| Objective:In this study,the incidence of various symptoms and the degree of distress in middle-aged and elderly patients with stable COPD were investigated by questionnaire.Exploratory factor analysis was used to determine the type of symptom groups in middle-aged and elderly patients with stable COPD,and the influencing factors of each symptom group were analyzed.A structural equation model with symptom group as independent variable,coping style as mediating variable and quality of life as effect variable was established to provide theoretical basis for developing targeted intervention measures of symptom group and coping style to improve the quality of life of COPD patients in stable period.Methods:A total of 256 middle-aged and elderly patients with stable COPD who received treatment in three community outpatient clinics in Taiyuan City from July to September 2020 and met the inclusion and exclusion criteria were selected as the research subjects by convenience sampling method.The general data questionnaire,the revised Memory Symptomatic Scale(RMSAS),the medical coping style questionnaire(MCMQ),the chronic obstructive pulmonary disease assessment scale(CAT)and the breathing difficulty scale(MMRC)were used to investigate the patients.SPSS22.0 software was used for data entry and statistical analysis,and frequency and percentage were used for descriptive analysis of general data.Exploratory factor analysis was used to extract the symptom groups of patients.Mean and standard deviation were used to describe the scores of symptom group,coping style and quality of life.Univariate analysis method,multiple linear regression method and Pearson correlation analysis method were used to analyze the influencing factors and correlation of the three.AMOS22.0 software was used to construct a structural equation model with symptom group as independent variable,coping style as mediating variable and quality of life as effect variable.The model was modified by the correction index,and the test level α=0.05.Results:1.The incidence of 19 symptoms in middle-aged and elderly patients with stable COPD ranged from 22.22% to 89.74%,and the 5 symptoms with high incidence were:shortness of breath(89.74%),dry mouth(88.46%),cough(86.32%),lack of energy(84.62%)and irritability(81.20%).The scores of symptom distress ranged from(0.84±1.05)to(2.59±2.36),and the five symptoms with high degree of distress were:Shortness of breath(2.59±2.36),dry mouth(2.22±2.08),cough(2.13±1.07),lack of energy(2.07±1.12),difficulty falling asleep(2.11±1.15).2.Exploratory factor analysis was used to determine that middle-aged and elderly patients with stable COPD experienced three symptom groups: respiratory symptom group,physical symptom group and affective symptom group,with scores of(11.52±4.82),(10.84±4.37)and(9.38±4.09),respectively.3.Multiple linear regression results showed that age,occupation,residence and smoking status entered the respiratory symptom group prediction equation(P<0.05);Marital status,family monthly income and the presence or absence of other chronic diseases were included in the affective symptom group prediction equation(P<0.05);Age,residence,duration of illness,and degree of dyspnea entered the somatic symptom group prediction equation(P<0.05).4.Respiratory symptom group,somatic symptom group and affective symptom group were positively correlated with quality of life(r=0.476,r=0.383,r=0.484,P<0.01);Respiratory symptom group,somatic symptom group and affective symptom group were negatively correlated with coping style dimension(r=-0.325,r=-0.435,r=-0.524,P<0.01),were positively correlated with avoidance coping style dimension and yield coping style dimension(r=0.401,r=0.324,r=0.349,r=0.278,r=0.278,r=0.421,P<0.01);The coping style dimension of patients’ coping style was negatively correlated with quality of life(r=-0.347,P<0.01);The avoidance coping style dimension and the yield coping style dimension were positively correlated with the quality of life(r=0.279,r=0.396,P<0.01).5.Different coping styles had partial mediating effect on symptom group and quality of life.The mediating effect of coping style accounted for 17.53% of the total effect.The mediating effects of yield and avoidance coping styles were 15.64% and 8.29%,respectively.Conclusion:1.The symptoms of middle-aged and elderly stable COPD patients mainly appeared in three clusters: respiratory symptoms,somatic symptoms and emotional symptoms.2.Influencing factors of respiratory symptom cluster included age,occupation,residence and smoking status;The influencing factors of somatic symptom cluster include duration of disease and degree of dyspnea;The affective symptom cluster was influenced by marital status,monthly family income and the presence or absence of other chronic diseases.3.Different coping styles in middle-aged and elderly stable COPD patients played a partial mediating role in the relationship between symptom group and quality of life.Symptom group can indirectly affect the quality of life,by influencing the patients coping styles prompt medical workers to strengthen symptoms group intervention,on the basis of based on the patient’s own way to cope with disease take targeted psychological intervention situation,enhance the enthusiasm of patients to treat disease and the level of hope,encourage patients to establish positive coping styles in the face of disease. |
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