摘要
目的了解老年COPD患者自我管理水平及类型,分析各类型特征,为针对性干预提供参考。方法对627例老年COPD住院患者采用一般资料问卷、COPD自我管理量表、COPD评估测试量表、衰弱筛查表、中文版居家不出状态量表及社会支持量表进行调查。以自我管理量表的5个维度为聚类变量,对研究对象系统聚类并绘制树状图,结合"Elbow法"确定最佳K值,K-Means聚类完成最终聚类。结果患者自我管理能力总分(156.99±25.13)分;最佳聚类为3种类型,分别命名为Ⅰ类"中症状-依赖消极不依从型"、Ⅱ类"高症状-受限盲目应对型"、Ⅲ类"低症状-优越自信管理型";3种类型的性别、体重指数、现居住地、主要照顾者、文化程度、人均月收入、医疗支付方式、过去1年急性加重(次)、mMRC分级、吸烟、氧疗、吸入药物使用、呼吸肌训练、并存疾病、衰弱、生活质量评分、居家不出状态、社会支持方面存在差异且有统计学意义(P<0.05,P<0.01)。结论老年COPD患者自我管理处于中等偏低水平,基于聚类分析确定的3类自我管理类型间有较高的异质性,可根据不同类型制订针对性干预措施,以提升各类型患者的自我管理能力。
Objective To identify the level and patterns of self-management in elderly patients with COPD,to analyze the characteristics of each distinct pattern,and to provide reference for targeted intervention.Methods A total of 627 elderly patients with COPD were investigated by using a general information questionnaire,the COPD Self-management Scale,the COPD Assessment Test,the FRAIL Scale,the Chinese Version of Housebound Scale,and the Social Support Rating Scale.Five dimensions of the COPD Self-management Scale were treated as clustering variables to yield the dendrogram,then the optimal k value was determined with the "Elbow method",at last K-means algorithm was performed to determine the final clustering.Results The total self-management score was 156.99 ± 25.13.Three different self-management groups were identified and designated as clusterⅠ:moderate symptom,dependent,negative and non-compliant profile;cluster Ⅱ:severe-symptom,restricted and blindly coping profile;and cluster Ⅲ:mild symptom,superior and self-confident profile.The three patterns showed significant differences in gender,body mass index,current residence,main caregivers,education level,per capita monthly income,medical payment type,the number of acute exacerbations in the past year,mMRC,smoking status,oxygen therapy,use of inhaled drugs,respiratory muscle training,comorbid disease,frailty,CAT result,housebound status and social support(P<0.05,P<0.01).Conclusion Self-management of elderly COPD patients is at a low to moderate level.The three patterns of self-management identified through cluster analysis show high heterogeneity.Interventions based on these specific patterns of self-management may improve self-management of patients.
作者
赵杰
丁菊花
魏丽芝
芦鸿雁
冯向侃
张晓娜
李鑫丹
Zhao Jie;Ding Juhua;Wei Lizhi;Lu Hongyan;Feng Xiangkan;Zhang Xiaona;Li Xindan(School of Nursing,Ningxia Medical University,Yinchuan 750004,China)
出处
《护理学杂志》
CSCD
北大核心
2022年第3期88-92,共5页
Journal of Nursing Science
基金
2021年宁夏回族自治区重点研发项目(2021BEG03116)。
