脊髓损伤患者康复期生存质量的影响因素

目的：通过对住院康复期的脊髓损伤人群生存质量的影响因素研究,探讨改善脊髓损伤患者生存质量的干预方式。方法：对91例初次发病后1—2个月住院康复期的脊髓损伤者生存质量及其社会人口统计学指标、生理学指标、功能活动等17种可能相关因素进行调查、评估,采用逐步多重线性回归分析法进行分析,筛选影响患者生存质量的相关因素。 结果：影响生存质量总分的多因素分析,进入回归方程的变量共有4个：日常生活活动能力、家庭摩擦、医疗费来源及性别,复相关系数为0.773。影响生理领域的多因素分析,进入回归方程的变量共有4个：康复治疗方法、日常生活活动能力、大小便自控能力及并发症,复相关系数为0.703。影响心理领域的多因素分析,进入回归方程的变量共有4个：日常生活活动能力、家庭摩擦、婚姻状况及性别,复相关系数为0.668。影响社会领域的多因素分析,进入回归方程的变量共有2个：性生活满意与否、婚姻状况,复相关系数为0.462。影响环境领域的多因素分析,进入回归方程的变量共有3个：闲暇活动、日常生活活动能力及并发症,复相关系数为0.593。结论：影响脊髓损伤患者康复期生存质量的相关因素涉及社会人口统计学、心理、生理及康复治疗方法等多方面的因素,对这些因素的干预是提高脊髓损伤患者生存质量的重要手段。     

老年住院患者生存质量的调查与影响因素分析

目的探讨老年住院患者的生存质量以及影响生存质量的因素。方法采用生存质量调查量表对121名老年住院患者进行调查,与常模的生存质量进行比较。同时分析年龄、性别、在职情况、文化程度、费用支出情况对生存质量的影响。结果老年住院患者的生存质量各维度明显低于常模,差异有统计学意义（P〈0．01）。年龄、性别、婚姻状况和费用支出方式对老年住院患者的心理健康影响较大,且年龄、性别、在职情况和文化程度对老年住院患者的生理影响较大。结论老年住院患者作为特殊人群,需要社会投入更多的关注。     

娱乐康复对脊髓损伤患者生存质量的影响

目的探讨娱乐康复治疗对脊髓损伤患者生存质量的影响。方法将64例脊髓损伤患者随机分成治疗组(32例)和对照组(32例),两组均给予常规的康复治疗及药物治疗,治疗组再给予娱乐康复治疗,两组治疗时间均为2个月。两组治疗前后各用Barthel指数和生存质量评定量表(WHOQOL-BREF)对其生存质量(QOL)进行评定。结果 2个月后治疗组的WHOQOL-BREF评分(79.36±11.47)明显高于对照组的68.42±10.27,差异有统计学意义(P0.05),治疗组Barthel指数81.79±13.52明显高于对照组的70.12±12.36,差异有统计学意义(P0.05)。结论娱乐康复治疗对提高脊髓损伤患者的生存质量有显著疗效。     

脊髓损伤患者康复期生存质量的研究

目的：测量脊髓损伤患者住院康复期的生存质量,以及康复治疗对脊髓损伤患者生存质量的影响,探讨改善脊髓损伤患者生存质量的干预方式。方法：91例符合入选标准的住院康复期的脊髓损伤患者,分为综合康复组和传统康复组;100例符合入选标准的骨关节疾患非脊髓损伤需要康复治疗的患者作为对照组。结果：脊髓损伤患者26—50岁占57.14%,损伤原因交通事故、高处坠落、重物砸伤占73.63%。比较生存质量总分及各领域得分,脊髓损伤患者明显低于骨关节疾患非脊髓损伤患者(P<0.05)。治疗前后比较,综合康复组和传统康复组生存质量总分、生理领域得分、环境领域得分均有所提高(P<0.05),但心理领域得分有所下降,社会领域得分差异无显著性意义。治疗前后生存质量总分、生理领域得分综合康复组比传统康复组提高更明显(P<0.05)。治疗后两组BI均有明显提高（P<0.01）,综合康复组比传统康复组改善更明显（P<0.05）。结论：脊髓损伤患者以青壮年为主,康复期脊髓损伤患者的生存质量比骨关节疾患非脊髓损伤人群低。现代康复治疗技术与传统中医相结合的综合康复治疗能更有效地提高康复期脊髓损伤患者的日常生活活动能力及生存质量。     

