CAJ | 학술논문

目的：研究老年尿失禁患者对治疗效果的评价和医生的评价的一致性程度，并分别与尿失禁客观测量结果进行比较，旨在比较患者和医生评价尿失禁治疗效果的异同并探索更全面、客观的评价尿失禁疗效的方法。方法选取泰安市3家医院泌尿、妇科就诊的100例老年女性尿失禁患者进行研究，根据患者病情实施行为干预；治疗后3个月进行复查，由患者和医生分别填写患者总体印象量表（Patient Global Impression of Improvement，PGI-I）和临床总体印象量表（Clinician Global Impression of Improvement，CGI-I）代表患者和医生对治疗效果的评价；同时要求患者填写尿失禁生活质量影响问卷（Incontinence Quality of Life， I-QOL）并完成一份随访前3 d的排尿日记。结果患者和医生对于尿失禁治疗效果的评价一致性程度良好，加权kappa值0.429；患者和医生对尿失禁治疗效果的评价存在一定差异性，患者对尿失禁治疗效果的评价高于医生的评价结果；患者和医生的评价结果与客观测量结果相关性比较，患者总体印象量表得分与漏尿次数和尿失禁生活质量影响问卷得分的相关性分别为 r=0.4和r=-0.5较临床总体印象量表（r=0.3和r=-0.4）高。结论患者和医生对尿失禁疗效的评价存在差异，患者对尿失禁治疗效果的评价比医生的评价结果更积极，医生评价结果容易低估治疗效果，建议在医生评价结果的基础上多关注患者自我对治疗效果的评价结果，形成更全面客观的评价结果。
목적：연구노년뇨실금환자대치료효과적평개화의생적평개적일치성정도，병분별여뇨실금객관측량결과진행비교，지재비교환자화의생평개뇨실금치료효과적이동병탐색경전면、객관적평개뇨실금료효적방법。방법선취태안시3가의원비뇨、부과취진적100례노년녀성뇨실금환자진행연구，근거환자병정실시행위간예；치료후3개월진행복사，유환자화의생분별전사환자총체인상량표（Patient Global Impression of Improvement，PGI-I）화림상총체인상량표（Clinician Global Impression of Improvement，CGI-I）대표환자화의생대치료효과적평개；동시요구환자전사뇨실금생활질량영향문권（Incontinence Quality of Life， I-QOL）병완성일빈수방전3 d적배뇨일기。결과환자화의생대우뇨실금치료효과적평개일치성정도량호，가권kappa치0.429；환자화의생대뇨실금치료효과적평개존재일정차이성，환자대뇨실금치료효과적평개고우의생적평개결과；환자화의생적평개결과여객관측량결과상관성비교，환자총체인상량표득분여루뇨차수화뇨실금생활질량영향문권득분적상관성분별위 r=0.4화r=-0.5교림상총체인상량표（r=0.3화r=-0.4）고。결론환자화의생대뇨실금료효적평개존재차이，환자대뇨실금치료효과적평개비의생적평개결과경적겁，의생평개결과용역저고치료효과，건의재의생평개결과적기출상다관주환자자아대치료효과적평개결과，형성경전면객관적평개결과。
Objective To determine whether elderly female patients ’ assessment of improvement following treatment for UI (urinary incontinence) correspond with physicians’, to compare patients’ and physicians’ assessment with objective UI measures and to ex-plore a comprehensive and objective assessment for UI treatment. Methods One hundred elderly female patients with UI in Depart-ment of Urinary and Gynecology of three hospitals in Tai ’an city were selected and received behavioural intervention treatment for UI. After three-month follow-up, patients and physicians were independently interviewed for their impression of change in UI status and surveyed with PGI-I (Patient Global Impression of Improvement) and CGI-I (Clinician Global Impression of Improvement ,CGI-I). Pa-tients completed three-day voiding diaries and a UI-specific quality-of-life index before and after treatment. ResuIts Agreement regarding improvement between patients and physicians was moderate (kappa=0.429). When ratings differed, patients ’ assessment were more positive than physicians’;Patients’ rating correlated more strongly with improvement in UI episodes in voiding diaries (r=0.4 versus r=0.3)and on quality-of-life index(r=-0.5 versus r=-0.4). ConcIusion The assessments of treatment effect are different between physicians and patients with UI, and patients ’ assessment appear to be more positive than physicians ’. Physicians tend to underestimate clinically meaningful changes in UI. We suggest that health-care staff should put more emphasis on patients ’ assess-ment so to obtain a comprehensive and objective assessment.