慢性阻塞性肺疾病患者呼吸困难恐惧影响因素及路径分析  

Influencing factors and the pathway analysis of dyspnea-related fear in patients with chronic obstructive pulmonary disease

作　　者：缪小浪 钮美娥[2] 韩燕霞[1] 张蓓蕾[1] 金晓亮 卢向敏 赵茜 高婷婷 Miao Xiaolang;Niu Mei′e;Han Yanxia;Zhang Beilei;Jin Xiaoliang;Lu Xiangmin;Zhao Qian;Gao Tingting(Department of Pulmonary and Critical Care Medicine,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院呼吸与危重症医学科,江苏苏州215006 [2]苏州大学附属第一医院护理部,江苏苏州215006 [3]苏州大学护理学院

出　　处：《护理学杂志》2024年第18期37-41,47,共6页Journal of Nursing Science

基　　金：国家自然科学基金青年科学基金项目(72204182);苏州市科技发展计划(医疗卫生科技创新)项目(SKY2022122);苏州市科技发展计划(医疗卫生科技创新)项目(SKJY2021063)。

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)患者呼吸困难恐惧的影响因素及作用路径,为开展针对性护理干预减轻患者呼吸困难恐惧提供依据。方法便利选取376例COPD患者为调查对象,采用一般资料调查表、呼吸困难改良量表、医院焦虑抑郁量表、中文版呼吸困难灾难化认知量表、COPD自我效能量表、呼吸困难信念问卷进行横断面调查。结果COPD患者呼吸困难恐惧得分为20.0(17.0,22.0)分。多因素分析结果显示,灾难化认知、自我效能、焦虑及抑郁情绪、身体质量指数是COPD患者呼吸困难恐惧的影响因素(均P<0.05)。结构方程模型拟合结果:χ~2/df=1.468,RMSEA=0.035,GFI=0.997、AGFI=0.973、NFI=0.999、IFI=1.000、CFI=1.000、TLI=0.997,模型适配度良好。路径分析显示,灾难化认知、自我效能、焦虑和抑郁情绪对呼吸困难恐惧影响的直接效应分别是0.534、-0.362、0.196、-0.113,呼吸困难可通过焦虑和抑郁情绪、灾难化认知、自我效能间接影响呼吸困难恐惧水平(均P<0.05)。结论COPD患者呼吸困难恐惧处于较高水平,影响COPD患者呼吸困难恐惧的影响因素较多。临床医护人员应综合考虑COPD患者的个体、心理等多种影响因素及其之间的作用路径,制订个性化的干预策略,以降低患者呼吸困难恐惧水平。Objective To explore the influencing factors and the pathway of dyspnea-related fear in patients with chronic obstructive pulmonary disease(COPD),and to provide a reference for conducting targeted intervention to alleviate their dyspnea-related fear.Methods A total of 376 COPD patients were selected by the convenience sampling method,then they were investigated by utilizing a general information questionnaire,the modified Medical Research Council(mMRC),the Hospital Anxiety and Depression Scale(HADS),the Chinese version of the Breathlessness Catastrophizing Scale(BCS),the COPD Self-efficacy Scale(CSES),and the Breathlessness Beliefs Questionnaire(BBQ).Results The participants′score of dyspnea-related fear was 20.0(17.0,22.0).Mul-tivariate analysis showed that,the scores of BCS,CSES,HADS,and Body Mass Index(BMI)were influencing factors of dyspnea-related fear in COPD patients(all P<0.05).The results of structural equation model were:χ2/df=1.468,RMSEA=0.035,GFI=0.997,AGFI=0.973,NFI=0.999,IFI=1.000,CFI=1.000,TLI=0.997,which showed good fitting.Pathway analysis showed that,the direct affect effects of catastrophizing cognition,self-efficacy,anxiety and depression on dyspnea-related fear were 0.534,-0.362,0.196,-0.113,respectively,and dyspnea indirectly affected dyspnea-related fear via anxiety,depression,catastrophizing cognition and self-efficacy(all P<0.05).Conclusion Dyspnea-related fear in COPD patients is at a high level,which is influenced by multiple factors.Clinical medical staff should develop personalized intervention strategies by considering patients′individual,psychological and other influencing factors and the pathways,so as to reduce their dyspnea-related fear.

关 键 词：慢性阻塞性肺疾病 呼吸困难 灾难化认知 呼吸困难恐惧 焦虑 抑郁 自我效能 

分 类 号：R473.5[医药卫生—护理学]