270例肺结核患者生命质量评价及影响因素分析

目的 调查肺结核患者的生命质量情况,分析其影响因素。方法 2018年1—12月采取简单随机抽样方法选取来自首都医科大学附属北京胸科医院和中国人民解放军总医院第八医学中心全军结核病研究所的住院肺结核患者336例,采用调查问卷和欧洲五维度健康量表对肺结核患者进行调查。调查共发放336份调查问卷,回收336份,应答率为100.00%,有效问卷为270份,有效率80.36%。利用SPSS 19.0软件进行数据录入和统计学分析,计数资料采用χ ²检验,对单因素分析有意义的结果进行多因素logistic回归分析。结果 270例肺结核患者视觉模拟尺度(EQ-VAS)得分为(73.59±18.24)分,EQ指数(EQ-index)得分为(0.78±0.29)分,五维度测量水平存在困难构成比在21.5%(58/270)和30.7%(83/270)之间。生命质量影响因素的logistic回归分析结果显示:自我行动能力的危险因素有年龄[OR=4.291(95%CI:1.714~10.744)]、自觉结核病严重程度[OR=5.029(95%CI:1.810~13.971)]、是否咯血[OR=2.315(95%CI:1.036~5.173)];自我照顾能力的危险因素有年龄[OR=6.652(95%CI:2.495~17.734)]、自觉结核病严重程度[OR=6.248(95%CI:2.099~18.597)];日常活动能力的危险因素有年龄[OR=3.028(95%CI:1.295~7.081)]、自觉结核病严重程度[OR=3.640(95%CI:1.471~9.010)]、是否咯血[OR=2.522(95%CI:1.146~5.554)];疼痛或不舒服的危险因素有自觉结核病严重程度[OR=7.923(95%CI:2.431~25.822)];焦虑或抑郁的危险因素有自觉结核病严重程度[OR=2.479(95%CI:1.007~6.102)]和患病后心理压力[OR=5.112(95%CI:1.736~15.052)];自我行动能力和自我照顾能力的保护因素为是否接受过结核病相关健康教育[OR=0.259(95%CI:0.105~0.638);OR=0.227(95%CI:0.085~0.606)]。结论 年龄和心理压力是影响肺结核患者生命质量的主要危险因素,应加强对肺结核患者的心理健康管理。是否接受结核病相关健康教育是影响肺结核患者生命质量的主要保护因素,应强调结核病健康教育的重要性,提高患者的保护意识和预防意识,从而改善结核病患者的生命质量。

Quality of life assessment and risk factors analysis of 270 pulmonary tuberculosis patients

Objective To investigate the quality of life of patients with tuberculosis, and analyze its influencing factors. Methods A total of 336 tuberculosis patients hospitalized in Beijing Chest Hospital affiliated to Capital Medical University and the Eighth Medical Center of the People’s Liberation Army General Hospital from January to December 2018 were randomly selected as subjects in this study. The tuberculosis patients were investigated with questionnaires and European quality of life-5 dimensions (EQ-5D). A total of 336 questionnaires were distributed and 336 were actually recovered, with a response rate of 100.00%. There were 270 valid questionnaires with an effective rate of 80.36%. SPSS 19.0 software was used for data entry and statistical analysis, and Chi-square test and logistic regression were used for multivariate analysis. Results The visual analogue scaling (VAS) score of 270 tuberculosis patients was 73.59±18.24, and the EQ-index score was 0.78±0.29. The proportion of difficulty in five-dimension measurement was between 21.5% (58/270) and 30.7% (83/270). Logistic regression analysis showed that the risk factors of self-action ability were age (OR=4.291 (95%CI: 1.714-10.744)), conscious tuberculosis severity (OR=5.029 (95%CI: 1.810-13.971)), hemoptysis (OR=2.315 (95%CI: 1.036-5.173)). The risk factors of self-care ability were age (OR=6.652 (95%CI: 2.495-17.734)), conscious tuberculosis severity (OR=6.248 (95%CI: 2.099-18.597)). Risk factors for ability of daily activities included age (OR=3.028 (95%CI: 1.295-7.081)), conscious tuberculosis severity (OR=3.640 (95%CI: 1.471-9.010)), hemoptysis (OR=2.522 (95%CI: 1.146-5.554)). Risk factor for pain or discomfort was conscious tuberculosis severity (OR=7.923 (95%CI: 2.431-25.822)). Risk factors for anxiety or depression included conscious tuberculosis severity (OR=2.479 (95%CI: 1.007-6.102)) and psychological stress after illness (OR=5.112 (95%CI: 1.736-15.052)). Received tuberculosis-related health education (OR=0.259 (95%CI: 0.105-0.638); OR=0.227 (95%CI: 0.085-0.606)) was the protective factor of self-action ability and self-care ability. Conclusion Age and psychological stress are the main factors influencing the quality of life of tuberculosis patients. Receiving tuberculosis-related health education is the main protective factor affecting the quality of life of tuberculosis patients. We should strengthen the mental health management of tuberculosis patients, emphasize the importance of tuberculosis health education to improve the awareness of protection and prevention of patients, so as to improve the quality of life of tuberculosis patients.