以Orem自理理论为基础的健康教育对消化性溃疡患者自我护理能力影响的研究
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摘要
【目的】
调查消化性溃疡(Peptic Ulcer, PU)患者自我护理能力的现状；探讨PU患者自我护理能力的影响因素；以Orem自理理论为理论指导,对PU患者进行健康教育(Health Education, HE),评价该健康教育方式对PU患者自我护理能力的影响,为提高PU患者自我护理能力提供科学的理论依据。
【方法】
采用便利抽样法,通过问卷调查方式对2009.12—2010.7在天津医科大学总医院消化内镜中心确诊的146例PU患者的自我护理能力进行调查和描述；用单因素分析和多元逐步回归对146例研究对象自我护理能力的影响因素进行分析。采用完全随机化的方法将研究对象分为试验组和对照组,分别为74例和72例；依据调查分析结果运用Orem自理理论为试验组研究对象设计健康教育内容并对其进行干预,为对照组研究对象提供PU防治常规健康知识。初次胃镜检查后6周,对两组研究对象的自我护理能力、社会支持、焦虑、胃镜下溃疡愈合情况、幽门螺杆菌(Helicobacter pylori, Hp)感染情况及疼痛状况进行评价调查,并运用两独立样本t检验、配对设计资料t检验和卡方检验(χ2)等方法对研究结果进行统计分析,比较两种健康教育方式对PU患者自我护理能力的影响。
【结果】
1.PU患者整体自我护理能力水平相对较高。146例患者中,45.89%处于高等水平,54.11%处于中等水平。四个维度中,60.96%患者自我概念处于高等水平,39.04%处于中等水平；35.62%患者自护责任感处于高等水平,64.38%处于中等水平；42.47%患者自护知识处于高等水平,52.05%处于中等水平,5.48%处于低等水平；34.25%患者自护技能处于高等水平,65.07%处于中等水平,0.68%处于低等水平。
2.通过单因素分析得出影响PU患者自我护理能力的是性别、受教育程度、职业、个人月收入、医疗费用支付方式、有无PU史、对PU的了解程度、健康教育获得情况、社会支持和焦虑状况,而年龄、婚姻状况、居住方式和有无PU住院史与其自我护理能力无关；通过多元逐步回归进一步对PU患者自我护理能力的影响因素进行分析,得出主要影响因素依次是焦虑状况、个人月收入、医疗费用支付方式和社会支持状况。
3.两种健康教育方式均能够提高PU患者的自我护理能力和社会支持水平、缓解焦虑情绪、减少Hp感染和促进溃疡愈合,以Orem自理理论为基础的健康教育在以上几个方面都优于常规健康教育。但两种健康教育方式对于减轻或消除PU患者疼痛症状的差别没有统计学意义。
[结论]
PU患者整体自我护理能力水平较高,焦虑情绪、个人月收入、医疗费用支付方式和社会支持水平是影响患者自我护理能力的主要因素。以Orem自理理论为基础的健康教育和常规健康教育都能够提高患者的自我护理能力,但前者更好。应将Orem自理理论更好地应用于临床上,做好对PU患者有针对性的健康教育,让患者主动参与到疾病的治疗、护理和康复中,提高其自我照顾能力。
Objectives
To investigate the present situation of self-care agency of patients with PU; To explore the factors which influence patients' self-care agency; To do and evaluate HE which was based on Orem self-care theory for patients with PU to provide scientific theoretical foundation for improving patients self-care agency.
Methods
To use the questionnaires to investigate and describe the self-care agency of 146 patients diagnosed with PU in endoscope center of Tianjin Medical University General Hospital during December 2009 to July 2010 by convenience sampling. The n use one-way ANOVA and multiple regressions to analyze the factors which influence patients' self-care agency. All the subjects were divided into intervention group (n=74) and control group (n=72) randomly, intervention group received HE based on Orem self-care theory and control group received routine HE on PU. Evaluation questionnaires were administered to all the subjects after 6 weeks to evaluate the changes of their self-care agency, social support, and anxiety, therapeutic effects of PU, Hp infection and pain. Descriptive statistic,t test and Chi-square test were performed to observe the effects of HE on patients' self-care agency.
Results
1. Patients with PU own a high level of self-care agency generally,45.89% and 54.11% patients perceived higher and medium levels of ESCA respectively. In the four dimensions,60.96% and 39.04% patients perceived higher and medium levels of self-concept respectively; 35.62% and 64.38% patients perceived higher and medium levels of self-care responsibility respectively; 42.47% and 52.05% patients perceived higher and medium levels of self-care knowledge, but 5.48% patients perceived lower level of self-care knowledge; 34.25% and 65.07% patients perceived higher and medium levels of self-care skills, but 0.68% patients perceived lower level of self-care skills.
2. Patients' sex、education、career、monthly income、treatment payment、PU history、the comprehension of PU、HE、social support and anxiety are the factors influence their self-care agency by one-way ANOVA, but patients' age、marriage、living and PU hospitalizations are irrelevant with their self-care agency. Then we find that patients' anxiety、monthly income、treatment payment and social support are the major factors influence their self-care agency consecutively by multiple regressions.
3. Both HE based on Orem self-care theory and routine HE can improve patients' self-care agency and social support relieve anxiety、reduce Hp infection and promote healing, but the former is better than the latter. There is no difference between the two ways in eliminating patients' pain.
Conclusion
The level of self-care agency of patients with PU is high generally, patients' anxiety、monthly income、treatment payment and social support influence their self-care agency. Both HE based on Orem self-care theory and routine HE can improve patients' self-care agency, but the former is better. We should do special HE to patients, in order to let patients involve in the management of disease actively and improve their self-care agency.