早期康复治疗对脊髓损伤患者生存质量的影响

目的探讨早期康复治疗对脊髓损伤患者生存质量（Quality of life,QOL）的影响。方法选择脊髓损伤患者86例,按康复治疗介入的时间分为早期康复组（3个月内就诊）46例和对照组（3个月后就诊）40例,两组均接受常规康复治疗,并对每组患者在入组时和6个月后利用生存质量评定量表（WHOQOL—BREF）中文版对其QOL进行评定。结果与治疗前比较,早期康复组和对照组患者在治疗后的QOL评分均有显著提高（分别提高21．39±6．57;12．53±6．88,P〈0．05）,但治疗后,早期康复组的QOL评分（78．55±8．32）高于对照组（69．98±14．06）,且差异有统计学意义（P〈0．05）。结论早期康复治疗可以提高脊髓损伤患者的生存质量。     

老年前列腺增生症患者生存质量影响因素分析

目的探讨老年前列腺增生症患者生存质量影响因素，为制定相应的干预措施提供依据。方法采用整群抽样方法，用世界卫生组织生存质量量表简表（WHOQOL—BREF）及老年抑郁量表（GDS）对294名60岁以上老年前列腺增生症患者及健康老年男性进行问卷调查。结果老年前列腺增生症患者在生存质量的生理领域、心理领域、社会关系及环境领域得分均低于健康组，抑郁得分高于健康组。两组人群t检验比较在生理领域差异有统计学意义，但在心理、社会关系和环境领域，不能认为有差异。用多重逐步回归分析，对生存质量影响因素有：经济状况、与伴侣的关系、身体是否健康、疾病症状、饮酒、目前的职业。结论前列腺增生症对老年患者的生存质量有影响，尤其是生理活动方面。要提高患者的生存质量，首先要采取积极治疗措施，减轻病症对患者生理活动的影响，其次要改善患者的抑郁症状，还要对患者进行有针对性的医疗干预。     

脑卒中患者生存质量影响因素分析

目的：研究分析脑卒中患者生存质量的影响因素。方法：采用前瞻性队列研究设计，运用方便抽样的原则选取80例在我院就诊的中老年脑卒中患者进行研究，研究数据均经SPSS 13．0软件包进行处理分析。结果：脑卒中后1个月患者的总体生存质量主要与文化程度、照顾类型、性别、病变部位、婚姻、合并症6个变量有关，脑卒中后4个月患者的总体生存质量主要与是否接受护理干预、婚姻、社会支持、性别4个变量有关。结论：随着脑卒中后时间的不同，患者生存质量的主要影响因素会发生变化，在护理过程中要注意识别这些影响因素，并采取相应的对策加以控制。     

脊髓损伤患者呼吸肌功能障碍及影响因素分析

目的：调查脊髓损伤（SCI）患者呼吸肌功能及其影响因素,为SCI患者呼吸功能康复策略的制定提供依据。方法：选取SCI患者60例,根据吸气肌百分比（实际肌力指数/预计肌力指数）将患者分为呼吸肌功能障碍组（<50%）35例和对照组（≥50%）25例。收集所有患者的基本资料,包括性别、年龄、职业、运动爱好、BMI、病因、病程、损伤平面、ASIA残损程度分级、ASIA感觉/运动评分。采用多因素Logistic 回归分析影响SCI患者呼吸肌功能障碍的影响因素。结果：在60例患者中,呼吸肌功能障碍发生率为58.27%。单因素分析结果显示,不同呼吸肌功能障碍组间在性别、损伤部位、ASIA残损程度分级、运动得分和感觉得分间差异均具有统计学意义(P<0.05),进一步多因素Logistic 回归分析表明,BMI、病程和AISA残损分级是SCI患者呼吸肌功能障碍的独立影响因素（P<0.05）,其中BMI分级和ASIA残损程度分级为危险因素,病程为保护性因素。结论：SCI后约有60%患者会存在呼吸肌功能障碍,BMI、病程和ASIA残损程度分级是影响SCI患者呼吸肌功能的重要因素,对于肥胖伴完全性SCI患者应尽早介入呼吸肌训练,促进患者呼吸功能恢复。     

老年尿毒症患者生存质量影响因素的调查分析

目的探讨老年尿毒症患者生存质量的影响因素,为制定相应的干预措施提供依据。方法采用世界卫生组织生存质量量表简表（WHOQOL—BREF）和老年模块量表（WHOQOL—OLD）,对56例60岁以上老年尿毒症患者及健康老年男性进行问卷调查。以14项人口学资料作为预筛选因素中的自变量,分别以WHOQOL—BREF总分和WHOQOL—OLD总分为因变量,对老年尿毒症患者生存质量进行影响因素分析。结果疾病并发症对老年尿毒症患者的生存质量有显著影响,其他影响因素包括：和伴侣的关系、性生活满意度、与孙辈的关系、经济状况、健康状况自评。结论尿毒症对老年患者生存质量有影响,尤其是生理活动方面,有针对性的医疗干预始终是提高患者生存质量的保证,其次要注意对患者的心理护理,发挥家庭与情感对提高生存质量的积极作用。     

