老年髋部骨折术后患者心理状况与应对方式的研究

Study on Psychological Status and Coping Style of Elderly Patients after Hip Fracture Operation

摘要: 目的：分析老年髋骨骨折术后患者心理状况和应对方式现状，探讨其应对方式影响因素，为开展以患者为中心的生物–心理–社会医学模式的整体性护理提供相关依据。方法：采用便利抽样法，选取2023年1月~2024年6月于延安市吴起县人民医院骨科或疼痛科住院的老年髋骨骨折术后患者作为调查对象，选用一般资料调查表、抑郁–焦虑–压力量表(DASS-21)、医学应对方式问卷(MCMQ)进行调查。采用SPSS 26.0软件进行数据分析，以α = 0.05为检验水准，当P < 0.05表示差异有统计学意义。采用频数(n)、构成比(%)描述患者的一般资料，均数 ± 标准差(X¯±S)描述患者各研究变量的得分情况；采用独立样本t检验、单因素方差分析比较患者应对方式得分在不同人口学资料、疾病相关资料方面上的差异。结果：该研究共纳入125例老年髋骨骨折术后患者，其抑郁–焦虑–压力量表(DASS-21)得分为(21.15 ± 2.42)分，焦虑维度得分最低为(19.13 ± 3.12)分，抑郁维度得分为(20.12 ± 2.10)分，压力维度得分最高，分值为(25.28 ± 3.10)分；老年髋骨骨折术后患者中63.2%的患者存在不同程度的压力，中度压力的患者占比例最多，77.6%、79.2%的患者存在焦虑、抑郁情绪，其中重度焦虑、轻度抑郁的患者占比较多；老年髋骨骨折术后患者应对方式中，回避维度得分为(16.26 ± 0.92)分，面对维度得分为(18.88 ± 2.32)分，屈服维度得分为(12.77 ± 2.92)分，回避与屈服得分均高于国内一般患者常模，即患者采取回避和屈服的消极态度面对。结论：老年髋骨骨折术后患者焦虑、抑郁、压力水平及发生率较高，且其多采取回避和屈服消极的应对方式，医护人员和家属应关注患者的心理状态和应对方式，提供必要的心理支持，帮助患者培养积极的心态，以促进其早日康复。

Abstract: Objective: To analyze the psychological status and coping style of elderly patients after hip fracture surgery, and to explore the influencing factors of coping style, so as to provide relevant evidence for patient-centered biological-psycho-social medical holistic nursing. Methods: Convenience sampling method was used to select elderly patients who were hospitalized in the Department of Orthopedics or pain Department of Wuqi County People’s Hospital of Yan’an City from January 2023 to June 2024 as the investigation objects. General data questionnaire, depression-Anxiety-stress Scale (DASS-21) and Medical coping style Questionnaire (MCMQ) were used to investigate. SPSS26.0 software was used for data analysis, α = 0.05 was used as the test level, and P < 0.05 meant that the difference was statistically significant. Frequency (n) and component ratio (%) were used to describe the general data of patients, and mean ± standard deviation (X¯±S) was used to describe the scores of each study variable. Independent sample t test and one-way analysis of variance were used to compare the differences of coping style scores in different demographic data and disease-related data. Results: A total of 125 elderly patients after hip fracture were included in this study. The score of depression-Anxiety-stress scale (DASS-21) was (21.15 ± 2.42), the score of anxiety dimension was (19.13 ± 3.12), the score of depression dimension was (20.12 ± 2.10), and the score of stress dimension was the highest. The score was (25.28 ± 3.10) points; Among the elderly patients after hip fracture, 63.2% patients had different degrees of stress, the proportion of patients with moderate stress was the highest, 77.6% and 79.2% patients had anxiety and depression, among which severe anxiety and mild depression accounted for more. In the coping styles of elderly patients after hip fracture surgery, the avoidance dimension score was (16.26 ± 0.92), the face dimension score was (18.88 ± 2.32), and the yield dimension score was (12.77 ± 2.92). The avoidance and yield scores were higher than the common patient norms in China, that is, patients adopted a negative attitude of avoidance and submission. Conclusion: The anxiety, depression and stress levels and incidence of elderly patients after hip fracture surgery are high, and most of them adopt negative coping styles of avoidance and submission. Medical staff and family members should pay attention to the psychological state and coping styles of patients, provide necessary psychological support, and help patients develop a positive attitude to promote their early recovery.