急性冠狀動脈症候群病人焦慮程度、自我效能及生活品質之相關因素探討

Relationship among anxiety, self-efficacy and quality of life in patients with acute coronary syndrome

趙恩伶(En-Ling Chao)

指導教授 ： 黃瓊玉

義守大學/醫學院/醫務管理學系/碩士(2019年)

摘要

世界衛生組織(world health organization; WHO)預測2020年時，全球約有36%人因心血管疾病死亡，有研究指出罹患急性冠狀動脈症候群，會使日後的生活品質較差，且急性冠狀動脈症候群發作時及心臟病病人在接受相關檢查前皆會引起焦慮的情緒，一旦有焦慮情緒產生，則可能會降低心律變異性，增加心臟血管相關疾病的發生率以及增加其死亡率。故研究目的為探討急性冠狀動脈症候群病人的個人屬性及罹病時之焦慮程度及與自我效能及生活品質間的相關性，期盼研究結果能提供臨床照護者以為照顧急性冠狀動脈症候群病人之參考依據。研究方法以量性結構式問卷為主，採橫斷式、相關性研究設計，以便利性取樣收集南部區域教學醫院急診、病房、門診的98位診斷急性冠狀動脈症候群病人，以結構式問卷收集資料，測量工具包括：基本屬性、情境特質焦慮量表、一般性自我效能量表、SF-36健康相關生活品質問卷。統計方法包括皮爾森積差相關、獨立樣本t檢定、單因子變異數分析、複迴歸分析。
結果發現急性冠狀動脈症候群病人罹病時之焦慮程度，以中度焦慮93.9%佔最多，抽血報告中CK值越高(r=0.319、p＜0.01)、Troponin值越高(r=0.222、p＜0.05)，病人焦慮程度也越高；在生活品質的部分，年齡越低(r=0.305、p＜0.01)、BMI越高(r=0.214、p＜0.05)、教育程度越高(r=-0.200、p＜0.05)其生活品質越好；自我效能越好，病人生活品質也越好(r=0.419、p＜0.001)；自我效能越好，其罹病過程之特質焦慮層面之焦慮程度越輕(r=-0.648、p＜0.001)。研究結果發現自我效能為影響急性冠狀動脈症候群病人生活品質及焦慮狀態之重要預測因子，可解釋急性冠狀動脈症候群病人健康相關生理生活品質總變異量為17.9%的解釋力，心理生活品質總變異量為13.6%的解釋力，在情境焦慮總變異量為18%的解釋力。自我效能越好，病人情境焦慮狀態越低，生活品質越好。本研究結果能提供第一線醫護人員在臨床上照護急性冠狀動脈症候群病人過程中，可了解病人自我照顧之狀態，了解病人平日生活品質，在臨床照顧過程中，規劃並加強訓練提高病人自我效能之程度，促使病人提高對自我照護及疾病治療之遵從性，減少因疾病不是症狀導致的焦慮感，進而增進生活舒適度，並提升生活品質。

關鍵字

自我效能 ； 焦慮程度 ； 生活品質 ； 急性冠狀動脈症候群

並列摘要

The World Health Organization (WHO) predicts that about 36% of people will die from cardiovascular disease by 2020. Studies have shown that acute coronary syndromes can lead to poor quality of life and acute coronary syndrome episodes. And acute coronary syndrome and heart disease patients will cause anxiety before receiving an examination. If there is anxiety, it may reduce heart rate variability, increase the incidence of cardiovascular disease and increase its mortality. Therefore, the purpose of the study was to investigate the personal attributes of patients with acute coronary syndrome and the degree of anxiety during rickets and their correlation with self-efficacy and quality of life. The research results can provide to clinical caregivers to care for patients with acute coronary syndrome. The research method was based on the quantitative structural questionnaire, and the cross-sectional and correlation research design was adopted to collect and collect 98 patients with acute coronary syndrome diagnosed in the emergency department, ward and outpatient department of the southern regional teaching hospital by a convenient sampling. Data and measurement tools include: basic attributes, situational trait anxiety scale, general self-efficacy scale, and SF-36 health-related quality of life questionnaire. Statistical methods include Pearson product difference correlation, independent sample t-test, single-factor variance analysis, and complex regression analysis.
The results showed that the anxiety degree of rickets in patients with acute coronary syndrome was the highest with moderate anxiety of 93.9%. The higher the CK value in blood sampling (r=0.319, p<0.01), the higher the Troponin value (r=0.222, p <0.05), the patient's anxiety level is also higher; in the quality of life part, the lower the age (r=0.305, p<0.01), the higher the BMI (r=0.214, p<0.05), the higher the education level (r= -0.200, p<0.05) The better the quality of life; the better the self-efficacy, the better the patient's quality of life (r=0.419, p<0.001); the better the self-efficacy, the more the anxiety level of the traits of the rickets process Light (r = -0.648, p < 0.001). The study found that self-efficacy is an important predictor of quality of life and anxiety in patients with acute coronary syndrome. It can explain the total variation of health-related physiological quality of life in patients with acute coronary syndrome as 17.9%, and the total variation in mental quality of life. For a 13.6% explanatory power, the total variation in situational anxiety is 18% of the explanatory power. The patient's self-efficacy better, made situational anxiety state lower and better the quality of life. The results of this study can provide first-line medical staff in the process of clinical care of patients with acute coronary syndrome, can understand the state of self-care of patients, understand the quality of life of patients, and plan and strengthen training to improve patient self-efficacy during clinical care. The degree of self-care and disease treatment is improved, and the anxiety caused by the disease is not reduced, thereby improving the comfort of life and improving the quality of life.

並列關鍵字

self-efficacy ； anxiety ； quality of life ； acute coronary syndrome

參考文獻

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