创伤性脊髓损伤慢病管理期患者功能独立性现状及影响因素分析

目的:了解创伤性脊髓损伤慢病管理期患者的功能独立性现状,并分析其影响因素。方法:本研究为横断面研究。采用多阶段分层抽样法,选取2018年1—10月在四川省9所医院骨科、康复科接受治疗的161例创伤性脊髓损伤患者为研究对象,采用一般资料调查表和中文版脊髓独立性评定量表（第三版）对其进行调查。采用多重线性回归分析进行影响因...     

广东省脊髓损伤患者社区融合现状及其影响因素的分析

目的:调查广东省脊髓损伤患者的社区融合现状,分析影响社区融合的因素。方法:本研究采用电话随访、线上调查、实地调研的方式收集脊髓损伤患者的一般社会资料和疾病资料、日常生活能力情况及社区融合情况。统计描述脊髓损伤患者社区融合现状并采用单因素分析及多元线性回归分析影响脊髓损伤患者社区融合的因素。结果:154名脊髓损伤患者的社区融合问卷(CIQ)平均得分为10.31±6.03,其中家庭融合平均得分为3.20±3.00;社交融合平均得分为5.59±2.37;生产活动平均得分为1.53±1.93。单因素分析表明:年龄、损伤节段、病程、出入口是否方便、有无照顾者等因素对社区融合影响较为显著。多因素分析表明:病程对社区融合影响最大,其次为年龄、有无照顾者、损伤节段。结论:广东省脊髓损伤患者社区融合现状整体偏低。脊髓损患者的社区融合程度受患者损伤节段、病程、年龄、有无照顾者以及物理环境因素的影响。     

The level and influencing factors of quality of life in patients with brachial plexus injury

PurposeTo investigate the overall quality of life level and identify influencing factors in patients with traumatic brachial plexus injury.MethodsOne hundred three patients with brachial plexus injury were assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Family Adaptability and Cohesion Evaluation Scale (FACESII-CV) questionnaires.ResultsThe overall quality of life score from patients with brachial plexus injury was 65.78 ± 15.2. The scores for the physical, psychological and environmental factors were significantly lower than the norm (Ps < 0.05). Regression analysis showed that age, injury located ipsilateral to the dominant hand, upper limb function score, score of family intimacy and family income were all factors influencing the of quality of life.ConclusionsA brachial plexus injury significantly compromises an individual's quality of life. Multiple factors influence this quality, which should be targeted to augment the physical and psychological care provided.     

Interference due to pain following spinal cord injury: important predictors and impact on quality of life

Two studies were designed to examine important predictors of pain following spinal cord injury (SCI), and the impact of pain on self-reported quality of life (QOL). Pain was defined as ‘interference in day-to-day activities secondary to pain’. In order to determine risk factors associated with the development of pain interference, Study 1 examined the predictive validity of multiple demographic, medical, and QOL variables at year 1 post-SCI to self-reported pain interference 2 years post-injury. Results showed that middle age (30–59-year-olds), lower self-reported mental health, and pain interference at 1 year post-SCI were the most important unique predictors of pain interference 2 years post-SCI. In Study 2, participants were separated into four groups; (1) those pain-free at years 1 and 2, (2) those pain-free at year 1 and in pain at year 2, (3) those in pain at year 1 and pain-free at year 2, and (4) those in pain at years 1 and 2. Results showed that only those experiencing a change in pain interference status reported a change in QOL. More specifically, those developing pain interference (group 2) from year 1 to year 2 reported decreased life satisfaction, physical health, and mental health, whereas, those with resolving pain interference from year 1 to year 2 reported an increase in these same domains. Unexpectedly, change in pain interference status was unrelated to change in self-reported handicap. Implications and future directions are discussed.     