调查消化性溃疡(Peptic Ulcer, PU)患者自我护理能力的现状；探讨PU患者自我护理能力的影响因素；以Orem自理理论为理论指导,对PU患者进行健康教育(Health Education, HE),评价该健康教育方式对PU患者自我护理能力的影响,为提高PU患者自我护理能力提供科学的理论依据。
【方法】
采用便利抽样法,通过问卷调查方式对2009.12—2010.7在天津医科大学总医院消化内镜中心确诊的146例PU患者的自我护理能力进行调查和描述；用单因素分析和多元逐步回归对146例研究对象自我护理能力的影响因素进行分析。采用完全随机化的方法将研究对象分为试验组和对照组,分别为74例和72例；依据调查分析结果运用Orem自理理论为试验组研究对象设计健康教育内容并对其进行干预,为对照组研究对象提供PU防治常规健康知识。初次胃镜检查后6周,对两组研究对象的自我护理能力、社会支持、焦虑、胃镜下溃疡愈合情况、幽门螺杆菌(Helicobacter pylori, Hp)感染情况及疼痛状况进行评价调查,并运用两独立样本t检验、配对设计资料t检验和卡方检验(χ2)等方法对研究结果进行统计分析,比较两种健康教育方式对PU患者自我护理能力的影响。
【结果】
1.PU患者整体自我护理能力水平相对较高。146例患者中,45.89%处于高等水平,54.11%处于中等水平。四个维度中,60.96%患者自我概念处于高等水平,39.04%处于中等水平；35.62%患者自护责任感处于高等水平,64.38%处于中等水平；42.47%患者自护知识处于高等水平,52.05%处于中等水平,5.48%处于低等水平；34.25%患者自护技能处于高等水平,65.07%处于中等水平,0.68%处于低等水平。
2.通过单因素分析得出影响PU患者自我护理能力的是性别、受教育程度、职业、个人月收入、医疗费用支付方式、有无PU史、对PU的了解程度、健康教育获得情况、社会支持和焦虑状况,而年龄、婚姻状况、居住方式和有无PU住院史与其自我护理能力无关；通过多元逐步回归进一步对PU患者自我护理能力的影响因素进行分析,得出主要影响因素依次是焦虑状况、个人月收入、医疗费用支付方式和社会支持状况。
3.两种健康教育方式均能够提高PU患者的自我护理能力和社会支持水平、缓解焦虑情绪、减少Hp感染和促进溃疡愈合,以Orem自理理论为基础的健康教育在以上几个方面都优于常规健康教育。但两种健康教育方式对于减轻或消除PU患者疼痛症状的差别没有统计学意义。
[结论]
PU患者整体自我护理能力水平较高,焦虑情绪、个人月收入、医疗费用支付方式和社会支持水平是影响患者自我护理能力的主要因素。以Orem自理理论为基础的健康教育和常规健康教育都能够提高患者的自我护理能力,但前者更好。应将Orem自理理论更好地应用于临床上,做好对PU患者有针对性的健康教育,让患者主动参与到疾病的治疗、护理和康复中,提高其自我照顾能力。
Objectives
To investigate the present situation of self-care agency of patients with PU; To explore the factors which influence patients' self-care agency; To do and evaluate HE which was based on Orem self-care theory for patients with PU to provide scientific theoretical foundation for improving patients self-care agency.
Methods
To use the questionnaires to investigate and describe the self-care agency of 146 patients diagnosed with PU in endoscope center of Tianjin Medical University General Hospital during December 2009 to July 2010 by convenience sampling. The n use one-way ANOVA and multiple regressions to analyze the factors which influence patients' self-care agency. All the subjects were divided into intervention group (n=74) and control group (n=72) randomly, intervention group received HE based on Orem self-care theory and control group received routine HE on PU. Evaluation questionnaires were administered to all the subjects after 6 weeks to evaluate the changes of their self-care agency, social support, and anxiety, therapeutic effects of PU, Hp infection and pain. Descriptive statistic,t test and Chi-square test were performed to observe the effects of HE on patients' self-care agency.
Results
1. Patients with PU own a high level of self-care agency generally,45.89% and 54.11% patients perceived higher and medium levels of ESCA respectively. In the four dimensions,60.96% and 39.04% patients perceived higher and medium levels of self-concept respectively; 35.62% and 64.38% patients perceived higher and medium levels of self-care responsibility respectively; 42.47% and 52.05% patients perceived higher and medium levels of self-care knowledge, but 5.48% patients perceived lower level of self-care knowledge; 34.25% and 65.07% patients perceived higher and medium levels of self-care skills, but 0.68% patients perceived lower level of self-care skills.
2. Patients' sex、education、career、monthly income、treatment payment、PU history、the comprehension of PU、HE、social support and anxiety are the factors influence their self-care agency by one-way ANOVA, but patients' age、marriage、living and PU hospitalizations are irrelevant with their self-care agency. Then we find that patients' anxiety、monthly income、treatment payment and social support are the major factors influence their self-care agency consecutively by multiple regressions.
3. Both HE based on Orem self-care theory and routine HE can improve patients' self-care agency and social support relieve anxiety、reduce Hp infection and promote healing, but the former is better than the latter. There is no difference between the two ways in eliminating patients' pain.
Conclusion
The level of self-care agency of patients with PU is high generally, patients' anxiety、monthly income、treatment payment and social support influence their self-care agency. Both HE based on Orem self-care theory and routine HE can improve patients' self-care agency, but the former is better. We should do special HE to patients, in order to let patients involve in the management of disease actively and improve their self-care agency.
引文
[1]萧树东,许国栋.中华胃肠病学[M].北京：人民卫生出版社,2008：350.
[2]尤黎明.内科护理学[M].北京：人民卫生出版社,2004：212—214.
[3]Bak-Romaniszyn L, Wojtun S, Gil J,et al. Peptic ulcer disease etiology diagnosis and treatment[J].Pol Merkur Lekarski,2004,17(1):128-132.
[4]Jones MP. The role of psychosocial factors in peptic ulcer disease:beyond Helicobacter pylori and NSAIDs[J] Journal of Psychosomatic Research,2006,60 (4):407-412.
