唐山震后创伤后应激障碍对肝硬化患者自我健康管理水平的影响
|
摘要
目的探讨唐山地震后创伤后应激障碍(PTSD)对肝硬化患者自我健康管理水平的影响。方法选取2016年10月至2017年8月住院的271例亲身经历大地震的肝硬化患者进行问卷调查,包括一般状况调查问卷、肝硬化患者自我管理行为量表和PTSD检查表平民版,通过单因素及多因素分析明确影响肝硬化患者自我健康管理水平的危险因素。结果亲历地震的肝硬化患者的自我健康管理水平平均分为(53. 47±8. 32)分,处于偏低水平;PTSD患病率为11. 8%(32/271)。单因素分析结果显示,患者自我健康管理水平与肝硬化家族史、文化程度、病程、Child-Push分级和PTSD有关(P <0. 05,P <0. 01);多元线性回归分析结果显示,病程短和PTSD为肝硬化患者自我健康管理水平的独立不利影响因素(P均<0. 01)。结论 PTSD合并肝硬化患者存在特殊的心理状况,健康教育的内容、手段和方法等方面应加强心理干预,体现个性化。
Objective To investigate the impacts of post-traumatic stress disorder( PTSD) after Tangshan earthquake on self-health management level in patients with liver cirrhosis. Methods A total of 271 patients with liver cirrhosis who experienced Tangshan earthquake were selected from October 2016 to August 2017 for questionnaire survey,including general status questionnaire,Self-management Behavior Scale and PTSD Checklist-Civilian Version. Using single factor and multi-factor analysis,the risk factors affecting self-health management level were identified. Results The average level of self health management of these patients was 53. 47 ± 8. 32,being in the low level. The prevalence rate of PTSD was 11. 8%( 32/271). Univariate analysis showed that patients' self-health management level was related to family history of corrhosis,educated level,duration of disease,Child-Push classification and PTSD( P < 0. 05,P < 0. 01). Multiple linear regression analysis showed that shorter duration of disease and PTSD were the adverse factors affecting self-health management level of patients with liver cirrhosis( all P < 0. 01). Conclusion PTSD patients with liver cirrhosis present special psychological status,so the psychological intervention content,means and methods of health education should be strengthened and individualized.
Objective To investigate the impacts of post-traumatic stress disorder( PTSD) after Tangshan earthquake on self-health management level in patients with liver cirrhosis. Methods A total of 271 patients with liver cirrhosis who experienced Tangshan earthquake were selected from October 2016 to August 2017 for questionnaire survey,including general status questionnaire,Self-management Behavior Scale and PTSD Checklist-Civilian Version. Using single factor and multi-factor analysis,the risk factors affecting self-health management level were identified. Results The average level of self health management of these patients was 53. 47 ± 8. 32,being in the low level. The prevalence rate of PTSD was 11. 8%( 32/271). Univariate analysis showed that patients' self-health management level was related to family history of corrhosis,educated level,duration of disease,Child-Push classification and PTSD( P < 0. 05,P < 0. 01). Multiple linear regression analysis showed that shorter duration of disease and PTSD were the adverse factors affecting self-health management level of patients with liver cirrhosis( all P < 0. 01). Conclusion PTSD patients with liver cirrhosis present special psychological status,so the psychological intervention content,means and methods of health education should be strengthened and individualized.
引文
[1]杨燕,韦国永,黄永偶. 2004-2014年创伤后应激障碍文献的内容分析[J].中国心理卫生杂志,2016,30(9):689-693.
[2] Huber M,Schwarz W,Vogl T,et al. Clinical aspects of liver cirrhoses and its complications and diagnostic problems[J]. Radiologe,2001,41(10):840-851.
[3]王倩,王燕,高健,等.肝硬化患者自我管理行为量表的研制[J].中华护理杂志,2014,49(12):1515-1520.
[4] Weathers FW,Litz BT,Herman DS,et al. The PTSD Checklist(PCL):Reliability,validity,and diagnostic utility[C]. Preeding from the 9th Annual Conference of the International Society for Traumatic Stress Studies,San Antonio,[s. n],1993.
[5] Li H,Wang L,Shi Z,et al. Diagnostic utility of the PTSD Checklist in detecting ptsd in Chinese earthquake victims[J]. Psychol Rep,2010,107(3):733-739.
[6] Cone JE,Li J,Kornblith E,et al. Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11[J]. Am J Ind Med,2015,58(5):483-493.
[7]张本,张风阁,王丽萍,等. 30年后唐山地震所致孤儿创伤后应激障碍现患率调查[J].中国心理卫生杂志,2008,22(6):469-473.