Aging,spinal cord injury,and quality of life: structural relationships

OBJECTIVE: To quantify relationships among 3 sets of factors: demographic factors, health and disability factors, and quality of life (QOL). DESIGN: Part of a program of longitudinal research on aging and spinal cord injury (SCI) involving 3 populations: American, British, and Canadian. The present analysis uses data from the 1999 interval. SETTING: The Canadian sample was derived from the member database of the Ontario and Manitoba divisions of the Canadian Paraplegic Association. The British sample was recruited from a national and a regional SCI center in England. The American sample was recruited through a hospital in Colorado. PARTICIPANTS: A sample of 352 participants was assembled from 4 large, well-established databases. The sample included individuals who had incurred an SCI at least 20 years earlier, were admitted to rehabilitation within 1 year of injury, and were between the ages of 15 and 55 at the time of injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A combination of self-completed questionnaires and interviews. Data included demographics, injury-related variables, health and disability-related factors, QOL, and perceptions about aging. RESULTS: Using linear structural relationships modeling, we found that QOL was affected both directly and indirectly by age, health and disability problems, and perceptions of aging. Two surprising findings were as follows: those who experienced fewer disability-related problems were more likely to report a qualitative disadvantage in aging, and the younger members of the sample were more likely to report fatigue. CONCLUSIONS: Fatigue is a concern because of the relationship of fatigue with perceived temporal disadvantage in aging, health problems, and disability problems. This finding highlights the need for clinical vigilance among those just beginning to experience the effects of aging.     

脊髓损伤患者神经病理性疼痛现况调查及相关影响因素分析

目的 调查脊髓损伤患者神经病理性疼痛（NP）现况,并分析其相关影响因素。 方法 先用DN4量表在所有诊断为脊髓损伤的患者中筛选出伴有NP的患者,搜集70例脊髓损伤伴NP患者的性别、年龄、文化程度、职业、平均月收入、损伤部位、婚姻状态等一般调查资料,然后再对筛选出来的患者用简化的McGill疼痛问卷表（SF-MPQ）进行NP现况调查,记录患者的疼痛目测类比法（VAS）评分以及疼痛评级指数(PRI),包括PRI-感觉项、PRI-情感项及PEI等平均得分;采用SPSS13.0统计软件对患者的基本资料进行单因素和多因素统计分析,分析患者NP的影响因素。 结果 ①患者的平均疼痛目测类比法（VAS）评分4.37分;SF-MPQ调查的平均PRI得分8.23分,PRI-感觉项平均得分5.2 3分,PRI-情感项平均得分3.00分;现在疼痛强度(PPI)平均程度为1.86,PPI介于轻痛和难受之间,PPI中出现最多的是难受这个描述词。疼痛描述词按出现频率排在前三位的是刺痛、烧灼痛和坠胀痛。有60例（85.7%）患者认为疼痛对其情感状态造成影响,出现最多的是疲惫耗竭感这个描述词。②单因素分析显示损伤程度、文化程度、婚姻状况、家庭人均月收入、家人支持与否以及是否用药是NP的影响因素（P<0.01）,而性别、年龄、病程、损伤部位、职业等因素与VAS评分无明显相关性（P>0.05）;多因素Logistic回归分析显示,未婚、损伤程度重为NP的独立保护因素（OR＜1）,家庭人均月收入低、没有家人支持、没有用药为NP的独立危险因素（OR＞1）。 结论 脊髓损伤患者NP感觉多样,疼痛程度中等,绝大多数患者情感状态受到影响;未婚和损伤程度重为独立保护因素,家庭人均月收入低、没有家人支持及没有用药为其独立危险因素。     

Mechanical ventilation, health, and quality of life following spinal cord injury

Charlifue S, Apple D, Burns SP, Chen D, Cuthbert JP, Donovan WH, Lammertse DP, Meade MA, Pretz CR. Mechanical ventilation, health, and quality of life following spinal cord injury.

Objective

To examine differences in perceived quality of life (QOL) at 1 year postinjury between people with tetraplegia who required mechanical ventilation assistance at discharge from rehabilitation and those who did not.

Design

Prospective cross-sectional examination of people with spinal cord injury (SCI) drawn from the SCI Model Systems National Database.

Setting

Community.

Participants

People with tetraplegia (N=1635) who sustained traumatic SCI between January 1, 1994, and September 30, 2008, who completed a 1-year follow-up interview, including 79 people who required at least some use of a ventilator at discharge from rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Satisfaction With Life Scale (SWLS); Craig Handicap Assessment and Reporting Technique (CHART)-Short Form Physical Independence, Mobility, Social Integration, and Occupation subscales; Patient Health Questionnaire-9 (PHQ-9), Medical Outcomes Study 36-Item Short-Form Health Survey self-perceived health status.

Results

Significant differences were found between the ventilator-user (VU) group and non–ventilator-user (NVU) group for cause of trauma, proportion with complete injury, neurologic impairment level, and number of rehospitalizations. The NVU group had significantly higher SWLS and CHART Social Integration scores than the VU group after controlling for selected covariates. The NVU group also had more positive perceived health status compared with a year previously and a lower incidence of depression assessed by using the PHQ-9 than the VU group. There were no significant differences between groups for perceived current health status.

