脊髓损伤清洁间歇导尿患者自我管理现状及影响因素

doi:10.3969/j.issn.1006-9771.2022.06.014

摘要/Abstract

摘要：

目的调查脊髓损伤清洁间歇导尿患者自我管理现状并探讨其影响因素。方法 2020年5月至2021年2月,便利抽样选取某脊髓损伤病友俱乐部255例脊髓损伤患者为调查对象,采用一般资料调查表、自制自我管理量表、自我效能感量表进行网络问卷调查,多元线性逐步回归探讨其影响因素。结果脊髓损伤清洁间歇导尿患者自我管理量表中疾病症状管理、日常生活管理、间歇导尿行为管理及情绪管理和社会回归各维度得分分别为(40.458±9.122)分、(33.945±6.800)分、(36.709±8.736)分、(25.011±4.932)分;日常生活管理维度单题平均得分最高(3.772±0.755),情绪管理和社会回归维度单题平均得分最低(3.573±0.705)。间歇导尿时长、患病后家人的态度、自我效能感、职业是疾病症状管理维度的主要影响因素(R² = 0.135, F = 7.744, P < 0.001);自我效能感、间歇导尿时长、使用亲水涂层导尿管、并发症是日常生活管理维度的主要影响因素(R² = 0.173, F = 13.042, P < 0.001);自我效能感、间歇导尿时长、使用亲水涂层导尿管、医疗费用支付方式是间歇导尿行为管理维度的主要影响因素(R² = 0.141, F = 10.259, P < 0.001);自我效能感、间歇导尿时长、并发症、近一周每日间歇导尿次数是情绪管理和社会回归维度的主要影响因素(R² = 0.282, F = 19.590, P < 0.001)。结论脊髓损伤清洁间歇导尿患者自我管理能力处于中等水平。患者自我管理能力受诸多因素影响,医护人员应针对其中可控因素,制定相应策略。

关键词: 脊髓损伤, 清洁间歇导尿, 自我管理

Abstract:

Objective To investigate the status of self-management in patients with spinal cord injury and the related factors. Methods From May, 2020 to February, 2021, 255 patients from a spinal cord injury club were enrolled, and investigated with the general information questionnaire, self-management ability scale, Chronic Disease Self-efficacy Scale through internet. Multiple linear stepwise regression was used to explore the related factors. Results The scores of disease symptom management, daily life management, intermittent catheterization behavior management, emotional management and social return were (40.458±9.122), (33.945±6.800), (36.709±8.736) and (25.011±4.932), respectively. The average score for the single question of daily life management was the highest (3.772±0.755), while emotional management and social return was the lowest (3.573±0.705). Duration of intermittent catheterization, family members' attitude, self-efficacy and occupation were the related factors of symptom management (R² = 0.135, F = 7.744, P < 0.001). Self-efficacy, duration of intermittent catheterization, use of hydrophilic coated catheters and complications were the related factors of daily life management (R² = 0.173, F = 13.042, P < 0.001). Self-efficacy, duration of intermittent catheterization, use of hydrophilic coated catheters and medical insurance were the related factors of intermittent catheterization behavior management (R² = 0.141, F = 10.259, P < 0.001). Self-efficacy, duration of intermittent catheterization, complications and frequency of intermittent catheter in the last week were the related factors of emotional management and social regression dimensions (R² = 0.282, F = 19.590, P < 0.001). Conclusion The self-management of patients with spinal cord injury by clean intermittent catheterization is at medium level. Moreover, it may be affected by many factors. Some of them can be targets of intervention.

Key words: spinal cord injury, clean intermittent catheterization, self-management

中图分类号:

R651.2

张妙媛,何英,李晓霞,彭敏,张蕾,刘姝颖,孔瑛. 脊髓损伤清洁间歇导尿患者自我管理现状及影响因素[J]. 《中国康复理论与实践》, 2022, 28(6): 716-724.

ZHANG Miaoyuan,HE Ying,LI Xiaoxia,PENG Min,ZHANG Lei,LIU Shuying,KONG Ying. Self-management status and related factors of patients with intermittent clean catheterization after spinal cord injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(6): 716-724.

