【作者】 孙晶；

【导师】 李静；

【作者基本信息】 吉林大学 ， 疾病预防与控制（专业学位）， 2015， 硕士

【摘要】 随着科学技术的不断进步,人们的健康意识逐渐提高,温饱问题已不再是人们生活的重点,怎么提高生活质量成了大家深思的问题。类风湿关节炎(rheumatoid arthritis,RA)是一种慢性的反复发作的全身免疫性疾病,临床表现为对称性的多关节炎,可伴有发热、贫血、皮下结节及淋巴结肿大等关节外表现。即使经正确治疗,RA也不能完全治愈,疾病缓慢进展最终可导致关节畸形。RA患者由于长期遭受关节损害,如不及时治疗,病情将逐渐发展加重,最终导致关节强直、畸形、功能丧失,从而产生不同程度的残废,极大地降低患者的生活质量。因此,RA患者的生活质量状况不容忽视,而对于RA患者生活质量的研究具有非常重要的实践意义。目的:了解RA患者的生活质量、自我效能的现状,分析生活质量与一般情况、自我效能的关联,探讨RA患者生活质量的影响因素,临床的医护工作者可以以此为参考,为RA患者制定有针对性的护理措施和心理干预提供科学依据。方法:以长春市某三级甲等医院风湿免疫科住院的成年RA患者为研究对象,采用整群抽样,用问卷调查的方式对每个RA患者进行调查,所用问卷包括一般情况调查表、SF-36量表、慢性病自我效能量表,共发放问卷115份,回收问卷105份,其中有效问卷99份。采用Excel 2007进行数据录入,使用统计软件SPSS19.0对数据进行统计分析。计量资料采用均数±标准差(X±S)表示,计数资料采用构成比表示。一般资料(包括年龄、性别、病程等)对生活质量的影响,两组资料间比较采用独立样本t检验;生活质量与自我效能之间的关联,采用Pearson检验进行相关分析,以P<0.05为具有统计学意义。结果(1)RA患者生活质量情况及影响因素:被调查的99例RA患者生活质量的八个维度的得分方面,活力和心理健康维度得分相对较高,生理职能和情感问题所致的角色限制两个维度得分相对较低。影响因素方面,不同性别、职业状态的RA患者生活质量的八个维度得分差异均无统计学意义;而不同年龄的RA患者在生理功能、躯体疼痛、心理健康三个维度得分的差异有统计学意义(P<0.05);不同文化程度的RA患者在生理功能、躯体疼痛、总体健康、活力四个维度得分的差异有统计学意义(P<0.05);不同病程的RA患者在生理功能、躯体疼痛、活力、心理健康四个维度得分差异有统计学意义(P<0.05);不同活动受限程度的RA患者在生理功能、躯体疼痛、总体健康、活力、情感问题所致角色限制、心理健康六个维度的得分差异有统计学意义(P<0.05)。(2)RA患者自我效能情况及影响因素:被调查的99例RA患者自我效能在四个维度得分方面,应对问题维度得分最高,达成结果维度得分最低,总自我效能得分处于中等自我效能水平上。影响因素方面,不同性别、年龄、职业状态、文化程度、病程、活动受限程度的RA患者在自我效能四个维度的得分差异均无统计学意义。(3)生活质量与自我效能相关分析:自我效能中的自我管理分别与躯体疼痛、总体健康、活力、情感问题所致角色限制、心理健康;一般自我效能与躯体疼痛、总体健康、活力、社会功能;达成结果与生理职能、躯体疼痛、总体健康、活力、社会功能;应对问题与生理功能、生理职能、躯体疼痛、活力、社会功能、情感问题所致角色限制、心理健康之间存在相关(P<0.05),其余维度关联无统计学意义。其中,自我管理与躯体疼痛、总体健康、活力、情感问题所致角色限制、心理健康之间存在中度相关(0.3≤|r|<0.8且P<0.05);一般自我效能与躯体疼痛、总体健康、社会功能之间存在中度相关(0.3≤|r|<0.8且P<0.05);达成结果与生理职能、躯体疼痛、总体健康、社会功能之间存在中度相关(0.3≤|r|<0.8且P<0.05);应对问题与生理职能、躯体疼痛、社会功能情感问题所致的角色限制之间存在中度相关(0.3≤|r|<0.8且P<0.05),应对问题与心理健康相关性很强。结论:(1)RA患者的自我效能水平处于低水平。(2)RA患者的生活质量得分与年龄、文化程度、病程、活动受限程度等结果:因素相关,其中,≤44岁年龄段的RA患者生理功能、躯体疼痛维度得分高于>44岁年龄段的RA患者;初中以上文化程度的RA患者在生理功能、躯体疼痛、总体健康、活力四个维度得分高于初中及以下的RA患者;病程≤6年的RA患者在生理功能、躯体疼痛、活力、心理健康维度得分高于>6年的RA患者;活动受限程度≤2级的RA患者在生理功能、躯体疼痛、总体健康、活力、情感问题所致的角色限制、心理健康六个维度得分均高于活动受限程度>2级的RA患者。(3)不同年龄、性别、文化程度、职业状态、病程和活动受限程度的RA患者在自我效能四个维度得分差异无统计学意义。(4)生活质量得分与自我效能得分呈显著正相关。更多还原

