内科

目的分析妊娠期高血压疾病（HDP）患者妊娠期医疗决策参与现状及其影响因素。方法选取2022年2月至2023年12月莆田学院附属医院收治的119例HDP患者作为研究对象。采用患者参与治疗决策问卷评定其医疗决策参与度；分别采用一般资料调查表、社会支持评定量表、中文版决策自我效能量表及患者对医疗决策参与态度问卷，收集患者的一般资料并评定其社会支持水平、决策自我效能水平及医疗决策参与态度。采用多因素logistic回归模型分析HDP患者妊娠期医疗决策参与度的独立影响因素。结果 119例HDP患者中，医疗决策参与度低者共38例，占31.93%。多因素logistic回归分析结果显示，文化水平为高中以下（OR=2.745，95%CI：1.218～6.187）、既往无不良孕产史（OR=2.333，95%CI：1.037～5.251）、社会支持水平低下（OR=2.642，95%CI：1.163～6.000）、决策自我效能水平低下（OR=2.857，95%CI：1.275～6.404）、医疗决策参与态度消极（OR=2.802，95%CI：1.260～6.231）均是HDP患者妊娠期医疗决策参与度低的独立危险因素（均P<0.05）。结论 HDP患者妊娠期医疗决策参与度有待提高，并受文化水平、既往不良孕产史、社会支持水平、决策自我效能水平及医疗决策参与态度等因素影响。未来应针对上述因素，通过加强分层健康教育、完善社会支持系统、进行自我效能干预及心理疏导等综合策略予以改善。

Objective To analyze the status of participation in medical decision-making during pregnancy in patients with hypertensive disorders of pregnancy (HDP) and its influencing factors. Methods A total of 119 patients with HDP admitted to the Affiliated Hospital of Putian University from February 2022 to December 2023 were enrolled as research subjects. The Patient Participation in Treatment Decision-Making Questionnaire was used to evaluate their level of participation in medical decision-making. A general information questionnaire, Social Support Rating Scale, Chinese version of the Decision Self-Efficacy Scale, and the Patients Attitude toward Participation in Medical Decision-Making Questionnaire were used to collect general data and assess social support level, decision self-efficacy level, and attitude toward participation in medical decision-making. The multivariate logistic regression model was used to identify independent influencing factors for participation in medical decision-making during pregnancy in patients with HDP. Results Among the 119 HDP patients, 38 (31.93%) had a low participation level in medical decision-making. Multivariate logistic regression analysis showed that education level below senior high school (OR=2.745, 95%CI: 1.218-6.187), no history of adverse pregnancy outcomes (OR=2.333, 95%CI: 1.037-5.251), low social support level (OR=2.642, 95%CI: 1.163-6.000), low decision self-efficacy level (OR=2.857, 95%CI: 1.275-6.404), and negative attitude toward participation in medical decision-making (OR=2.802, 95%CI: 1.260-6.231) were independent risk factors for low participation level in medical decision-making during pregnancy in patients with HDP (all P<0.05). Conclusion Participation level in medical decision-making during pregnancy in HDP patients needs to be improved, and it is influenced by education level, history of adverse pregnancy outcomes, social support level, decision self-efficacy level, and attitude toward participation in medical decision-making. In light of the aforementioned factors, it is imperative that future endeavors be directed toward ameliorating outcomes through the implementation of multifaceted strategies, incorporating enhanced stratified health education, a strengthened social support system, self-efficacy interventions, and psychological counseling.