[5]Medalie JH, Stange KC, Zyzanski SJ, et al. The importance of biopsychosocial factors in the development of duodenal ulcer in a cohort of middle-aged men [J].Am J Epidemiol,1992,136(10):1280-1287.
[6]Murthy SN, Dinoso VP Jr, Clearfield HR,et al. Simultaneous measurement of basal pancreatic, gastric acid secretion, plasma gastrin and secretin[J]. Gastroenterology,1977,73(4):758-761.
[7]Wachirawat W, Hanucharurnkul S, Suriyawongpaisal P, et al. Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population[J].J Med Assoc Thai,.2003,86(7):672-685.
[8]汪晓艳,刘一鸣,季明惠,等.消化性溃疡病人负性情绪与自我管理知识的调查分析[J].护理研究,2008,22(10)：2556—2557.
[9]吕振雷,蒋颖,华敏峰,等.消化性溃疡患者社会心理因素研究[J].精神医疗杂志,2008,21(5)：347—349.
[10]林玲萍.消化性溃疡与社会支持[J].护理研究,2002,16(4)：209—210.
[11]卢东芳,沙卫红.非甾体消炎药致老年人消化性溃疡出血的护理[J].广东医学,2009,30(1)：155-156.
[12]于皆平,王小众,张介眉.胃部疾病的诊断和治疗[M].北京：人民卫生出版社,2004：354.
[13]王斌全,赵晓云Orem与自理理论[J].护理研究,2008,22(2)：375.
[14]殷磊.护理学基础[M].北京：人民卫生出版社,2004：40-42.
[15]蒋凤菊,赵庆华.自理理论在临床护理中的应用进展[J].护理研究,2007,21(8)：2072-2074.
[16]Baird KK, Pierce LL. Adherence to cardiac therapy for men with coronary artery disease [J].Rehabilitation Nursing,2001,26(6):233-237,243.
[17]Kearney BY, Fleischer BJ. Development of an Instrument to Measure Exercise of Self-care Agency [J].Research in Nursing and health,1979,2(1):25-34.
[18]Yamashita M. The Exercise of Self-care Agency Scale[J].Western Journal of Nursing Research,1998,20(3):370-381.
[19]Wang HH, Laffrey SC. A Predictive Model of Well-Being and Self-Care for Rural Elderly Women in Taiwan[J]. Research in Nursing and health,2001,24(2):122-132.
[20]高丽红,李萍,张俊娥,等.急性心肌梗死患者的自我护理能力与机体功能状态的相关性分析[J].中华护理杂志,2003,38(4)：248-250.
[21]李淑霞.慢性阻塞性肺疾病病人自我护理能力与生活质量的相关性研究[J].护理研究,2007,21(2)：313-315.
[22]申铁梅,苏小茵,谭坚铃,等.冠心病患者自我护理能力与社会支持的相关性调查[J].护士进修杂志,2008,23(24)：2278-2280.
[23]肖水源.《社会支持评定量表》的理论基础与研究应用[J].临床精神医学杂志,1994,4(2)：98-100.
[24]刘继文,李富业,连玉龙.社会支持评定量表的信度效度研究[N].新疆医科大学学报,2008,2(31)：1-3.
[25]刘贤臣,唐茂芹,彭秀桂,等.焦虑自评量表SAS的因子分析[J].中国神经精神疾病杂志,1995,21(6)：359-360.
[26]陆小英,赵存凤,张婷婷,等.“长海痛尺”在疼痛评估中的应用[J].解放军护理杂志,2003,20(4)：6-7.
[27]赵继军,陆小英,赵存凤,等.数字疼痛量表和描述疼痛量表的相关性研究和改进[J].现代护理,2002,8(9)：660-661.
[28]郎巍.沈阳市区原发性高血压病人自我护理能力及其影响因素的研究[D].中国医科大学,2009：
[29]Thoits PA. Dimensions of life events that influence psychological distress [J].Ann Rev Psychology,1991,42:401-426.
[30]肖水源.社会支持对身心健康的影响[J].中国心理卫生杂志,1987,1(4)：183-187.
[31]Goodwin RD,Keyes KM, Stein MB, et al.Peptic ulcer and mental disorders among adults in the community:the role of nicotine and alcohol use disorders[J]. Psychosomatic Medicine,2009,71(4):463-468.
[32]Adams RJ, Wilson DH, Taylor AW, et al.Psychological factors and asthma quality of life:A population based study [J].Thorax,2004,59:930-935.
[33]徐仁华,贾灵芝,纪象芹,等.哮喘病人自我护理能力及其影响因素的研究进展[J].护理研究,2009,23(9)：2257-2258.
[34]杨支兰.汾阳市城区老年人的自我护理能力及其相关因素研究[D].山西医科大学,2007：
[35]Akyol AD, Cetinkaya Y, Bakan G, et al.Self-care agency and factors related to this agency among patients with hypertension[J].J Clin Nurs,2007,16(4):679-687.
[36]赵文慧,孙华.脑卒中病人的自我护理能力及影响因素分析[J].中国老年学杂志,2009,29(6)：750-751.
[37]赵文芳,周卫,李翠萍COPD病人社会支持与自我护理能力的相关性研究[J].护理研究,2008,22(4)：1047-1048.
[38]Koukouli S, Vlachonikolis IG, Philalithis A. Socio-demographic factors and self-reported functional status:the significance of social support [J].BMC Health Services Research,2002,2(1):20.
[39]耿桂灵,梁涛,袁义厘,等.脑卒中病人自我护理能力及影响因素分析[J].护理管理杂志,2007,7(2)：3-5.
[40]Lukkarinen H, Hentinen M. Self-care agency and factors related to this agency among patients with coronary heart disease [J]. International Journal of Nursing Studies,1997,34(4):295-304.
[41]王玉博,黄雪雯,康喜讯.健康教育对鼻咽癌患者自我护理能力和生活质量的影响研究[J].广州医药,2010,41(3)：75-77.
