摘要
目的探讨院外健康护理指导对老年慢性病患者生活及心理的影响。方法选取某院住院的年龄〉60岁的老年慢性疾病患者300例，采用随机数字表法分为干预组和对照组，每组150例。出院后，对照组患者回家后正常自然生活；干预组由护理人员每半月与受试者及其家属进行沟通，予以护理指导。并分别在出院后第3个月和第6个月应用简明健康调查量表（SF．36）和SCL-90症状自评量表分别对两组患者的生活质量和心理健康状况进行评估。结果出院前，两组患者的sF一36量表各维度评分差异无统计学意义（P〉0．05）；出院后3个月，干预组患者的sF-36量表中，机体功能、总体健康、活力、社会功能、情感职能、精神健康维度评分分别为（76．8±9．81），（63．4±8．6），（65．2±9．2），（59．1±14．3），（59．1±8．21），（64．2±11．3）分，均高于对照组的（60．4±9．6），（53．3±11．8），（54．8±15．3），（54．3±11．3），（44．4±9．8），（55．3±15．9）分，差异有统计学意义（t值分别为14．63，8．47，7．13，3．23，14．08，5．59；P〈0．01）；出院后6个月，干预组患者的sF-36量表中，机体功能、总体健康、活力、社会功能、情感职能、精神健康维度评分分别为（73．5±11．4），（63．8±10．9），（64．1±17．3），（60．1±11．7），（58．3±8．7），（64．3±15．1）分，均高于对照组的（63．3±11．1），（56．7±14．7），（54．2±14．4），（59．1±10．2），（45．9±10．5），（57．1±18．7）分，差异有统计学意义（t值分别为7．85，4．75，5．39，3．79，11．10，3．67；P〈0．01）。出院前，两组患者的SCL-90症状自评量表各因子得分差异无统计学意义（P〉0．05）；出院后3个月干预组患者的躯体化和抑郁2个因子得分分别为（1．79±0．32），（1．78±0．34）分，优于对照组的（1．89±0．34），（1．89±0．41）分，差异有统计学意义（t值分别为2．62，2．53；P〈0．01）；出院后6个月干预组患者的躯体化和抑郁2个因子得分分别为（1．73±0．52），（1．76±0．44）分，优于对照组的（2．02±0．51），（1．98±0．32）分，差异有统计学意义（t值分别为4．88，4．95；P〈0．01）。出院后3个月和6个月干预组患者再次就诊次数分别为（0．20±0．04）和（0．33±0．11）次，均低于对照组的（0．37±0．07），（0．42±0．10）次，差异有统计学意义（t值分别为25．82，7．41；P〈0．01）。出院后3个月和6个月干预组患者出院后医疗费用分别为（450．00±125．14）和（1000．00±300．11）元，均低于对照的（600．78±120．67）和（1500．00±205．56）元，差异有统计学意义（t值分别为10．62，16．83；P〈0．01）。出院后两组患者的死亡人数差异无统计学意义（P〉0．05）。结论出院患者进行院外护理干预支持可以改善患者的生存质量及部分心理状态，从整体而言可以减少患者的医疗花费和社会负担，节省社会医疗资源。
Objective To study the effect of on the healthcare instructions outside the hospital on the quality of life and psychology of elderly patients with chronic diseases. Methods A total of 300 patients over 60 years old suffering from chronic diseases without mental illness and obvious damage to the memory and intelligence, with the ability of taking care of themselves and the expected survival of greater than 12 months were recruited. Research subjects were randomly divided into the control group and the intervention group. Afterdischarge, maintaining the communication with the participants and their families and the heahhcare instructions were given every half month. Then the Short Form 36 （SF-36） and the Symptom Checklist （SCL-90） were used to assess the quality of life and the situation of mental at 3 month and 6 month after discharge. Results The scores of SF-36 had no difference between groups before discharge （P 〉 0. 05）. 3 month after discharge, the scores of SF-36 on Physical Functioning, General Health Perception, Vitality, Social Functioning, Role Function-Emotional and Mental Health were （76. 8 ± 9.81）, （63.4 ±8.6）, （65.2 ±9.2）, （59.1 ±14.3）, （59.1±8.21） and （64.2±11.3） in the intervention group, which were significantly higher than （60.4 ±9. 6）, （53.3 ± 11.8）, （54.8 ±15.3）, （54.3 ± 11.3）, （44.4 ± 9.8） and （55.3 ± 15.9） in the control group （ t = 14. 63,8.47,7.13,3.23,14.08,5.59, respectively; P 〈 0. 01 ）. 6 month after discharge, the scores of SF-36 on Physical Functioning, General Health Perception, Vitality, Social Functioning, Role Function-Emotional and Mental Health were （73.5 ± 11.4 ）, （63. 8 ± 10.9）, （64.1 ± 17.3）, （60.1 ± 11.7）, （58.3 ± 8. 7）, （64.3 ± 15.1 ） in the intervention group, which were significantly higher than （63.3± 11.1 ）, （56.7 ± 14.7）, （54.2 ±14.4）, （59.1 ± 10.2）, （45.9 ± 10.5）, （57.1 ± 18.7） in the control group （t =7. 85,4. 75, 5.39, 3.79, 11.10, 3.67, respectively;P 〈0. 01 ）. The scores of SL-90 had no difference between groups before discharge （P 〉 0. 05 ）. 3 month after discharge, the somatization and depression scores of SCL-90 were （ 1.79 ± 0.32 ） and （ 1.78 ± 0.34 ）, which were significantly higher than （ 1.89 ±0. 34） and （ 1.89 ±0.41 ）. The differences were significant （ t = 2. 62,2.53, respectively ; P 〈0. 01 ）. 6 month after discharge, the somatization and depression scores of SCL-90 were （ 1.73 s0.52） and （ 1.76 ± 0.44）, which were significantly higher than （2.02 ± 0.51 ） and （ 1.98 ±0.32）. The differences were significant （t =4. 88,4.95, respectively; P 〈0. 01 ）. 3 month and 6 month after discharge, the readmission in the intervention group were （0.20 ±0.04） and （0.33± 0.11 ） , which were significantly lower than （0.37±0.07） and （0.42 ±0.10） in the control group （t =25. 82,7.41, respectively; P 〈0. 01）. 3 month and 6 month after discharge, the medical costs in the intervention group were （450.00 ± 125.14） and （1 000.00 ± 300.11 ） RMB, which were significantly lower than （600.78 ± 120.67） and （ 1 500.00 ±205.56） RMB in the control group （ t = 25.82,7.41, respectively ; P 〈 0. 01 ）. Conclusions The nursing intervention of healthcare instructions outside the hospital can improve patients＇ quality of life and the psychological state of some patients. On the whole, it can reduce the healthcare costs and social burden of patients, and save the medical resource for the society.
出处
《中华现代护理杂志》
2014年第14期1651-1655,共5页
Chinese Journal of Modern Nursing
基金
基金项目：黑龙江省教育厅课题（12531406）
