慢性阻塞性肺疾病患者出院后运动行为特征及预测因素分析

doi:10.3761/j.issn.0254-1769.2024.17.005

摘要/Abstract

摘要：

目的了解慢性阻塞性肺疾病（简称“慢阻肺”）患者出院后运动行为阶段分布特征并分析其预测因素，为实施全程、连续的康复护理决策提供参考。方法采用便利抽样法，选取2022年2月—2023年2月于重庆市2所三级甲等医院呼吸内科或老年科住院治疗的380例慢阻肺患者为调查对象，跟踪随访至出院后6个月。采用自行设计的一般及疾病相关资料调查表、运动阶段变化量表、锻炼益处/障碍量表、慢阻肺患者运动自我调控效能量表、社会支持评定量表、医院焦虑抑郁量表进行问卷调查。采用单因素分析及有序多分类Logistic回归分析慢阻肺患者出院后的运动行为特征及预测因素。结果纳入的380例慢阻肺患者出院后运动行为处于前意向阶段者53例（14.0%），意向阶段者97例（25.5%），准备阶段者103例（27.1%），行动阶段者75例（19.7%），维持阶段者52例（13.7%）。年龄、家庭月收入、日常家务、睡眠、运动习惯、本次住院康复史、近一年急性发作次数、居家氧疗、规律使用呼吸系统疾病药物、呼吸困难程度、感知锻炼益处/障碍、社会支持、抑郁是慢阻肺患者出院后运动行为阶段分布的主要预测因素。结论大部分慢阻肺患者出院后未养成规律的运动行为习惯，且其运动行为水平受个体特征、疾病因素、决策平衡、社会支持及心理等影响，提示医护人员应根据患者所处的行为阶段特点制订个性化的早期运动干预，增加干预的远期效果。

关键词: 肺疾病, 慢性阻塞性, 运动行为, 行为分阶段转变理论, 预测因素, 护理

Abstract:

Objective To understand the characteristics and the predictors of the distribution of exercise behavior stages in COPD patients after discharge from the hospital，and to provide a reference basis for the implementation of the whole process and continuous rehabilitation care decision-making. Methods Using the convenience sampling method，380 COPD patients who were hospitalized in the departments of respiratory medicine or geriatrics in 2 tertiary-level hospitals in Chongqing from February 2022 to February 2023 were selected for the study，and were followed up until 6 months after the patients were discharged from the hospital. Questionnaires were administered using the self-designed General and Disease-Related Information Questionnaire，Exercise Stages of Change Scale，Exercise Benefits and Barriers Scale，Exercise Self-Regulatory Efficacy Scale，Social Support Rate Scale and Hospital Anxiety and Depression Scale. Characteristics and predictors of exercise behavior in COPD patients after hospital discharge were analyzed using univariate analysis and ordered multicategorical logistic regression. Results The included 380 COPD patients of post-discharge exercise behavior were 53 cases（14.0%） in the pre-intentional stage，97 cases（25.5%） in the intentional stage，103 cases（27.1%） in the preparatory stage，75 cases（19.7%） in the action stage，and 52 cases（13.7%） in the maintenance stage. The age，monthly household income，daily chores，sleep，exercise habits，and history of the current inpatient rehabilitation，number of acute episodes in the last year，whether home oxygen therapy and regular use of medication for respiratory diseases，degree of dyspnea，perceived exercise benefit/impairment，social support，and depression were the main predictors of the distribution of the stages of exercise behavior in COPD patients after discharge from the hospital. Conclusion Most COPD patients did not develop regular exercise behavior habits after discharge，and the level of their exercise behavior was affected by a variety of factors，including individual characteristics，disease factors，decision-making balance，social support，and psychology，suggesting that healthcare professionals should develop personalized early exercise interventions according to the characteristics of the behavioral stage in which the patient is located in order to increase the long-term effects of the intervention.

Key words: Pulmonary Disease, Chronic Obstructive, Exercise Behavior, The Transtheoretical Model, Predictive Factors, Nursing Care

唐欢, 陈贵华, 李琴, 周锡鑫, 吴绣岑, 沈鹏华. 慢性阻塞性肺疾病患者出院后运动行为特征及预测因素分析[J]. 中华护理杂志, 2024, 59(17): 2084-2092.

TANG Huan, CHEN Guihua, LI Qin, ZHOU Xixin, WU Xiucen, SHEN Penghua. Analysis of distribution characteristics on exercise behavior stages and its predictive factors in patients with chronic obstructive pulmonary disease after discharge[J]. Chinese Journal of Nursing, 2024, 59(17): 2084-2092.

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