Conclusions

People in this study who did not require mechanical ventilation at discharge from rehabilitation post-SCI reported generally better health and improved QOL compared with those who required ventilator assistance at 1 year postinjury. Nonetheless, the literature suggests that perceptions of QOL improve as people live in the community for longer periods.     

The association of race, cultural factors, and health-related quality of life in persons with spinal cord injury

Myaskovsky L, Burkitt KH, Lichy AM, Ljungberg IH, Fyffe DC, Ozawa H, Switzer GE, Fine MJ, Boninger ML. The association of race, cultural factors, and health-related quality of life in persons with spinal cord injury.

Objective

To examine the association of race and cultural factors with quality-of-life factors (participation, life satisfaction, perceived health status) in people with spinal cord injury (SCI).

Design

Cross-sectional multisite study using structured questionnaires.

Setting

Six National SCI Model Systems centers.

Participants

People with SCI (N=275; age ≥16y; SCI with discernable neurologic impairments; used power or manual wheelchair for >1y as primary means of mobility; nonambulatory except for exercise purposes).

Interventions

None.

Main Outcome Measures

Participation (Craig Handicap Assessment and Reporting Technique Short Form); satisfaction (Satisfaction With Life Scale); and perceived health status (2 items from 36-Item Short Form Health Survey).

Results

African American (n=96) with SCI reported more experiences of discrimination in health care, greater perceived racism, more health care system distrust, and lower health literacy than whites (n=156; P range, <.001–<.05). Participants who reported experiencing more discrimination in health care reported better occupational functioning (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.07–2.09; P<.05). Those who perceived more racism in health care settings reported better occupational functioning (OR, 1.65; 95% CI, 1.12–2.43; P<.05) and greater perceived health (β=.36; 95% CI, .05–.68; P<.05). Those who reported more distrust in the health care system reported better current health compared with 1 year ago (β=.38; 95% CI, .06–.69; P<.05). Those who reported better communication with their health care provider reported higher levels of mobility (OR, 1.5; 95% CI, 1.05–2.13; P<.05) and better general health (β=.27; 95% CI, .01–.53; P<.05).

Conclusions

In this cross-sectional study of people with SCI, higher levels of perceived discrimination and racism and better communication with health care providers were associated with an increase in participation and functioning and improvements in perceptions of well-being. These associations are different from those reported in other study populations and warrant confirmation in future prospective studies.     

肠造口患者初期不同阶段生活质量调查及影响因素分析

目的 探讨肠造口患者初期生活质量的变化及各阶段生活质量的影响因素.方法 选取2009年12月-2010年10月确诊为直肠癌行Miles术肠造口患者60例,采用欧洲癌症研究与治疗组织的生活质量核心量表（EORTC QLQ-C30）第3版分别对肠造口患者出院时、出院1个月、出院3个月生活质量进行调查,并进行多因素分析.结果 出院时、出院1个月、出院3个月生活质量总分分别为（6.68±1.490）,（9.12±1.474）,（10.80±1.695）分,差异有统计学意义（F=106.100,P＜0.01）;功能量表、症状量表、症状子量表得分3个阶段比较差异均有统计学意义（F值分别为90.941,7.612,3.619,P＜0.05）;症状及子症状于出院1个月时加重,3个月时有所恢复.生活质量量表多元逐步回归分析结果显示,出院时,年龄和文化程度为生活质量的主要影响因素;出院1个月时,文化程度、造口护理者、排便情况、治疗和并发症5个因素为生活质量的主要影响因素;出院3个月时,年龄、收入、医保、造口护理者、治疗和并发症6个因素为生活质量的主要影响因素.结论 通过本研究为护理人员寻求有针对性及时调整的干预方案,为最大限度地提高造口患者的生活质量提供科学依据.     

脊髓损伤患者的康复护理体会

目的：对脊髓损伤患者进行日常生活能力等方面的护理干预,提高患者日常生活能力,减轻患者及家庭和社会的负担,提高生活质量。方法：对5例脊髓损伤患者进行系统的康复护理,观察病情及效果。结果：经2—3个月康复护理干预后,5例患者自理能力均全面提高,其中1例患者完全自理,2例患者基本自理,2例患者部分自理。结论：对脊髓损伤患者进行护理干预,可显著提高患者的自理能力：减轻患者的痛苦,提高生活质量,减轻家庭以及社会的负担。