[42]Laurie Simmons. Dorthea Orem's Self Care Theory as Related to Nursing Practice in Hemdialysis [J]. Nephrology Nursing Journal,2009,36(4):419-421.
[43]Hellman EA, Stewart C. Social support and the elderly client [J].Home Health Nurse,1994,12(5):51-60.
[44]刘菁,李欣,杨萍.乳腺癌病人与配偶同步健康教育对病人社会支持及主观幸福 感影响的研究[J].护理研究,2008,22(7)：1801-1803.
[45]王美峰,林琳,林征,等.综合干预对功能性消化不良病人临床症状及心理状况的影响[J].护理研究,2010,24(3)：783-784.
[46]蔺刚.浅谈幽门螺杆菌感染的控制[J].中国公共卫生管理,2009,25(3)：266-267.
[47]李萍,张澜.自我护理理论与实践的发展研究[J].护理研究,2008,22(3)：575-577.
[1]王斌全,赵晓云Orem与自理理论[J].护理研究,2008,22(2)：375.
[2]殷磊.护理学基础[M].北京：人民卫生出版社,2004：40-42.
[3]蒋凤菊,赵庆华.自理理论在临床护理中的应用进展[J].护理研究,2007,21(8)：2072-2074.
[4]萧树东,许国栋.中华胃肠病学[M].北京：人民卫生出版社,2008：350.
[5]尤黎明.内科护理学[M].北京：人民卫生出版社,2004：212—214.
[6]Bak-Romaniszyn L, Wojtun S, Gil J,et al. Peptic ulcer disease etiology diagnosis and treatment[J].Pol Merkur Lekarski,2004,17(1):128-132.
[7]Jones MP. The role of psychosocial factors in peptic ulcer disease:beyond Helicobacter pylori and NSAIDs[J] Journal of Psychosomatic Research,2006,60 (4):407-412.
[8]Medalie JH, Stange KC, Zyzanski SJ, et al. The importance of biopsychosocial factors in the development of duodenal ulcer in a cohort of middle-aged men [J]. Am J Epidemiol,1992,136(10):1280-1287.
[9]Murthy SN, Dinoso VP Jr, Clearfield HR,et al. Simultaneous measurement of basal pancreatic, gastric acid secretion, plasma gastrin and secretin [J]. Gastroenterology,1977,73(4):758-761
[10]Wachirawat W, Hanucharurnkul S, Suriyawongpaisal P, et al. Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population[J].J Med Assoc Thai,.2003,86(7):672-685.
[11]汪晓艳,刘一鸣,季明惠,等.消化性溃疡病人负性情绪与自我管理知识的调查分析[J].护理研究,2008,22(10)：2556—2557.
[12]吕振雷,蒋颖,华敏峰,等.消化性溃疡患者社会心理因素研究[J].精神医疗杂志,2008,21(5)：347—349.
[13]林玲萍.消化性溃疡与社会支持[J].护理研究,2002,16(4)：209—210.
[14]于皆平,王小众,张介眉.胃部疾病的诊断和治疗[M].北京：人民卫生出版社,2004：354.
[15]王筱敏,杨敏,魏奉才.护理学实践与研究[M].北京：人民卫生出版社,2004：238.
[16]王素娟.消化性溃疡病人饮食治疗的护理[J].护理研究,2007,21(5)：1333—1334.
[17]刘红,王会.上消化道出血饮食教训与护理对策[J].中国现代医生,2008,46(29)：118—120.
[18]刘建清.消化性溃疡患者的饮食指导[J].护理实践与研究,2007,4(2)：86—87.
[19]姚宏昌.重视消化系统心身疾病的研究[J].中华消化杂志,2001,21(3)：133—134.
[20]陈春芳.消化性溃疡患者的心理社会因素调查及心理干预[J].护理实践与研究,2008,5(7)：1—2.
[21]Overmier JB, Murison R. Anxiety and helplessness in the face of stress predisposes, precipitates, and sustains gastric ulceration [J].Behav Brain Res,2000, 110(1-2):161-174.
[22]毛先华,陈春芳,王爱.慢性溃疡性结肠炎病人的心理护理[J].护理研究,2008,22(1)：119—120.
[23]郑建盛,杨丽全,陈金寿.消化性溃疡患者心理健康问题初探[J].中国健康心理学杂志,2004,12(5)：347—348.
[24]Gulick EE.Social support among persons with multiple sclerosis[J].Research in Nursing Health,1994,17(3):195-206.
[25]张明,陈卫红,黄钢.不同病期消化性溃疡患者社会心理相关因素的比较[J].中国行为医学科学,2003,12(5)：509—510.
[26]曲臣.不良行为习惯对消化性溃疡的影响和行为干预措施[J].中国医药指南,2010,8(25)：167—168.
[27]王宏利,郝向红,封小兵.消化性溃疡胃镜临床特点和季节变化规律分析[J].延安大学学报(医学科学版),2010,8(3)：22—23.
[28]陈灏珠,林果为.实用内科学[M].北京人民卫生出版社,2009：1987—1988.
[29]Bo-Linn GW, Davis GR, Buddrus DJ,et al. An evaluation of the importance of gastric acid secretion in the absorption of dietary calcium[J].J Clin Invest,1984,73 (3):640-647.
[30]Targownik LE, Lix LM, Metge CJ, et al.Use of proton pump inhibitors and risk of osteoporosis-related fractures[J].CMAJ,2008,179(4):319-326.
[31]姜中伟,俞远怀.质子泵抑制剂联合胃黏膜保护剂与胃肠动力药对胆汁反流的影响[J].安徽医学,2010,31(7)：825—827.
[32]张川光.抗消化性溃疡药的临床应用[J].中国药物与临床,2010,10(3)：320—321.
[33]石力夫.抗消化性溃疡药物的选择与应用(Ⅱ)[J].药学服务与研究,2010,10(4)：s1—s2.