图/表 9

表1

表2

表3

自我管理各维度单因素分析(n = 255)"

项目		n	疾病症状管理	日常生活管理	间歇导尿行为管理	情绪管理和社会回归	t/F值^a	P值^a	t/F值^b	P值^b	t/F值^c	P值^c	t/F值^d	P值^d
年龄/岁	10~< 20	17	35.41±12.62	29.59±8.54	31.35±11.91	22.35±5.58	1.375	0.249	3.352	0.011	2.642	0.034	2.013	0.093
	20~< 30	63	40.30±10.07	35.02±6.27	38.49±8.49	25.11±5.10
	30~< 40	75	41.09±8.54	34.59±6.48	36.88±7.99	25.08±4.61
	40~< 50	68	41.38±7.85	34.38±6.46	37.00±8.53	25.88±4.65
	≥50	32	40.00±8.52	31.72±7.27	35.03±8.53	24.22±5.25
居住地	城镇	126	39.11±9.87	33.43±6.98	36.06±9.57	24.52±5.18	2.420	0.016	1.216	0.225	1.202	0.230	1.618	0.107
	农村	129	41.84±8.10	34.47±6.59	37.37±7.78	25.52±4.63
婚姻状况	未婚	88	39.36±10.55	33.42±7.25	35.72±9.99	23.81±5.19	0.980	0.377	0.476	0.622	0.897	0.409	4.179	0.016
	已婚	157	41.06±8.15	34.27±6.44	37.27±7.78	25.61±4.65
	离异	10	40.60±10.26	33.40±8.48	36.60±11.16	26.20±5.45
职业	学生	39	36.83±11.79	32.03±8.80	33.60±11.57	23.18±5.53	3.003	0.013	1.746	0.127	2.029	0.077	1.732	0.128
	农民	52	39.58±9.58	33.21±6.91	36.62±8.73	24.64±4.64
	职员	24	42.63±9.16	36.63±6.15	40.58±7.49	26.21±5.14
	工人	72	40.90±7.25	34.40±5.87	36.85±7.79	25.43±4.42
	商人	22	38.41±10.18	33.00±7.32	36.46±8.77	25.36±5.45
	其他	46	43.84±6.57	34.80±5.69	37.42±7.22	25.60±4.93
家庭收入主要来源	是	151	40.95±9.14	34.38±6.75	37.17±8.72	25.68±4.93	1.044	0.298	1.225	0.222	1.019	0.309	2.646	0.009
家庭收入主要来源	否	104	39.74±9.10	33.32±6.85	36.04±8.76	24.04±4.79
医疗费用支付方式	全部自费	83	41.80±9.48	34.83±6.47	38.39±8.90	25.72±5.35	3.872	0.022	3.690	0.026	4.464	0.012	5.193	0.006
	小部分报销	83	38.21±9.59	32.30±6.77	34.49±8.65	23.60±4.63
	大部分或全报	89	41.36±7.98	34.65±6.92	37.21±8.32	25.66±4.56
间歇导尿时长	1~< 2周	35	38.03±11.50	30.77±8.44	33.23±11.01	23.37±5.50	3.738	0.006	3.619	0.008	2.977	0.021	3.413	0.010
	2~< 4周	30	35.70±10.98	32.13±7.83	33.77±9.49	23.90±5.79
	1~< 3个月	38	40.84±6.80	34.34±4.41	37.40±6.62	24.92±3.81
	3~<6个月	30	39.90±8.42	33.47±6.39	36.80±9.02	23.77±4.53
	≥ 6个月	122	42.34±8.15	35.30±6.39	38.20±7.97	26.09±4.75
每日间歇导尿次数	1~2次	37	39.03±9.12	32.78±7.55	34.03±9.08	23.54±5.16	0.704	0.552	1.061	0.371	2.541	0.061	4.859	0.003
	3~4次	82	40.29±9.89	34.27±6.21	37.74±8.40	25.61±4.52
	5~6次	108	41.39±7.50	34.60±5.38	37.69±7.14	25.71±4.87
	其他	28	39.25±12.18	32.00±10.98	33.46±12.89	22.50±5.03
使用亲水涂层导尿管	是	181	40.84±8.66	34.52±6.48	37.45±8.23	25.19±4.91	0.976	0.331	2.165	0.035	2.847	0.050	1.852	0.374
使用亲水涂层导尿管	否	74	39.53±10.16	32.54±7.38	34.91±9.70	24.58±4.98
并发症	有	109	39.34±9.13	32.42±6.84	35.03±8.54	23.73±4.75	-1.699	0.090	-3.145	0.002	-2.690	0.008	-3.689	< 0.001
并发症	无	146	41.30±9.06	35.08±6.56	37.97±8.70	25.97±4.86
患病后家人的态度	很关心	114	42.20±9.04	33.98±7.31	37.47±9.30	25.46±5.56	7.414	0.001	0.888	0.413	3.804	0.024	1.104	0.343
	关心	129	39.65±8.88	34.15±6.21	36.64±8.09	24.78±4.20
	不关心	12	32.58±7.62	31.42±7.85	30.25±7.67	23.33±5.77

