田慧 王珊珊 柏亚中 方心鑫 解辉 吕丹

【摘要】 目的：对中老年不稳定型心绞痛（unstable angina，UA）患者的疾病不确定感现状及影响因素进行调查，并探讨其与生活质量的关系，旨在为患者提供高质量的医疗服务奠定理论基础。方法：采用便利抽样的方法，选取2020年8月-2021年1月在本院治疗的181例中老年UA患者为研究对象。采用Mishel疾病不确定感及世界卫生组织生存质量测定量表简表进行横断面调查，通过多重线性回归，明确疾病不确定感的影响因素及与生活质量的关系。结果：UA患者的疾病不确定感总均分为（104.83±10.42）分，其中复杂性维度各条目均分得分最高，为（3.87±0.42）分，不确定感维度各条目均分得分最低，为（2.99±0.53）分。家中有无医护人员、發病次数不同的患者疾病不确定感水平不同，差异均有统计学意义（P<0.05）。Pearson相关分析研究结果显示，UA患者疾病不确定感总分均分、不确定感、复杂性及信息缺乏及不可预测性评分与生活质量总分均分呈负相关（P<0.01）。家中无医护人员能正向预测UA患者疾病不确定感（P<0.05）;发病次数>3次与疾病不确定感呈现正相关（P<0.05）;而疾病不确定感与生活质量呈现负相关（P<0.05）。结论：中老年UA患者疾病不确定感处于中等偏上水平，并对其生活质量有较大影响，医护人员应重视患者的心理状态，采取针对性措施，以改善疾病不确定感体验，提高其生活质量。

【关键词】 不稳定型心绞痛 中老年 疾病不确定感 生活质量

Investigation on the Current Situation and Influencing Factors of Disease Uncertainty in Middle-aged and Elderly Patients with Unstable Angina/TIAN Hui， WANG Shanshan， BAI Yazhong， FANG Xinxin， XIE Hui， LYU Dan. //Medical Innovation of China， 2021， 18（14）： 0-090

[Abstract] Objective： To investigate the current situation and influencing factors of disease uncertainty in middle-aged and elderly patients with unstable angina （UA）， and to explore the relationship between disease uncertainty and quality of life， in order to lay a theoretical foundation for patients to provide high-quality medical services. Method： A total of 181 middle-aged and elderly patients with UA who were treated in our hospital from August 2020 to January 2021 were selected as the research objects by convenience sampling method. A cross-sectional survey was conducted using the Mishel disease uncertainty scale and the World Health Organization （WHO） quality of life scale. Through multiple linear regression， the influencing factors of disease uncertainty and the relationship between disease uncertainty and quality of life were determined. Result： The total score of disease uncertainty of UA patients was （104.83±10.42） scores， among which the average score of each item in the complexity dimension was the highest （3.87±0.42） scores， and the average score of each item in the uncertainty dimension was the lowest （2.99±0.53） scores. With or without medical staff at home， patients with different incidence of disease had different levels of disease uncertainty， the differences were statistically significant （P<0.05）. The results of the person correlation analysis showed that the average score of disease uncertainty， uncertainty， complexity， lack of information and unpredictability of UA patients were negatively correlated with the average score of life quality （P<0.01）. The absence of medical personnel at home could positively predict disease uncertainty in UA patients （P<0.05）. the incidence >3 times was positively correlated with disease uncertainty （P<0.05）; however， disease uncertainty was negatively correlated with quality of life （P<0.05）. Conclusion： The disease uncertainty of middle-aged and elderly UA patients is above the medium level， and has a great impact on their quality of life， medical staff should pay attention to the psychological state of patients and take targeted measures to improve the experience of disease uncertainty and improve their quality of life.

[Key words] Unstable angina Middle-aged and elderly Illness uncertainty Quality of life

First-authors address： Qilu Hospital of Shandong University， Jinan 250012， China

doi：10.3969/j.issn.1674-4985.2021.14.021

不稳定型心绞痛（unstable angina， UA）属于急性冠脉综合征的一种，以冠状动脉粥样硬化为基础病因，主要的特点是冠状动脉内不稳定的粥样斑块激发性病理改变，如斑块内出血、斑块纤维帽出现裂隙、表面存在血小板聚集和/或刺激冠状动脉痉挛，进而导致局部的心肌血流明显下降，使患者出现缺血性心绞痛[1-2]。仅有少数UA患者伴有感染、低血压及低氧血症等明确的诱因，大多数患者起病急骤，甚者休息状态时仍可发生[3]。中老年人随年龄增加，血管会出现生理性脆性增加、血流速度缓慢等特点，较年轻人其更易诱发UA[4-5]。……