[34]Weil J, Langman MJ, Wainwright P, et al. Peptic ulcer bleeding:accessory risk factors and interaction with non-steroidal anti-inflammatory drugs [J]. Gut,2000, 46(1):27-31.
[35]王超.非甾体类抗炎药致上消化道出血的临床回顾分析[D].山东大学,2008：
[36]卢东芳,沙卫红.非甾体消炎药致老年人消化性溃疡出血的护理[J].广东医学,2009,30(1)：155—156.
[37]Willett LR, Carson JL, Strom BL. Epidemiology of gastrointestinal damage associated with nonsteroidal anti-inflammatory drugs [J].Drug Saf,1994,10(2):170-181.
[38]罗宜辉,徐杨.非甾体抗炎药相关胃黏膜损伤研究进展[J].临床医学研究,2008,25(3)：563—565.
[39]Nguyen TL, Uchida T, Tsukamoto Y, et al. Helicobacter pylori infection and gastroduodenal diseases in Vietnam:a cross-sectional, hospital-based study[J].BMC Gastroenterology,2010,10:114.
[40]田一玲,蒋任举,杨致邦.幽门螺杆菌感染途径的探讨[J].中国病原生物学杂志,2009,4(4)：266—267.
[41]陈湖,彭铁立.幽门螺杆菌的传播途径[J].临床消化病杂志,2006,18(2)：68—69.
[42]Osato MS, Ayub K, Le HH, et al. Houseflies are an unlikely reservoir or vector for Helicobacter pylori[J].J Clin Microbiol,1998,36(9):2786-2788.
[43]胡伏莲.幽门螺杆菌根除失败的原因分析和处理策略[J].现代消化及介入诊疗,2010,15(2)：108—112.
[44]季瑞焱.消化性溃疡幽门螺杆菌反复阳性患者相关因素分析及护理对策[J].中国中医急症,2009,18(3)：485—486.
[45]Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastro-intestinal bleeding [J].Annals Of Internal Medicine,2003,139(10):843-857.
[46]李仁芝.消化性溃疡并出血患者个性化健康教育的体会现代[J].中西药结合杂志,2010,19(4)：518—519.
[47]苏秉忠.急性上消化道出血的诊断和处理常规[J].中国临床医生,2010,38(3)：12—15.
[48]赵静.上消化道出血患者的护理[J].中国实用神经疾病杂志,2010,13(20)：62—63.
[49]刘维.上消化道出血禁食病人逐步开放饮食的护理干预[J].护理研究,2007,21(2)：502—503.
[50]葛臻琼.上消化道出血158例的护理[J].中国误诊学杂志,2010,10(17)：4183.
[51]邢洛红,马红云,赵智侠.上消化道出血患者的饮食护理[J].河南科技大学学报(医学版),2010,28(2)：145—146.
[52]Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer [J].N EngI J Med,2008,359(9):928-937.
[53]李岩.上消化道出血的药物治疗[J].中国实用内科杂志,2008,28(3)：167—168.
[54]Lau JY, Leung WK, Wu JC, et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding[J].N EngI J Med,2007,356(16):1631-1640.
[55]Sung JJ, Barkun A, Kuipers EJ, et al. Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding:a randomized trial[J].Ann Intern Med,2009,150 (7):455-464.
[56]张运强.消化性溃疡并出血的内镜治疗临床疗效观察[J].中国现代医生,2010,48(24)：134—135.
[57]亢殿召.消化性溃疡穿孔129例临床分析[J].中国当代医药,2010,17(24)：197—198.
[58]Feliciano DV. Do perforated duodenal ulcers need an acid-decreasing surgical procedure now that omeprazole is available? [J].Surg Clin North AM,1992,72(2): 369-380.
[59]刘红梅.浅谈老年消化性溃疡与消化道穿孔的临床护理[J].医学信息,2010,23(6)：21—22.
[60]汪卫平.胃十二指肠溃疡穿孔45例分析[J].医学临床研究,2010,27(6)：1167—1168.
[61]李华,杨霁,陈晓明,等.消化性溃疡穿孔非手术治疗28例报告[J].腹部外科,2009,22(2)：102—103.
[62]刘金凤.消化性溃疡穿孔的临床治疗分析[J].中华中西医学杂志,2008,6(2)：43—44.
[63]邓光,周俊强,胡东升等.消化性溃疡穿孔治疗方法的选择[J].中国医疗前沿,2008,3(18)：58.
[64]潘凯.腹腔镜在十二指肠溃疡穿孔手术治疗中的应用[J].中华普通外科学文 献,2008,2(1)：54—56.
[65]Jamieson GG..Current status of indications for surgery in peptic ulcer disease [J]. World Journal of Surg,2000,24(3):256-258.
[66]熊少伟,刘铮,雷云鹏,等.腹腔镜与开腹胃十二指肠溃疡穿孔修补术对比研究[J].中国实用医药,2008,3(18)：49—51.
[67]王辉,陈正平,黄诚,等.腹腔镜与开腹胃十二指肠溃疡穿孔修补术的对比研究[J].山东医药,2008,48(37)：92—93.
[68]Khoursheed M, Fuad M, Safar H, et al. Laparoscopic closure of perforated duodenal ulcer [J].Surg Endosc,2000,14(1):56-58.
[69]邵安健.89例幽门梗阻的病因探讨[J].皖南医学院学报,2009,28(3)：213—214.
[70]赵黎东,黄琼.十二指肠球部溃疡并幽门梗阻52例胃镜下所见与临床分析[J].云南医药,2005,26(2)：148—149.
[71]Baird KK, Pierce LL. Adherence to cardiac therapy for men with coronary artery disease [J].Rehabilitation Nursing,2001,26(6):233-237,243.
[2]尤黎明.内科护理学[M].北京：人民卫生出版社,2004：212—214.
[3]Bak-Romaniszyn L, Wojtun S, Gil J,et al. Peptic ulcer disease etiology diagnosis and treatment[J].Pol Merkur Lekarski,2004,17(1):128-132.
