心脏瓣膜置换术后患者生存质量影响因素的路径分析  

The clinical pathway of influential factors concerning patients life quality after heart valve replacement

作　　者：周家梅[1] 刘达兴[1] 龚启华 罗明先[1] 江智霞[2] ZHOU Jia -mei;LIU Da -zing;GONG Qi -hua;LUO Ming -xian;JIANG Zhi -xia(Department of Cardiovascular Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi 563003, Guizhou, Chin)

机构地区：[1]遵义医学院附属医院心血管外科,贵州遵义563003 [2]遵义医学院附属医院护理部,贵州遵义563003

出　　处：《广东医学》2018年第11期1719-1722,共4页Guangdong Medical Journal

基　　金：遵义市科技计划项目(编号:遵市科合社字(2014)67号)

摘　　要：目的探讨心脏瓣膜置换术后患者个体认知、社会支持、心理状态、自我管理能力对生存质量的影响,并建立它们之间的关系模型。方法应用自行设计的"心脏机械瓣膜置换术后患者自我管理能力调查问卷",Cronbach a系数为0.817,随访心脏机械瓣膜置换的79例患者,调查其个体认知、社会支持、心理状态、自我管理能力及生存质量,并应用结构方程模型进行路径分析。结果模型拟合较理想,心脏瓣膜置换术后患者生存质量可以被个体认知、社会支持、心理状态、自我管理能力解释的变异量为80%,个体认知、社会支持、心理状态与自我管理能力均有显著相关性,自我管理能力与生存质量具有显著相关性,差异均有统计学意义(P<0.05)。自我管理能力对生存质量具有直接效应作用(路径系数为0.74);个体认知、社会支持、心理状态对自我管理能力具有直接效应作用(路径系数为0.40、0.18、0.15);个体认知对生存质量起正向作用(路径系数为0.33),可分解为直接影响和通过自我管理能力而间接影响(路径系数分别为0.04、0.29),社会支持对生存质量起正向作用(路径系数为0.34),可分解为直接影响和通过自我管理能力而间接影响(路径系数分别为0.21、0.13),心理状态对生存质量起正向作用(路径系数为0.20),可分解为直接影响和通过自我管理能力而间接影响(路径系数分别为0.09、0.11)。结论提高心脏瓣膜置换术后患者的自我管理能力可改善患者的生存质量;社会支持度越高,患者的生存质量越佳。Objective To investigate the effect of individual cognition, social support, psychological state and self - management ability on survival quality of patients after heart valve replacement and to establish the relation model a- mong them. Methods The self - designed questionnaire was applied for telephone survey of 79 patients with mechanical heart valve replacement. The individual cognition, social support, psychological state, self management ability and the quality of survival were collected. The structural equation mode was used for the pathway analysis. Results The model fitting was ideal and patients＇ quality of life can be explained by patients＇ individual cognition, social support, psychologi- cal state, and self- management ability. The variance of explanation was 80%. The individual cognition, social support, psychological state and self - management ability were all significantly correlated with the self - management ability and the quality of life （ P 〈 0. 05 ）. The self - management ability had a direct effect on the quality of life （ the path coefficient was 0. 74）. The individual cognition, social support and psychological state had direct effects on self- management ability （the path coefficients were 0. 40, 0. 18 and 0. 15, respectively）. The individual cognition had a positive effect on the quality of life （ the path coefficient was 0. 33 ）, which can be divided into direct effect and indirect effect that through self - management ability （the path coefficient was 0. 04, 0. 29, respectively）. The social support had a positive effect on the quality of life （the path coefficient was O. 34）, which can be divided into direct effect and indirect effect that throttgh self- management ability （the path coefficients were 0. 21 and 0. 13, respectively）. Mental state had a positive effect on the quality of life （ the path coefficient was 0. 20）, which can be divided into direct effect and indirect effect that through self - management ability （ The path coefficients

关 键 词：心脏瓣膜置换术 生存质量 路径分析 

分 类 号：R654.2[医药卫生—外科学]