心脏起搏器植入患者出院指导质量与出院后生活质量的现状调查及相关性分析

马芳芳; 杨丽潇; 何叶; 杨德彦; 杨竹; 夏莹

doi:10.16766/j.cnki.issn.1674-4152.004330

心脏起搏器植入患者出院指导质量与出院后生活质量的现状调查及相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.004330

马芳芳¹,
杨丽潇¹,
何叶¹,
杨德彦²,
杨竹¹,
夏莹^2, ,

1.
中国医学科学院北京协和医院内科学系心内科CCU，北京 100730
2.
中国医学科学院北京协和医院内科学系

基金项目:

中央高水平医院临床科研专项青年培优项目 2025-PUMCH-A-176

详细信息

通讯作者:
夏莹，E-mail：xiaying881@sina.com

中图分类号: R541
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出版历程
- 收稿日期: 2025-01-21
- 网络出版日期: 2026-04-01

Investigation and correlation analysis on the quality of discharge teaching and the quality of life post discharge for patients with cardiac pacemaker implantation

1.
Division of CCU, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China

摘要

摘要: 目的探讨出院指导质量对心脏起搏器植入患者出院后生活质量的影响，并分析可能的影响因素，以期为临床提供更有效的出院指导策略，改善患者长期生活质量。方法采用横断面研究设计，便利抽样选取2023年1月—2024年8月在中国医学科学院北京协和医院接受心脏起搏器植入手术并出院的患者作为研究对象。使用出院准备度量表(RHDS)、出院指导质量问卷(QDTS)、一般自我效能量表(GES)、简明生活质量量表(SF-12)进行调查，通过Pearson相关分析及多元线性回归构建模型，评估出院指导与生活质量之间的关系，识别影响患者生活质量的因素。结果共纳入患者174例，其中男性98例，女性76例，年龄为18~89岁。相关分析结果显示，出院指导质量与患者出院准备度呈正相关关系(r=0.559，P＜0.01)，而患者出院准备度、自我效能与出院后1个月的生活质量呈正相关关系(r=0.400，P＜0.01；r=0.537，P＜0.01)。多元线性回归分析显示，出院指导和自我效能均为影响心脏起搏器植入患者生活质量的独立因素(B=1.429，P < 0.001；B=0.534，P=0.026)。结论出院指导质量及自我效能对心脏起搏器植入患者出院后的生活质量具有正向影响，因此，医护人员应重视对患者的出院指导工作，制定个性化指导计划，以提高患者的自我管理能力，改善远期生活质量。
- 心脏起搏器 /
- 出院指导 /
- 生活质量 /
- 影响因素
Abstract: Objective To assess how discharge instruction quality affects post-discharge quality of life (QoL) in pacemaker-implanted patients and analyze potential influencing factors, with the aim of providing more effective discharge guidance strategies for clinical practice and improving patients ' long-term QoL. Methods A cross-sectional study design was adopted, and patients who underwent cardiac pacemaker implantation surgery and were discharged from Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from January 2023 to August 2024 were selected as the research subjects through convenience sampling. The readiness for hospital discharge scale (RHDS), the quality of discharged teaching scale (QDTS), the general self-efficacy scale (GES), and the 12-item short form health survey (SF-12) were used for the investigation. A model was constructed through Pearson correlation analysis and multiple linear regression to evaluate the relationship between discharge guidance and quality of life. Identify the factors that affect the quality of life of patients. Results A total of 174 patients were included, including 98 males and 76 females, aged from 18 to 89 years old. Discharge instruction quality positively correlated with discharge readiness (r=0.559, P < 0.01), while higher discharge readiness and self-efficacy predicted better 1-month QoL (r=0.400, P < 0.01; r=0.537, P < 0.01). Regression confirmed discharge instructions (B=1.429, P < 0.001) and self-efficacy (B=0.534, P=0.026) as independent QoL determinants. Conclusion Optimizing discharge guidance and enhancing self-efficacy improve long-term QoL. Clinicians should emphasize patient discharge education, develop individualized guidance plans to enhance patients ' self-management abilities, and improve their long-term QoL.
- Pacemaker /
- Discharge teaching /
- Quality of life /
- Influencing factors