[4]Jones MP. The role of psychosocial factors in peptic ulcer disease:beyond Helicobacter pylori and NSAIDs[J] Journal of Psychosomatic Research,2006,60 (4):407-412.
[5]Medalie JH, Stange KC, Zyzanski SJ, et al. The importance of biopsychosocial factors in the development of duodenal ulcer in a cohort of middle-aged men [J].Am J Epidemiol,1992,136(10):1280-1287.
[6]Murthy SN, Dinoso VP Jr, Clearfield HR,et al. Simultaneous measurement of basal pancreatic, gastric acid secretion, plasma gastrin and secretin[J]. Gastroenterology,1977,73(4):758-761.
[7]Wachirawat W, Hanucharurnkul S, Suriyawongpaisal P, et al. Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population[J].J Med Assoc Thai,.2003,86(7):672-685.
[8]汪晓艳,刘一鸣,季明惠,等.消化性溃疡病人负性情绪与自我管理知识的调查分析[J].护理研究,2008,22(10)：2556—2557.
[9]吕振雷,蒋颖,华敏峰,等.消化性溃疡患者社会心理因素研究[J].精神医疗杂志,2008,21(5)：347—349.
[10]林玲萍.消化性溃疡与社会支持[J].护理研究,2002,16(4)：209—210.
[11]卢东芳,沙卫红.非甾体消炎药致老年人消化性溃疡出血的护理[J].广东医学,2009,30(1)：155-156.
[12]于皆平,王小众,张介眉.胃部疾病的诊断和治疗[M].北京：人民卫生出版社,2004：354.
[13]王斌全,赵晓云Orem与自理理论[J].护理研究,2008,22(2)：375.
[14]殷磊.护理学基础[M].北京：人民卫生出版社,2004：40-42.
[15]蒋凤菊,赵庆华.自理理论在临床护理中的应用进展[J].护理研究,2007,21(8)：2072-2074.
[16]Baird KK, Pierce LL. Adherence to cardiac therapy for men with coronary artery disease [J].Rehabilitation Nursing,2001,26(6):233-237,243.
[17]Kearney BY, Fleischer BJ. Development of an Instrument to Measure Exercise of Self-care Agency [J].Research in Nursing and health,1979,2(1):25-34.
[18]Yamashita M. The Exercise of Self-care Agency Scale[J].Western Journal of Nursing Research,1998,20(3):370-381.
[19]Wang HH, Laffrey SC. A Predictive Model of Well-Being and Self-Care for Rural Elderly Women in Taiwan[J]. Research in Nursing and health,2001,24(2):122-132.
[20]高丽红,李萍,张俊娥,等.急性心肌梗死患者的自我护理能力与机体功能状态的相关性分析[J].中华护理杂志,2003,38(4)：248-250.
[21]李淑霞.慢性阻塞性肺疾病病人自我护理能力与生活质量的相关性研究[J].护理研究,2007,21(2)：313-315.
[22]申铁梅,苏小茵,谭坚铃,等.冠心病患者自我护理能力与社会支持的相关性调查[J].护士进修杂志,2008,23(24)：2278-2280.
[23]肖水源.《社会支持评定量表》的理论基础与研究应用[J].临床精神医学杂志,1994,4(2)：98-100.
[24]刘继文,李富业,连玉龙.社会支持评定量表的信度效度研究[N].新疆医科大学学报,2008,2(31)：1-3.
[25]刘贤臣,唐茂芹,彭秀桂,等.焦虑自评量表SAS的因子分析[J].中国神经精神疾病杂志,1995,21(6)：359-360.
[26]陆小英,赵存凤,张婷婷,等.“长海痛尺”在疼痛评估中的应用[J].解放军护理杂志,2003,20(4)：6-7.
[27]赵继军,陆小英,赵存凤,等.数字疼痛量表和描述疼痛量表的相关性研究和改进[J].现代护理,2002,8(9)：660-661.
[28]郎巍.沈阳市区原发性高血压病人自我护理能力及其影响因素的研究[D].中国医科大学,2009：
[29]Thoits PA. Dimensions of life events that influence psychological distress [J].Ann Rev Psychology,1991,42:401-426.
[30]肖水源.社会支持对身心健康的影响[J].中国心理卫生杂志,1987,1(4)：183-187.
[31]Goodwin RD,Keyes KM, Stein MB, et al.Peptic ulcer and mental disorders among adults in the community:the role of nicotine and alcohol use disorders[J]. Psychosomatic Medicine,2009,71(4):463-468.
[32]Adams RJ, Wilson DH, Taylor AW, et al.Psychological factors and asthma quality of life:A population based study [J].Thorax,2004,59:930-935.
[33]徐仁华,贾灵芝,纪象芹,等.哮喘病人自我护理能力及其影响因素的研究进展[J].护理研究,2009,23(9)：2257-2258.
[34]杨支兰.汾阳市城区老年人的自我护理能力及其相关因素研究[D].山西医科大学,2007：
[35]Akyol AD, Cetinkaya Y, Bakan G, et al.Self-care agency and factors related to this agency among patients with hypertension[J].J Clin Nurs,2007,16(4):679-687.
[36]赵文慧,孙华.脑卒中病人的自我护理能力及影响因素分析[J].中国老年学杂志,2009,29(6)：750-751.
[37]赵文芳,周卫,李翠萍COPD病人社会支持与自我护理能力的相关性研究[J].护理研究,2008,22(4)：1047-1048.
[38]Koukouli S, Vlachonikolis IG, Philalithis A. Socio-demographic factors and self-reported functional status:the significance of social support [J].BMC Health Services Research,2002,2(1):20.
[39]耿桂灵,梁涛,袁义厘,等.脑卒中病人自我护理能力及影响因素分析[J].护理管理杂志,2007,7(2)：3-5.
[40]Lukkarinen H, Hentinen M. Self-care agency and factors related to this agency among patients with coronary heart disease [J]. International Journal of Nursing Studies,1997,34(4):295-304.
