CAJ | 학술논문

目的了解健康管理式教育对乙型肝炎肝硬化腹水患者心理状况、营养状况和生存质量的影响.方法将121例乙型肝炎肝硬化腹水患者随机分为观察组(61例)和对照组(60例).对照组采用医嘱形式向患者交代病情及生活、饮食、用药等注意事项；观察组由肝病专科医生实行建立档案、定期随访,对患者与家属进行肝病知识健康教育,生活、用药、饮食指导和心理指导.健康教育前后采用Zung焦虑自评量表(SAS)、抑郁自评量表(SDS)对两组患者测评；测肱三头肌皮褶厚度(TSF)、上臂围,评估营养状况；生存质量采用汉化版简明健康调查量表(SF-36)评估.结果健康教育后SAS与SDS评分,观察组为(39.9±8.8)与(40.6±8.8)分,对照组为(49.0±9.4)与(51.8±10.1)分,均低于健康教育前的(68.5±10.5)与(68.5±9.4)分、(69.7±11.4)与(67.4±8.4)分(t=3.59,均P＜0.01)；观察组SAS、SDS评分低于对照组(t=2.82,均P＜0.01).观察组TSF、血红蛋白和白蛋白分别为(13.2±2.9)mm、(130.6±11.7) g/L、(36.6±2.4) g/L,均高于对照组(12.3±2.6)mm、(110.7±10.3)g/L、(33.4±3.1)g/L(t =2.33,均P＜0.05)；观察组SF-36的8个维度评分高于对照组(t =2.74,均P＜0.01).结论慢性乙肝健康管理式教育可缓解肝硬化腹水患者心理压力,减少心理障碍的发生,改善患者的营养状况,提高患者生存质量.
목적 료해건강관리식교육대을형간염간경화복수환자심리상황、영양상황화생존질량적영향.방법 장121례을형간염간경화복수환자수궤분위관찰조(61례)화대조조(60례).대조조채용의촉형식향환자교대병정급생활、음식、용약등주의사항；관찰조유간병전과의생실행건립당안、정기수방,대환자여가속진행간병지식건강교육,생활、용약、음식지도화심리지도.건강교육전후채용Zung초필자평량표(SAS)、억욱자평량표(SDS)대량조환자측평；측굉삼두기피습후도(TSF)、상비위,평고영양상황；생존질량채용한화판간명건강조사량표(SF-36)평고.결과 건강교육후SAS여SDS평분,관찰조위(39.9±8.8)여(40.6±8.8)분,대조조위(49.0±9.4)여(51.8±10.1)분,균저우건강교육전적(68.5±10.5)여(68.5±9.4)분、(69.7±11.4)여(67.4±8.4)분(t=3.59,균P＜0.01)；관찰조SAS、SDS평분저우대조조(t=2.82,균P＜0.01).관찰조TSF、혈홍단백화백단백분별위(13.2±2.9)mm、(130.6±11.7) g/L、(36.6±2.4) g/L,균고우대조조(12.3±2.6)mm、(110.7±10.3)g/L、(33.4±3.1)g/L(t =2.33,균P＜0.05)；관찰조SF-36적8개유도평분고우대조조(t =2.74,균P＜0.01).결론 만성을간건강관리식교육가완해간경화복수환자심리압력,감소심리장애적발생,개선환자적영양상황,제고환자생존질량.
Objective To evaluate the effect of managed health education on psychological and nutritional status of patients with HBV-related cirrhosis and ascites.Methods One hundred and twenty one patents with decompensated HBV-related cirrhosis were enrolled for health education and randomly divided into two groups:61 patients received managed health education (trial group) and 60 received conventional health education (control group).In control group patients were informed with their condition and diet note by medical orders.In control group the hepatologists evaluated the baseline condition,nutritional status and quality of life,set up personal files of patients and followed up with communication and counselling periodically from June 2010 to August 2012.The psychological conditions were assessed with self-rating anxiety scale (SAS) and self-rating depression scale (SDS) ; nutritional status was assessed with triceps skinfold thickness (TSF) and mid-arm muscle circumference (MAMC) and the quality of life was assessed with MOS 36-item shoort from healthy survey (SF-36).Results Before health education,there was no statistical difference in the scores of SAS,SDS,TSF,SF-36 and blood Hb,albumin (Alb) levels between two groups.After health education,scores of SAS and SDS were decreased in both groups (P ＜ 0.0l),however,which in trial group were lower than those in control group (39.9 ±8.8 vs.49.0 ±9.4 and 40.6 ± 8.8 vs.51.9 ± 10.1 respectively,both P ＜0.01).The TSF scores and blood Hb and Alb levels in trial group were higher than those in control group (P ＜ 0.05).The accunulated scores of 8 dimensions in SF-36 forms in trial group were significantly higher than those in control group (P ＜ 0.01).Conclusion The managed health education model can better release psychological pressures,decrease mental disorders,elevate nutrition status,promote health and improve quality of life than conventional health education for patients with HBV-related cirrhosis and ascites.