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表 1 不同一般资料心脏起搏器植入术后患者QDTS、RHDS、GES及SF-12得分比较(x±s, 分)

Table 1. Comparison of QDTS, RHDS, GES, and SF-12 scores among patients with different general characteristics after cardiac pacemaker implantation(x±s, points)

项目	例(%)	QDTS得分	统计量	P值	RHDS得分	统计量	P值	GES得分	统计量	P值	SF-12得分	统计量	P值
年龄			0.747^b	0.059		0.595^b	0.704		0.434^b	0.824		0.571^b	0.763
18~50岁	12(6.9)	227.22±5.59			113.00±8.43			28.67±2.45			90.61±10.71
51~60岁	21(12.1)	220.56±15.22			111.22±5.67			31.56±2.06			97.41±9.34
61~70岁	34(19.5)	217.47±13.37			107.19±9.87			30.81±3.61			90.82±11.36
＞70岁	107(61.5)	213.13±16.94			108.79±8.63			28.69±2.95			88.48±11.90
性别			0.050^a	0.960		0.787^a	0.431		0.615^a	0.538		0.517^a	0.605
男性	98(56.3)	215.68±16.56			109.49±9.21			29.65±3.35			87.98±15.30
女性	76(43.7)	217.02±14.37			108.90±7.87			29.86±2.96			88.24±15.16
学历			6.954^b	0.224		3.650^b	0.601		2.938^b	0.710		0.799^b	0.977
小学及以下	28(16.1)	212.56±12.48			108.50±4.36			30.29±2.89			87.44±14.79
中学	60(34.5)	216.32±15.56			107.87±10.16			30.03±3.54			88.51±13.62
高中	36(20.7)	221.15±10.84			109.56±7.12			29.40±2.94			87.92±9.18
大学及以上	50(28.7)	219.71±17.36			112.50±8.42			29.29±3.13			88.35±8.56
工作状态			0.881^a	0.380		1.843^a	0.070		0.539^a	0.590		0.343^a	0.181
在职	11(6.3)	219.10±17.30			112.20±4.52			30.30±2.58			90.56±14.07
非在职	163(93.7)	215.63±15.23			109.48±8.59			29.76±2.49			88.05±15.04
宗教信仰			1.633^b	0.442		0.256^b	0.880		2.943^b	0.231		2.960^b	0.229
无	169(97.1)	216.14±15.60			109.11±8.62			29.76±3.18			88.17±15.23
基督教	2(1.1)	217.00±2.83			115.50±2.82			29.50±3.54			85.00±11.41
伊斯兰教	3(1.7)	218.25±4.47			116.33±10.60			28.16±3.45			91.00±11.41
医保类型			0.111^b	0.949		1.516^b	0.471		0.219^b	0.895		0.364^b	0.831
城镇职工医保	90(51.7)	217.69±16.62			109.22±8.10			29.86±3.68			88.34±15.60
城镇居民医保	72(41.4)	215.70±13.31			108.31±9.53			29.42±2.66			87.14±9.82
新农合	3(1.7)	213.11±26.87			113.00±5.30			31.67±2.08			93.67±10.58
公费医疗	8(4.6)	209.50±22.05			113.67±4.72			30.17±1.33			90.67±13.27
商业保险	1(0.6)	206.00			118.00			32.00			91.00
婚姻状态			2.983^b	0.078		0.444^b	0.508		0.584^b	0.449		0.034^b	0.857
未婚	4(2.3)	227.33±10.02			115.67±3.06			29.35±2.08			86.00±13.61
已婚	161(92.5)	216.40±15.47			109.01±8.76			29.69±3.21			88.09±15.29
离异	1(0.6)	192.00			105.00			36.00			97.00
丧偶	8(4.6)	212.00±17.65			111.00±5.92			30.40±1.82			88.00±12.92
合并症数量			4.178^b	0.242		4.089^b	0.252		4.053^b	0.264		4.789^b	0.190
0	5(2.9)	212.60±6.43			100.4±16.20			30.80±3.63			85.60±14.62
1~2	93(53.4)	221.48±13.13			108.03±9.08			29.39±2.68			87.54±14.97
≥3	76(43.7)	216.04±11.68			108.54±8.19			29.71±3.24			87.52±14.17
起搏器类型			0.684^b	0.713		0.119^b	0.937		0.524^b	0.229		3.721^b	0.163
临时起搏器	4(2.3)	218.00±2.83			95.67±20.60			26.00±5.00			81.33±14.04
半永久起搏器	8(4.6)	213.17±14.25			112.14±5.76			31.12±1.25			84.50±7.07
永久起搏器	162(93.1)	216.62±14.83			110.81±7.27			30.16±3.45			81.41±16.01
用药种类			3.701^b	0.158		3.473^b	0.180		4.073^b	0.133		4.302^b	0.116
无	79(45.4)	216.23±15.13			108.46±8.45			29.63±3.10			89.43±9.23
1~2种	68(39.1)	214.41±19.88			109.44±9.77			29.59±3.18			91.21±11.30
≥3种	27(15.5)	216.72±13.80			110.13±8.33			29.28±5.50			89.45±13.67
主要照顾者			0.872^b	0.833		2.462^b	0.477		2.398^b	0.493		1.811^b	0.608
自己	36(20.7)	217.03±16.30			109.90±9.52			30.43±1.92			89.66±13.88
配偶	57(32.8)	216.50±15.49			108.88±7.62			29.93±4.16			88.23±16.56
儿女	72(41.4)	216.25±14.57			109.87±7.76			29.50±2.53			87.64±9.36
其他	9(5.1)	212.14±21.72			104.14±14.18			27.29±2.93			83.86±13.18
注：^a为t值，^b为F值。