表3

表4

表5

表6

表7

表8

表9

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维度	得分
得分最高的5个条目
13.我会注意个人卫生习惯,如勤洗手	4.12±0.92
19.我会随时保持会阴部皮肤干燥清洁	4.05±0.97
25.每次清洁间歇导尿前,我会彻底清洁双手和尿道口	4.01±1.07
24.我会选择合适(材质、型号)的导尿管	3.96±1.17
33.我会保持积极乐观向上的态度	3.95±1.04
得分最低的5个条目
31.我会担心自己行清洁间歇导尿时出现疼痛、出血或插不进尿管的情况	2.63±1.35
9.我会定期进行尿常规、尿培养、泌尿系B超、残余尿量测定、尿流动力学等相关检查	3.10±1.21
22.我会坚持准确记录排尿日记,根据排尿日记总结排尿规律	3.12±1.36
17.我会使用带刻度的量杯喝水	3.96±1.39
36.我会主动和病友分享我的间歇导尿经验	3.44±1.26

自变量	哑变量
性别	0 =男,1 =女
年龄	0 = 10~< 20岁,1 = 20~< 30岁,2 = 30~< 40岁,3 = 40~< 50岁,4 = ≥ 50岁
居住地	0 =农村,1 =城镇
婚姻状况	0 =未婚,1 =已婚,2 =离异
职业	0 =其他,1 =学生,2 =农民,3 =办公职员,4 =工人,5 =商人
是否为家庭收入主要来源	0 =否,1 =是
医疗费用支付方式	0 =全部自费,1 =小部分报销,2 =大部分或全报
间歇导尿时长	0 = 1~< 2周,1 = 2~< 4周,2 = 1~< 3个月,3 = 3~< 6个月,4 = ≥ 6个月
近1周每日间歇导尿次数	0 =其他,1 = 1~2次,2 = 3~4次,3 = 5~6次
使用亲水涂层导尿管	0 =否,1 =是
并发症	0 =无,1 =是
患病后家人的态度	0 =不关心,1 =关心,2 =很关心
自我效能感	以原始值录入

项目	未标准化系数		β	t值	P值
项目	B	SE	β	t值	P值
(常量)	28.066	2.868	—	9.786	< 0.001
间歇导尿时长(4)	3.231	1.116	0.177	2.895	0.004
家人的态度(1)	9.229	2.619	0.504	3.523	0.001
家人的态度(2)	6.620	2.609	0.364	2.537	0.012
自我效能感	0.632	0.256	0.147	2.471	0.014
职业(1)	-3.495	1.533	-0.140	-2.279	0.023

项目	未标准化系数		β	t值	P值
项目	B	SE	β	t值	P值
(常量)	25.930	1.540	—	16.836	< 0.001
自我效能感	0.935	0.188	0.293	4.985	< 0.001
间歇导尿时长(4)	2.694	0.799	0.198	3.373	0.001
使用亲水涂层导尿管	2.378	0.869	0.159	2.737	0.007
并发症	-1.792	0.822	-0.131	-2.179	0.030

项目	未标准化系数		β	t值	P值
项目	B	SE	β	t值	P值
(常量)	27.359	1.976	—	13.844	< 0.001
自我效能感	1.066	0.244	0.260	4.359	< 0.001
间歇导尿时长4	3.122	1.033	0.179	3.022	0.003
使用亲水涂层导尿管	2.844	1.130	0.148	2.517	0.012
医疗费用支付方式1	-2.387	1.112	-0.128	-2.147	0.033