[41]王玉博,黄雪雯,康喜讯.健康教育对鼻咽癌患者自我护理能力和生活质量的影响研究[J].广州医药,2010,41(3)：75-77.
[42]Laurie Simmons. Dorthea Orem's Self Care Theory as Related to Nursing Practice in Hemdialysis [J]. Nephrology Nursing Journal,2009,36(4):419-421.
[43]Hellman EA, Stewart C. Social support and the elderly client [J].Home Health Nurse,1994,12(5):51-60.
[44]刘菁,李欣,杨萍.乳腺癌病人与配偶同步健康教育对病人社会支持及主观幸福 感影响的研究[J].护理研究,2008,22(7)：1801-1803.
[45]王美峰,林琳,林征,等.综合干预对功能性消化不良病人临床症状及心理状况的影响[J].护理研究,2010,24(3)：783-784.
[46]蔺刚.浅谈幽门螺杆菌感染的控制[J].中国公共卫生管理,2009,25(3)：266-267.
[47]李萍,张澜.自我护理理论与实践的发展研究[J].护理研究,2008,22(3)：575-577.
[1]王斌全,赵晓云Orem与自理理论[J].护理研究,2008,22(2)：375.
[2]殷磊.护理学基础[M].北京：人民卫生出版社,2004：40-42.
[3]蒋凤菊,赵庆华.自理理论在临床护理中的应用进展[J].护理研究,2007,21(8)：2072-2074.
[4]萧树东,许国栋.中华胃肠病学[M].北京：人民卫生出版社,2008：350.
[5]尤黎明.内科护理学[M].北京：人民卫生出版社,2004：212—214.
[6]Bak-Romaniszyn L, Wojtun S, Gil J,et al. Peptic ulcer disease etiology diagnosis and treatment[J].Pol Merkur Lekarski,2004,17(1):128-132.
[7]Jones MP. The role of psychosocial factors in peptic ulcer disease:beyond Helicobacter pylori and NSAIDs[J] Journal of Psychosomatic Research,2006,60 (4):407-412.
[8]Medalie JH, Stange KC, Zyzanski SJ, et al. The importance of biopsychosocial factors in the development of duodenal ulcer in a cohort of middle-aged men [J]. Am J Epidemiol,1992,136(10):1280-1287.
[9]Murthy SN, Dinoso VP Jr, Clearfield HR,et al. Simultaneous measurement of basal pancreatic, gastric acid secretion, plasma gastrin and secretin [J]. Gastroenterology,1977,73(4):758-761
[10]Wachirawat W, Hanucharurnkul S, Suriyawongpaisal P, et al. Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population[J].J Med Assoc Thai,.2003,86(7):672-685.
[11]汪晓艳,刘一鸣,季明惠,等.消化性溃疡病人负性情绪与自我管理知识的调查分析[J].护理研究,2008,22(10)：2556—2557.
[12]吕振雷,蒋颖,华敏峰,等.消化性溃疡患者社会心理因素研究[J].精神医疗杂志,2008,21(5)：347—349.
[13]林玲萍.消化性溃疡与社会支持[J].护理研究,2002,16(4)：209—210.
[14]于皆平,王小众,张介眉.胃部疾病的诊断和治疗[M].北京：人民卫生出版社,2004：354.
[15]王筱敏,杨敏,魏奉才.护理学实践与研究[M].北京：人民卫生出版社,2004：238.
[16]王素娟.消化性溃疡病人饮食治疗的护理[J].护理研究,2007,21(5)：1333—1334.
[17]刘红,王会.上消化道出血饮食教训与护理对策[J].中国现代医生,2008,46(29)：118—120.
[18]刘建清.消化性溃疡患者的饮食指导[J].护理实践与研究,2007,4(2)：86—87.
[19]姚宏昌.重视消化系统心身疾病的研究[J].中华消化杂志,2001,21(3)：133—134.
[20]陈春芳.消化性溃疡患者的心理社会因素调查及心理干预[J].护理实践与研究,2008,5(7)：1—2.
[21]Overmier JB, Murison R. Anxiety and helplessness in the face of stress predisposes, precipitates, and sustains gastric ulceration [J].Behav Brain Res,2000, 110(1-2):161-174.
[22]毛先华,陈春芳,王爱.慢性溃疡性结肠炎病人的心理护理[J].护理研究,2008,22(1)：119—120.
[23]郑建盛,杨丽全,陈金寿.消化性溃疡患者心理健康问题初探[J].中国健康心理学杂志,2004,12(5)：347—348.
[24]Gulick EE.Social support among persons with multiple sclerosis[J].Research in Nursing Health,1994,17(3):195-206.
[25]张明,陈卫红,黄钢.不同病期消化性溃疡患者社会心理相关因素的比较[J].中国行为医学科学,2003,12(5)：509—510.
[26]曲臣.不良行为习惯对消化性溃疡的影响和行为干预措施[J].中国医药指南,2010,8(25)：167—168.
[27]王宏利,郝向红,封小兵.消化性溃疡胃镜临床特点和季节变化规律分析[J].延安大学学报(医学科学版),2010,8(3)：22—23.
[28]陈灏珠,林果为.实用内科学[M].北京人民卫生出版社,2009：1987—1988.
[29]Bo-Linn GW, Davis GR, Buddrus DJ,et al. An evaluation of the importance of gastric acid secretion in the absorption of dietary calcium[J].J Clin Invest,1984,73 (3):640-647.
[30]Targownik LE, Lix LM, Metge CJ, et al.Use of proton pump inhibitors and risk of osteoporosis-related fractures[J].CMAJ,2008,179(4):319-326.
[31]姜中伟,俞远怀.质子泵抑制剂联合胃黏膜保护剂与胃肠动力药对胆汁反流的影响[J].安徽医学,2010,31(7)：825—827.