【Abstract】 With the continuous development of social economy, people’s living standards continue to improve, people’s attitudes to health are changing. We are no longer just concerned about survival, but more concerned about the quality of survival. Therefore, the quality of life more and more high-profile research. Rheumatoid arthritis(RA) is a chronic recurrent autoimmune disease, with the symmetry of the hands, wrists, ankles and feet joints polyarthritis based, it can be accompanied by fever, anemia, subcutaneous knot outer section and lymph nodes and other joint performance. Even after proper treatment, rheumatoid arthritis cannot be completely cured, disease progression can lead to joint deformity. RA patients suffer due to the long joint damage, resulting in bodily pain, if not treated, the disease will be develop gradually increased, eventually leading to joint stiffness, deformity, loss of function, resulting in varying degrees of disability, which greatly reduces the quality of life of patients, and therefore RA quality of life of patients cannot be ignored, for the study of the quality of life in patients with RA has a very important practical significance. Object:Understanding the quality of life in patients with RA, the status of self-efficacy, analyze the quality of life associated with the general situation, self-efficacy, and to explore the factors affecting the quality of life in patients with RA, clinical nursing work to develop targeted prevention and intervention measures to provide scientific in accordance with.Method:Adult RA patients in Changchun City, a Division of Rheumatology hospitals of hospitalization for the study, the use of cluster sampling, using questionnaires to investigate each of RA patients, the use of questionnaires including the general questionnaire, SF-36 scale, chronic self-efficacy scale, a total of 115 questionnaires, 105 questionnaires, of which 99 valid questionnaires.Data entry using Excel 2007, using statistical software SPSS19.0 for statistical data analysis. Measurement data are mean ± standard deviation(X ± S), count data using the constitution ratio. General information(including age, sex, duration, etc.) on the quality of life, between two sets of data were compared using independent samples t-test; correlation between quality of life and self-efficacy, using Pearson correlation analysis test to P <0.05 was statistically significant. Results:1. Quality of life in patients with RA and the impact of factors: the quality of the investigated 99 cases of RA patients scoring eight dimensions of life, vitality and mental health scores of relatively high, due to the physiological functions and emotional problems limit the role of two dimensions relative score low. Affecting factors, gender, occupation patient status and quality of life of the eight scores of RA was no significant difference; the physiological function dimensions of RA patients of different ages, body pain dimensions, mental health scores of statistical differences significance(P <0.05); RA patients with different degrees of culture in physiological function, bodily pain, general health, vitality score four dimensions of difference was statistically significant(P <0.05). RA patients with different course of physiological function, bodily pain, vitality, mental health is my score each dimension difference was statistically significant(P <0.05); RA patients with different degrees of activity limitation in the physiological function of the quality of life, bodily pain, general health, vitality, role limitations due to emotional problems, mental health score six dimensions of difference was statistically significant(P <0.05).2. RA patients and influencing factors of self-efficacy: 99 cases of the four dimensions of RA patients were investigated aspects of self-efficacy scores, answers to scores of the highest scores of the results to reach the lowest total score in the self-efficacy of self-efficacy. Influence factors, RA patients with different sex, age, occupation status, education level, duration, degree of activity limitation in self-efficacy score difference was not statistically significant in four dimensions.3. Quality of life and self-efficacy correlation analysis: self-efficacy, respectively, in the self-management and physical pain, general health, vitality, role limitations due to emotional problems, mental health, general self-efficacy and physical pain, general health, vitality, social function, reach Results and physical function, bodily pain, general health, vitality, social function, to deal with problems and physical function, physical function, bodily pain, vitality, social functioning, role limitations due to emotional problems, there is a correlation(P between mental health <0.05), no statistically significant association remaining dimensions. Among them, the self-management and bodily pain, general health, vitality, role limitations due to emotional problems, there is a moderate correlation between mental health(0.3≤ | r | <0.8 and P <0.05); general self-efficacy and physical pain, general health, there is a moderate correlation between social function(0.3≤ | r | <0.8 and P <0.05); to achieve results with the physiological functions, physical pain, there is a moderate correlation(0.3≤ between general health, social function | r | <0.8 and P <0.05); between roles to deal with problems and physical function limitations, bodily pain, social function of emotional problems caused by moderate correlation(0.3≤ | r | <0.8 and P <0.05), to deal with psychological problems Health-related strong. Conclusion:1. The level of self-efficacy in RA patients at a low level.2. Quality of life in patients with RA scores with age, education level, duration, limited mobility and other factors related to where the quality of life of RA patients ≤44 years of age scored higher than> RA patients 44 years of age; junior high school or higher education score higher than junior high school and below the RA patients; duration ≤ 6 years of quality of life scores than patients with RA> RA patients 6 years; ≤2 degree of limitation of activity in RA patients is higher than the level of activity limitation level> 2 of RA patient.3. Different ages, RA patient sex, education, occupation status, duration and extent of activity limitation in self-efficacy score four dimensions no significant difference and so on.4. Quality of life scores and self-efficacy scores were significantly correlated, indicating that self-efficacy, the higher the score, the higher the quality of life, on the contrary, self-efficacy lower the score, the worse the quality of life.更多还原