老年慢性阻塞性肺疾病患者疲劳感知与应对体验的质性研究

薛佳丽; 芦鸿雁; 余芳; 蒋希芮; 冯向侃

doi:10.16766/j.cnki.issn.1674-4152.002985

老年慢性阻塞性肺疾病患者疲劳感知与应对体验的质性研究

doi: 10.16766/j.cnki.issn.1674-4152.002985

1.
宁夏医科大学护理学院，宁夏银川 750004
2.
宁夏医科大学总医院护理部，宁夏银川 750004

基金项目:

宁夏回族自治区重点研发计划项目 2021BEG03116

详细信息

通讯作者:
芦鸿雁, E-mail：hyalu@hotmail.com

中图分类号: R563
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- 被引次数: 0
出版历程
- 收稿日期: 2022-05-31

Perceived fatigue and coping experience in elderly patients with chronic obstructive pulmonary disease: A qualitative study

1.
School of Nursing, Ningxia Medical University, Yinchuan, Ningxia 750004, China

摘要

摘要: 目的了解老年慢性阻塞性肺疾病(COPD)患者的疲劳感知与应对体验，从患者角度理解疲劳现象，为医务人员进一步认识疲劳、管理疲劳提供参考。方法采用现象学研究方法，于2021年5—10月，选取宁夏医科大学总医院呼吸与危重症医学科就诊的老年COPD患者为研究对象，对患者进行半结构式访谈，最终访谈患者17位。运用Nvivo 12软件及Colaizzi 7步分析法对访谈资料进行整理和分析。结果老年COPD患者的疲劳感知可归纳出3个主题，(1)备受困扰的疲劳症状：患病后疲劳症状持续存在；疲劳症状晨轻午后加重；疲劳急剧加重是COPD急性加重的预兆；疲劳常与多种躯体症状同时存在。(2)难以摆脱的“禁锢”：躯体活动受限；社交活动受限。(3)承受沉重的心理负担：负性情绪的困扰；牵连家人的无奈；背负沉重的经济压力。老年COPD患者的疲劳应对可归纳出2个主题：(1)积极应对，寻求帮助；(2)消极应对，漠然置之。结论多数老年COPD患者的疲劳症状持续存在，且具有时间变化特征和可预测病情变化的特点，疲劳对老年COPD患者日常功能及心理状态的影响是降低其生活质量的关键。然而，受多种因素的影响，多数患者的疲劳症状仍未被积极有效的控制。因此，医务人员有必要认识到疲劳给患者造成的严重不良影响，切身感受和理解患者的疲劳，早日制定出适合我国老年COPD患者的疲劳症状管理方案。
- 慢性阻塞性肺疾病 /
- 疲劳 /
- 现象学 /
- 质性研究
Abstract: Objective To understand the perceived fatigue and coping experience in older patients with chronic obstructive pulmonary disease (COPD), and give a description of the fatigue phenomenon from the perspective of patients, providing medical workers with a reference for further understanding and management of fatigue. Methods A phenomenological research approach was used. Semi-structured interviews were conducted with elderly COPD patients from Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University from May to October 2021, and 17 cases were finally enrolled. Nvivo 12 and Colaizzi ' s seven-step method were used for data processing and analysis. Results Three themes of perceived fatigue in elderly COPD patients emerged from the analysis, (1) Troubled fatigue symptoms: fatigue symptoms persisted after COPD; Fatigue symptoms were lighter in the morning and worse in the afternoon; Acute exacerbation of fatigue was an omen of acute exacerbation of COPD; Fatigue often coexisted with multiple somatic symptoms. (2) Seemingly unconquerable "constraints": limited physical activities; limited social interactions. (3) Heavy psychological burden: suffering from negative emotions; helplessness in troubling families; influence of heavy economic burden. Two themes of coping with fatigue in elderly COPD patients were summarized: (1) actively coping and seeking help; (2) passively coping and indifferently handling. Conclusion Fatigue symptoms persist in most elderly patients living with COPD, which can vary over time and predict the changes in condition. Fatigue impairs their quality of life crucially through negatively affecting their daily functioning and psychological state. However, due to the influence of many factors, fatigue symptoms in these patients have not been actively and effectively controlled. Therefore, it is necessary for medical workers to realize the serious adverse impact of fatigue, feel and understand fatigue from patient perspective, and take actions to develop a fatigue management scheme applicable to Chinese elderly patients with COPD as soon as possible.
- Chronic obstructive pulmonary disease /
- Fatigue /
- Phenomenology /
- Qualitative research
利益冲突 无

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表 1 研究对象一般资料(n=17)

Table 1. General information about the study subjects (n=17)

编号	年龄 (岁)	性别	文化程度	婚姻状况	职业	吸烟年数	病程 (年)	合并症 (个)	BMI	医保类型	FSS评分 (分)
P1	70	男	小学	已婚	务农	48	5	0	22.22	居民医保	7
P2	71	男	小学	已婚	务农	36	20	0	23.14	居民医保	6
P3	69	女	文盲	已婚	务农	0	1	0	16.65	居民医保	7
P4	63	男	高中	已婚	退休	0	15	0	23.24	职工医保	6
P5	66	男	小学	已婚	务农	45	2	0	20.20	居民医保	5
P6	76	男	小学	已婚	务农	55	1	0	16.33	居民医保	7
P7	70	男	小学	已婚	务农	46	2	2	22.78	居民医保	6
P8	71	男	小学	已婚	退休	50	1	1	24.44	职工医保	6
P9	63	男	小学	已婚	务农	42	5	0	20.86	居民医保	6
P10	67	男	初中	已婚	务农	50	2	3	17.97	居民医保	7
P11	65	男	初中	已婚	退休	42	33	1	16.29	职工医保	6
P12	76	男	初中	丧偶	退休	55	7	0	19.72	职工医保	6
P13	72	女	文盲	已婚	务农	0	20	0	20.44	居民医保	6
P14	74	女	文盲	已婚	务农	0	20	3	15.55	居民医保	6
P15	67	男	小学	已婚	务农	44	15	1	17.41	居民医保	6
P16	64	男	初中	已婚	退休	30	15	0	24.02	职工医保	6
P17	66	男	初中	已婚	退休	40	3	1	23.88	职工医保	7
注：FSS均分≥4分表示存在疲劳。

