlation coefficient was 0.75.Expert evaluation method and confirmatory factor analysis were used to test the content validity and structure validity.The overall content validity of the questionnaire was 0.74,and the content validity of each item was between 0.090-1.Confirmatory factor analysis was conducted according to the preset dimensions of the earlier expert letter consultation,and the fitting indexes were as follows:X2/df:1.767,RMSEA:0.058,IFI:0.948,CFI:0.946,TLI:0.926,NFI:0.879,RFI:0.834.The questionnaire has good reliability and validity.At the same time,the difficulty and differentiation test were carried out.The total difficulty of the questionnaire was 0.65,and the difficulty range of each dimension was 0.217-0.834.The total differentiation of the questionnaire was 0.36,and the differentiation of each dimension was 0.20-0.542.The identification of the questionnaire was good.Since it basically meets the difficulty and differentiation of the test paper,60%full mark is used as the cut-off value,that is,33 points.2.The mean value of HTG-APKQ was 35.90,which was at the pass line level.Multivariate linear regression analysis showed that the score was correlated with marital status,low density lipoprotein level,blood glucose level 2 hours after meals,intake frequency of red meat,fat meat and viscera,and body weight(P<0.05).The score was negatively correlated with low density lipoprotein,blood glucose 2 hours after meals and the intake frequency of red meat,fat meat and offal.3.A total of 25 patients and 2 family members were interviewed in the qualitative study.After analyzing the data,the following five themes were generated:regret,uncertainty,conflict,coping style and benefit.After experiencing the painful struggle,the patient finally reached a relatively stable coping state.4.Before intervention,baseline data were comparable in each group(P<0.05).After intervention,repeated measurement variance analysis and T-test results of the two groups were analyzed as follows.4.1 There was no intergroup effect,number of measurements effect and interaction effect on blood lipid and fasting blood glucose(P>0.05).The blood glucose measured after intervention group was lower than baseline,and the blood glucose measured after control group was higher than baseline(P<0.001).4.2 The total score of disease cognition and knowledge of blood lipid had an interactive effect(P<0.05),and the medium test was higher than the pre-test.There was no intergroup effect on total score(P>0.05),but there was an intergroup effect on knowledge of blood lipid(P<0.05),and the intervention group was larger than the control group(P<0.05).4.3 The group effect and interaction effect of body fat percentage were not significant(P<0.05),but the number of measurements was significant(P<0.05),and the posttest was higher than the middle test.The posttest and middle testvalues of the intervention group were lower than those of the control group(P<0.05).There was no group effect,number of measurements effect and interaction effect(P>0.05).4.4 There was no group effect,number of measurements effect or interaction effect on the physical activity intensity(P<0.05),and the physical activity intensity in the intervention group was higher than that in the control group(P<0.05).4.5 In nutrient energy supply ratio,protein energy supply ratio had no intergroup effect,number of measurements effect and interaction effect(P>0.05).The energy supply ratio of fat had an interaction effect(P<0.05),but no intergroup effect or number of measurements effect(P>0.05).The energy supply ratio of carbon and water had the measurement frequency effect and the interaction effect(P<0.05),and the pre-test was higher than the middle test.The carbon and water energy supply ratio in the intervention group was lower than that in the control group at the time of post-test,and the fat energy supply ratio in the intervention group was higher than that in the control group at the time of mid-test and post-test(P<0.05).4.6 Chi-square test results showed that the proportion of high physical activity level in the intervention group was greater than that in the control group,while the proportion of medium physical activity level in the intervention group was lower than that in the control group(P<0.05).T-test results showed that the recurrence rate in the intervention group was lower than that in the control group(P<0.05).Conclusion1.The cognitive questionnaire for HTG-AP patients has good reliability and validity,and all indicators basically meet the measurement standards,which can be applied to the patient population.2.The overall cognitive level of TG-AP patients was fair and at the level of passing line.There is a certain correlation between patient behavior and disease cognition,so we should pay attention to health education after discharge.3.Patients with HTG-AP still need to undergo relatively strict lifestyle management during the recovery period after discharge,but this process is usually difficult,with a series of problems and obstacles to overcome.External support should be strengthened to assist patients.4.The research to improve patients’health behavior can effectively improve patients’ cognitive level,optimize their diet structure,improve some objective indicators and reduce the recurrence rate.更多还原