[32]张川光.抗消化性溃疡药的临床应用[J].中国药物与临床,2010,10(3)：320—321.
[33]石力夫.抗消化性溃疡药物的选择与应用(Ⅱ)[J].药学服务与研究,2010,10(4)：s1—s2.
[34]Weil J, Langman MJ, Wainwright P, et al. Peptic ulcer bleeding:accessory risk factors and interaction with non-steroidal anti-inflammatory drugs [J]. Gut,2000, 46(1):27-31.
[35]王超.非甾体类抗炎药致上消化道出血的临床回顾分析[D].山东大学,2008：
[36]卢东芳,沙卫红.非甾体消炎药致老年人消化性溃疡出血的护理[J].广东医学,2009,30(1)：155—156.
[37]Willett LR, Carson JL, Strom BL. Epidemiology of gastrointestinal damage associated with nonsteroidal anti-inflammatory drugs [J].Drug Saf,1994,10(2):170-181.
[38]罗宜辉,徐杨.非甾体抗炎药相关胃黏膜损伤研究进展[J].临床医学研究,2008,25(3)：563—565.
[39]Nguyen TL, Uchida T, Tsukamoto Y, et al. Helicobacter pylori infection and gastroduodenal diseases in Vietnam:a cross-sectional, hospital-based study[J].BMC Gastroenterology,2010,10:114.
[40]田一玲,蒋任举,杨致邦.幽门螺杆菌感染途径的探讨[J].中国病原生物学杂志,2009,4(4)：266—267.
[41]陈湖,彭铁立.幽门螺杆菌的传播途径[J].临床消化病杂志,2006,18(2)：68—69.
[42]Osato MS, Ayub K, Le HH, et al. Houseflies are an unlikely reservoir or vector for Helicobacter pylori[J].J Clin Microbiol,1998,36(9):2786-2788.
[43]胡伏莲.幽门螺杆菌根除失败的原因分析和处理策略[J].现代消化及介入诊疗,2010,15(2)：108—112.
[44]季瑞焱.消化性溃疡幽门螺杆菌反复阳性患者相关因素分析及护理对策[J].中国中医急症,2009,18(3)：485—486.
[45]Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastro-intestinal bleeding [J].Annals Of Internal Medicine,2003,139(10):843-857.
[46]李仁芝.消化性溃疡并出血患者个性化健康教育的体会现代[J].中西药结合杂志,2010,19(4)：518—519.
[47]苏秉忠.急性上消化道出血的诊断和处理常规[J].中国临床医生,2010,38(3)：12—15.
[48]赵静.上消化道出血患者的护理[J].中国实用神经疾病杂志,2010,13(20)：62—63.
[49]刘维.上消化道出血禁食病人逐步开放饮食的护理干预[J].护理研究,2007,21(2)：502—503.
[50]葛臻琼.上消化道出血158例的护理[J].中国误诊学杂志,2010,10(17)：4183.
[51]邢洛红,马红云,赵智侠.上消化道出血患者的饮食护理[J].河南科技大学学报(医学版),2010,28(2)：145—146.
[52]Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer [J].N EngI J Med,2008,359(9):928-937.
[53]李岩.上消化道出血的药物治疗[J].中国实用内科杂志,2008,28(3)：167—168.
[54]Lau JY, Leung WK, Wu JC, et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding[J].N EngI J Med,2007,356(16):1631-1640.
[55]Sung JJ, Barkun A, Kuipers EJ, et al. Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding:a randomized trial[J].Ann Intern Med,2009,150 (7):455-464.
[56]张运强.消化性溃疡并出血的内镜治疗临床疗效观察[J].中国现代医生,2010,48(24)：134—135.
[57]亢殿召.消化性溃疡穿孔129例临床分析[J].中国当代医药,2010,17(24)：197—198.
[58]Feliciano DV. Do perforated duodenal ulcers need an acid-decreasing surgical procedure now that omeprazole is available? [J].Surg Clin North AM,1992,72(2): 369-380.
[59]刘红梅.浅谈老年消化性溃疡与消化道穿孔的临床护理[J].医学信息,2010,23(6)：21—22.
[60]汪卫平.胃十二指肠溃疡穿孔45例分析[J].医学临床研究,2010,27(6)：1167—1168.
[61]李华,杨霁,陈晓明,等.消化性溃疡穿孔非手术治疗28例报告[J].腹部外科,2009,22(2)：102—103.
[62]刘金凤.消化性溃疡穿孔的临床治疗分析[J].中华中西医学杂志,2008,6(2)：43—44.
[63]邓光,周俊强,胡东升等.消化性溃疡穿孔治疗方法的选择[J].中国医疗前沿,2008,3(18)：58.
[64]潘凯.腹腔镜在十二指肠溃疡穿孔手术治疗中的应用[J].中华普通外科学文 献,2008,2(1)：54—56.
[65]Jamieson GG..Current status of indications for surgery in peptic ulcer disease [J]. World Journal of Surg,2000,24(3):256-258.
[66]熊少伟,刘铮,雷云鹏,等.腹腔镜与开腹胃十二指肠溃疡穿孔修补术对比研究[J].中国实用医药,2008,3(18)：49—51.
[67]王辉,陈正平,黄诚,等.腹腔镜与开腹胃十二指肠溃疡穿孔修补术的对比研究[J].山东医药,2008,48(37)：92—93.
[68]Khoursheed M, Fuad M, Safar H, et al. Laparoscopic closure of perforated duodenal ulcer [J].Surg Endosc,2000,14(1):56-58.
[69]邵安健.89例幽门梗阻的病因探讨[J].皖南医学院学报,2009,28(3)：213—214.
[70]赵黎东,黄琼.十二指肠球部溃疡并幽门梗阻52例胃镜下所见与临床分析[J].云南医药,2005,26(2)：148—149.
[71]Baird KK, Pierce LL. Adherence to cardiac therapy for men with coronary artery disease [J].Rehabilitation Nursing,2001,26(6):233-237,243.