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表 2 心脏起搏器植入术后患者QDTS、RHDS、GES、SF-12总分及各分维度得分情况(x±s, 分)

Table 2. The total scores and scores of each dimension of QDTS, RHDS, GES and SF-12 for patients after cardiac pacemaker implantation(x±s, points)

量表	维度	条目数	总分	条目均分
QDTS	患者所需指导内容	6	53.72±4.57	8.95±1.88
	患者所获指导内容	6	53.83±4.08	8.97±1.67
	指导技巧及效果	12	108.77±9.42	9.07±2.62
	QDTS总分	24	216.46±15.61	9.02±3.19
RHDS	个人状态	3	27.68±2.22	9.23±1.28
	适应能力	5	44.81±4.91	8.96±2.20
	预期性支持	4	36.54±3.97	9.13±1.99
	RHDS总分	12	109.04±8.72	9.09±2.52
GES		10	29.68±3.20	2.97±1.01
SF-12	躯体健康	6	40.67±7.48	-
	心理健康	6	49.93±8.21	-
	SF-12总分	12	90.61±11.59	-
注：SF-12各条目选项尺度不同，无法直接计算条目均分，以“-”表示。

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表 3 QDTS、RHDS、GES、SF-12得分的Pearson相关性分析(r值)

Table 3. Pearson correlation analysis of the scores of QDTS, RHDS, GES, and SF-12(rvalue)

项目	QDTS	RHDS	GSE	SF-12
QDTS	1.000
RHDS	0.559^a	1.000
GSE	0.003	0.173	1.000
SF-12	0.065	0.400^a	0.537^a	1.000
注：^aP＜0.01。

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表 4 心脏起搏器植入术后患者生活质量影响因素的多元线性回归分析

Table 4. Multivariate linear regression analysis of factors influencing the quality of life of patients after cardiac pacemaker implantation

变量	B	SE	β	t值	P值
出院指导质量	1.429	0.202	0.615	7.284	＜0.001
自我效能	0.534	0.228	0.187	2.273	0.026
注：本表仅列出差异有统计学意义的变量。

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