心力衰竭患者ICD植入治疗替代决策者决策困境现状及影响因素  

Current Situation and Influencing Factors of Decision-Making Dilemma for Alternative Decision-Makers in ICD Implantation Therapy for Heart Failure Patients

作　　者：段娟[1] 王颖[1] DUAN Juan;WANG Ying(Cardiology Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 453000,China)

机构地区：[1]郑州大学第一附属医院心血管内科,河南郑州453000

出　　处：《河南医学研究》2024年第15期2705-2711,共7页Henan Medical Research

摘　　要：目的调查心力衰竭患者植入型心律转复除颤器(ICD)植入治疗替代决策者的决策困境现状及影响因素。方法选取2020年4月至2023年3月在郑州大学第一附属医院心力衰竭中心就诊的ICD植入治疗患者及其替代决策者为调查对象,收集患者及代理决策者的社会人口学资料及患者疾病相关资料,由研究者代理患者填写中文简化版堪萨斯城心肌病问卷(KCCQ),由替代决策者填写决策困境量表、决策参与期待量表、维克森林医师信任量表、领悟社会支持量表和状态焦虑问卷,分析状态焦虑得分、维克森林医师信任得分、领悟社会支持得分、心力衰竭患者健康状况与决策困境的相关性,分析人口学特征与疾病特征与决策困境的关系,通过多重线性回归分析决策困境的影响因素。结果共纳入148例心力衰竭ICD植入治疗患者的替代决策者,决策者决策困境得分为(36.03±8.79)分,70.95%的替代决策者得分≥25分,存在决策困境;单因素分析结果显示决策困境的影响因素包括替代决策者年龄、受教育程度、婚姻、月收入、替代决策者角色、与患者关系、疾病了解程度、患者医疗保险类型、是否参与决策、病程等(P<0.05)。相关性分析结果显示:患者健康水平(KCCQ得分)、替代决策者焦虑水平、对医生的信任水平、社会支持水平与决策困境相关(P<0.05)。多重线性回归结果显示决策困境的影响因素包括替代决策者焦虑水平、对医生的信任水平、社会支持水平、月收入及患者病程。结论大多数心力衰竭患者ICD植入治疗替代决策者存在决策困境,医护人员在进行ICD植入手术知情同意沟通时应关注替代决策者的心理特征、调动决策者的社会支持力量,采用适当的沟通技巧,必要时采取决策辅助工具进行决策辅助。Objective To investigate the current situation and influencing factors of decision-making dilemma among decision makers for implantable cardioverter defibrillator(ICD)implantation therapy in patients with heart failure.Methods ICD implantation treatment patients and their alternative decision-makers who visited a heart failure center at the First Affiliated Hospital of Zhengzhou University from April 2020 to March 2023 were selected as the survey subjects.Collected social demography data of patients and deputy decision-makers and data related to patients’diseases.Researchers filled out the simplified Chinese version of the Kansas city cardiomyopathy questionnaire(KCCQ)on behalf of patients.Substituted decision-makers fill out the decision dilemma scale,decision participation expectation scale,Vick forest physician trust scale,perceived social support scale,and state anxiety questionnaire.Exploring the correlation between state anxiety scores,Vick Forest physician trust scores,perceived social support scores,and the health status of heart failure patients with decision-making difficulties using correlation analysis.Exploring the relationship between demography characteristics and disease characteristics and decision-making dilemma.Exploring the influencing factors of decision-making difficulties using multiple linear regression analysis.Results A total of 148 patients with heart failure treated with ICD placement were included as substitute decision-makers,with a decision dilemma score of(36.03±8.79)points.There were 70.95%of substitute decision-makers scored≥25 points,indicating the presence of decision difficulties.The results of univariate analysis showed that the influencing factors of decision-making difficulties included age,education level,marriage,monthly income,role of substitute decision-makers,relationship with patients,level of disease understanding,type of patient medical insurance,participation in decision-making,and duration of illness(P<0.05).The correlation analysis results showed that the pa

关 键 词：心力衰竭 植入型心律转复除颤器 替代决策者 决策困境 

分 类 号：R541.6[医药卫生—心血管疾病]