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参考文献(15)

[1]	HALPIN D, CRINER G J, PAPI A, et al. Global initiative for the diagnosis, management, and prevention of chronic obstructive lung disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease[J]. Am J Respir Crit Care Med, 2021, 203(1): 24-36. doi: 10.1164/rccm.202009-3533SO
[2]	WANG C, XU J Y, YANG L J, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health[CPH] study): a national cross-sectional study[J]. Lancet, 2018, 391(10131): 1706-1717. doi: 10.1016/S0140-6736(18)30841-9
[3]	GOËRTZ Y M J, SPRUIT M A, VAN T HUL A J, et al. Fatigue is highly prevalent in patients with COPD and correlates poorly with the degree of airflow limitation[J]. Ther Adv Respir Dis, 2019, 13: 327161316. DOI: 10.1177/1753466619878128.
[4]	GERICÓASEGUINOLAZA M, DÍEZ-MANGLANO J. Fatigue: a neglected symptom of COPD[J]. Rev Clin Esp (Barc), 2021, 221(2): 99-100. doi: 10.1016/j.rce.2020.09.003
[5]	KUPPUSWAMY A. The fatigue conundrum[J]. Brain, 2017, 140(8): 2240-2245. doi: 10.1093/brain/awx153
[6]	KOUIJZER M, BRUSSE-KEIZER M, BODE C. COPD-related fatigue: impact on daily life and treatment opportunities from the patient ' s perspective[J]. Respir Med, 2018, 141: 47-51. doi: 10.1016/j.rmed.2018.06.011
[7]	STRIDSMAN C, SKǍR L, HEDMAN L, et al. Fatigue affects health status and predicts mortality among subjects with COPD: report from the Population-Based OLIN COPD Study[J]. COPD, 2015, 12(2): 199-206. doi: 10.3109/15412555.2014.922176
[8]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3): 170-205. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202129002.htm Chronic obstructive Pulmonary Disease Group, Chinese Society of Respiratory Medicine, Chinese Medical Doctor Association, Chronic obstructive pulmonary Disease Working Committee, Chinese Medical Doctor Association. Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (2021 revision)[J]. Chinese Journal of Tuberculosis and Respiratory, 2021, 44(3): 170-205. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202129002.htm
[9]	刘明. Colaizzi七个步骤在现象学研究资料分析中的应用[J]. 护理学杂志, 2019, 34(11): 90-92. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201911031.htm LIU M. The application of Colaizzi's seven steps in the analysis of phenomenological research data[J]. Journal of Nursing Science, 2019, 34(11): 90-92. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201911031.htm
[10]	SPRUIT M A, VERCOULEN J H, SPRANGERS M A G, et al. Fatigue in COPD: an important yet ignored symptom[J]. Lancet Respir Med, 2017, 5(7): 542-544. doi: 10.1016/S2213-2600(17)30158-3
[11]	STRIDSMAN C, SVENSSON M, JOHANSSON S V, et al. The COPD Assessment Test (CAT) can screen for fatigue among patients with COPD[J]. Ther Adv Respir Dis, 2018, 12: 1753466618787380. DOI: 10.1177/1753466618787380.
[12]	肖慧宇, 王玉梅. 基于马斯洛层次论的糖尿病肾病护理干预的临床价值[J]. 中华全科医学, 2019, 17(6): 1065-1068. doi: 10.16766/j.cnki.issn.1674-4152.000864 XIAO H Y, WANG Y M. Clinical value of nursing intervention for diabetic nephropathy based on Maslow's hierarchy theory[J]. Chinese Journal of General Practice, 2019, 17(6): 1065-1068. doi: 10.16766/j.cnki.issn.1674-4152.000864
[13]	JAIME-LARA R B, KOONS B C, MATURA L A, et al. A qualitative metasynthesis of the experience of fatigue across five chronic conditions[J]. J Pain Symptom Manage, 2020, 59(6): 1320-1343. doi: 10.1016/j.jpainsymman.2019.12.358
[14]	EBADI Z, GOËRTZ Y M J, Van HERCK M, et al. The prevalence and related factors of fatigue in patients with COPD: a systematic review[J]. Eur Respir Rev, 2021, 30(160): 200298. DOI: 10.1183/16000617.0298-2020.
[15]	韩静, 张瑶, 汤瑞金, 等. 基于积极心理学的家庭干预对前列腺癌患者心理状态和生活质量的影响[J]. 中国护理管理, 2021, 21(2): 161-166. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202102002.htm HAN J, ZHANG Y, TANG R J, et al. The influence of family intervention program based on positive psychology on the mental state and quality of life of prostate cancer patients[J]. Chinese Nursing Management, 2021, 21(2): 161-166. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202102002.htm