[8] Liu ZY,Yang YF,Ye YL,et al. One-year follow-up study of posttraumatic stress disorder among adolescents following the Wen-Chuan earthquake in China[J]. Biosci Trends,2010,4(3):96-102.
[9]柯雄,杜军.震后远期青少年创伤后应激障碍与社会支持的关系研究[J].中国全科医学,2017,20(22):2788-2792.
[10]刘潇霞,熊国针,马道川,等.汶川地震灾区中学生地震创伤后应激障碍与领悟社会支持的关系[J].中华流行病学杂志,2009,30(10):1017-1020.
[11] Yang J. Development and validation of an online program for promoting self-management among korean patients with chronic hepatitis B[J]. Nurs Res Pract,2013,2013:702079.
[12]王瑞,张宗霞,骆欧,等.肝硬化患者心理特征和心理护理的系统评价[J].世界华人消化杂志,2012,20(31):3037-3042.
[13] Moore GA,Hawley DA,Bradley P. Hepatitis C:studying stigma[J].Gastroenterol Nurs,2008,31(5):346-352.
[14] Huang J,Guan ML,Balch J,et al. Survey of hepatitis B knowledge and stigma among chronically infected patients and uninfected persons in Beijing,China[J]. Liver Int,2016,36(11):1595-1603.
[15] Goenjian AK,Steinberg AM,Najarian LM,et al. Prospective study of posttraumatic stress,anxiety,and depressive reactions after earthquake and political violence[J]. Am J Psychiatry,2000,157(6):911-916.
[16] Schunk DH,Zimmerman BJ. Social origins of self-regulatory competence[J]. Educational Psychologist,1997,32(4):195-208.
[17] Bodenheimer T,Lorig K,Holman H,et al. Patient self-management of chronic disease in primary care[J]. JAMA,2002,288(19):2469-2475.
[2] Huber M,Schwarz W,Vogl T,et al. Clinical aspects of liver cirrhoses and its complications and diagnostic problems[J]. Radiologe,2001,41(10):840-851.
[3]王倩,王燕,高健,等.肝硬化患者自我管理行为量表的研制[J].中华护理杂志,2014,49(12):1515-1520.
[4] Weathers FW,Litz BT,Herman DS,et al. The PTSD Checklist(PCL):Reliability,validity,and diagnostic utility[C]. Preeding from the 9th Annual Conference of the International Society for Traumatic Stress Studies,San Antonio,[s. n],1993.
[5] Li H,Wang L,Shi Z,et al. Diagnostic utility of the PTSD Checklist in detecting ptsd in Chinese earthquake victims[J]. Psychol Rep,2010,107(3):733-739.
[6] Cone JE,Li J,Kornblith E,et al. Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11[J]. Am J Ind Med,2015,58(5):483-493.
[7]张本,张风阁,王丽萍,等. 30年后唐山地震所致孤儿创伤后应激障碍现患率调查[J].中国心理卫生杂志,2008,22(6):469-473.
[8] Liu ZY,Yang YF,Ye YL,et al. One-year follow-up study of posttraumatic stress disorder among adolescents following the Wen-Chuan earthquake in China[J]. Biosci Trends,2010,4(3):96-102.
[9]柯雄,杜军.震后远期青少年创伤后应激障碍与社会支持的关系研究[J].中国全科医学,2017,20(22):2788-2792.
[10]刘潇霞,熊国针,马道川,等.汶川地震灾区中学生地震创伤后应激障碍与领悟社会支持的关系[J].中华流行病学杂志,2009,30(10):1017-1020.
[11] Yang J. Development and validation of an online program for promoting self-management among korean patients with chronic hepatitis B[J]. Nurs Res Pract,2013,2013:702079.
[12]王瑞,张宗霞,骆欧,等.肝硬化患者心理特征和心理护理的系统评价[J].世界华人消化杂志,2012,20(31):3037-3042.
[13] Moore GA,Hawley DA,Bradley P. Hepatitis C:studying stigma[J].Gastroenterol Nurs,2008,31(5):346-352.
[14] Huang J,Guan ML,Balch J,et al. Survey of hepatitis B knowledge and stigma among chronically infected patients and uninfected persons in Beijing,China[J]. Liver Int,2016,36(11):1595-1603.
[15] Goenjian AK,Steinberg AM,Najarian LM,et al. Prospective study of posttraumatic stress,anxiety,and depressive reactions after earthquake and political violence[J]. Am J Psychiatry,2000,157(6):911-916.
[16] Schunk DH,Zimmerman BJ. Social origins of self-regulatory competence[J]. Educational Psychologist,1997,32(4):195-208.
[17] Bodenheimer T,Lorig K,Holman H,et al. Patient self-management of chronic disease in primary care[J]. JAMA,2002,288(19):2469-2475.