新型冠状病毒肺炎出院患者生活质量及影响因素研究

目的:了解新型冠状病毒肺炎(COVID-19)患者出院后的生活质量及其影响因素,为优化早期干预方案,预防社区生活受限,制定相应社区康复措施提供依据。方法:选择2020年3—4月在武汉华润武钢总医院治愈出院的COVID-19患者57例,于2020年4—5月通过"问卷星"平台采用简明健康状况调查量表(SF-12V2)调查患者的生活质量;采用焦虑自评量表(SAS)调查患者的焦虑状态;采用抑郁自评量表(SDS)调查患者的抑郁状态;采用呼吸困难指数量表(mMRC)调查患者的呼吸困难程度。比较不同特征COVID-19患者生活质量的差异;分析患者生活质量与焦虑、抑郁和呼吸困难程度的相关性及其相关的影响因素。结果:共发放57份调查问卷,剔除重复及无效问卷3份,获得有效问卷54份,问卷有效率达94.74%。(1)COVID-19出院后患者生活质量情况:生理总评分和心理总评分分别为(37.02±12.32)分、(38.46±14.42)分;呼吸困难等级0~3级的分别为3例(5.56%)、45例(83.33%)、5例(9.26%)、1例(1.85%);有19例(35.19%)存在焦虑情绪(SAS≥50分)和抑郁情绪(SDS≥53分)。(2)不同特征COVID-19患者生活质量比较:不同疾病分型的患者在生理总评分方面差异有统计学意义(P<0.05)。(3)生活质量与焦虑、抑郁和呼吸困难程度的相关性分析:Pearson相关分析结果显示,SF-12V2生理总评分与焦虑程度(r=-0.34,P=0.011)和呼吸困难程度(r=-0.39,P=0.003)之间存在负相关性,SF-12V2心理总评分与焦虑程度(r=-0.46,P=0.001)和抑郁程度(r=-0.40,P=0.002)之间存在负相关性。(4)COVID-19患者生活质量的影响因素分析:多元线性回归分析显示,性别(β=8.27)、抑郁程度(β=-0.34)和疾病分型(β=-11.68)是患者SF-12V2生理总评分的重要决定因素(P<0.05);焦虑程度(β=-0.62)是患者SF-12V2心理总评分的重要决定因素(P<0.05)。结论:COVID-19出院患者存在呼吸困难、焦虑抑郁情绪和生活质量下降的问题;性别、疾病分型、抑郁程度和焦虑程度是COVID-19患者生活质量下降的重要因素。COVID-19患者(特别是女性患者和重型患者)出院后要尽早进行抑郁症和焦虑症的筛查和干预,减少患者负性情绪,鼓励患者适当参与康复训练,提高呼吸功能,从而促进生活质量提高。

Quality of Life and Related Factors in Discharged Patients with COVID-19

Objective:To determine the factors associated with quality of life of discharged patients with coronavirus disease 2019(COVID-19),so as to provide a basis for optimizing early intervention programs,preventing community from life restriction,and formulating appropriate community rehabilitation measures.Methods:A total of 57 discharged patients with COVID-19 who were cured from Wuhan China resources&Wisco general hospital from March to April 2020.In the"Questionnaire Star"platform from April to May 2020,the 12-item short form health survey version 2(SF-12V2)was used to evaluate life quality of life;the self-rating anxiety scale(SAS)was used to evaluate dyspnea anxiety status;the self-rating depression scale(SDS)was used to evaluate depression status;the modified medical research council dyspnea scores(mMRC)was used to evaluate difficulty of breathing.The quality of life of discharged patients with COVID-19 with different characteristics was compared.The correlation between the quality of life of patients and anxiety,depression and dyspnea and the related factors were analyzed.Results:A total of 57 questionnaires were distributed,and three duplicate and invalid questionnaires were eliminated,54 valid questionnaires were obtained,with an effective questionnaire of 94.74%.①Quality of life of discharged patients with COVID-19:the physical component summary(PCS)scores and mental component summary(MCS)scores were(37.02±12.32)and(38.46±14.42)respectively;there were 3 cases(5.56%),45 cases(83.33%),5 cases(9.26%),and 1 case(1.85%)with dyspnea grade 0 to 3 respectively;19 cases(35.19%)had an anxiety state(SAS≥50),and 19 cases(35.19%)had an anxiety state(SDS≥53).②Comparison of quality of life of COVID-19 patients with different characteristics:patients with different disease types showed statistically significant differences in the SF-12V2 PCS(P<0.05).③Correlation analysis between quality of life,anxiety,depression and dyspnea:Pearson's correlation indicated that,anxiety(r=-0.34,P=0.011)and dyspnea(r=-0.39,P=0.003)were negatively correlated with the PCS scores,anxiety(r=-0.46,P=0.001)and depression(r=-0.40,P=0.002)were negatively correlated with the MCS scores.④Analysis of influencing factors on the quality of life of COVID-19 patients:multiple linear regression indicated that,sex(β=8.27),depression(β=-0.34)and severity of illness(β=-11.68)were significant predictors of the SF-12V2 PCS scores(P<0.05).Anxiety(β=-0.62)was a significant predictor of the SF-12V2 MCS scores(P<0.05).Conclusion:COVID-19 patients discharged from the hospital have problems with dyspnea,anxiety,depression,and the decline of quality of life.Sex,depression,anxiety and severity of illness are important factors for the decline of quality of life in patients with COVID-19.Patients with COVID-19(especially female patients and severe patients)should be screened for depression and anxiety as soon as possible after discharge and intervention should be carried out to reduce patients'negative emotions.Patients should be encouraged to participate in rehabilitation training appropriately to improve respiratory function and improve the quality of life.