医生与患者对老年女性尿失禁患者治疗效果评价的比较研究

2015年4月护理学报April，2015

第22卷第8期Journal of Nursing（China）Vol.22No.8

【研究生园地·论著】

医生与患者对老年女性尿失禁患者治疗效果评价的比较研究

郭卿，侯青芝，柳韦华

（泰山医学院护理学院，山东泰安271000）

[摘要]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3d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。

[关键词]尿失禁；老年；女性；医生；患者

[中图分类号]R473.59[文献标识码]A[DOI]10.16460/j.issn1008-9969.2015.08.001

Assessment Difference of Treatment Effect between Physicians and EIderIy FemaIe

Patients with Urinary Incontinence

GUO Qing,HOU Qing-zhi,LIU Wei-hua

(School of Nursing,Taishan Medical University,Tai’an271000,China)

Abstract：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= 0.4versus r=0.3)and on quality-of-life index(r=-0.5versus 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.

Key words：urinary incontinence;elderly;female;physicians;patients

尿失禁是老年女性的常见病，主要表现是尿液经尿道的不自主流出[1]。随着我国人口老龄化加剧，尿失禁的发病率上升，成为当前医务界的一大挑战。尿失禁发病率高虽不是致命性疾病却对患者的生活造成极大困扰，导致患病老年人产生孤僻、抑郁等心理问题,并逐渐远离社交活动，使其社会功能下降[2]，但鉴于大部分患者对尿失禁的认知不足及羞于启齿等原因，仅有不到一半的患者会寻求医治[3]，大多数患者采取使用尿垫、改变生活方式及减少社交等方法进行应对。随着现代西方医学模式从生物模式向生物—社会—心理模式的转变[4]，卫生保健的主要任务已不再是疾病的治愈，而是着重于对疾病症状的有效控制，促进患者功能的恢复和维持，提高其生活质量，使其生活的舒适、满意。医生报告结局多是以生理报告结局为基础，结合医生的经验判断和专

[收稿日期]2014-07-29

[基金项目]教育部人文社会科学研究规划基金（12YJAZH082）

[作者简介]郭卿（1988-），女，山东莱芜人，本科学历，硕士研

究生在读。

[通讯作者]柳韦华（1966-），女，山东泰安人，硕士，教授，硕士

研究生导师，副院长。

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