急性心肌梗死患者疲劳发展轨迹的调查研究

doi:10.3761/j.issn.0254-1769.2022.02.008

摘要/Abstract

摘要：

目的探讨急性心肌梗死（acute myocardial infarction,AMI）患者疲劳发展轨迹及影响因素。方法 2019年12月—2021年1月,采用方便抽样法,选取湖州市某三级甲等医院心内科首次发生AMI的206例患者作为调整对象。采用多维疲劳量表在患者入院后第2天、出院后1个月、2个月、4个月调查患者的疲劳水平,采用潜类别增长模型及单因素分析进行数据处理。结果识别出AMI患者疲劳轨迹分为3个潜在类别,分别为明显改善组（15.2%）、缓慢缓解组（62.8%）、持续疲劳组（22.0%）;不同轨迹类别在性别（χ²=29.384,P<0.001）、婚姻状况（χ²=6.774,P=0.034）、共病个数（χ²=27.131,P<0.001）和心功能分级（χ²=20.416,P<0.001）方面,差异有统计学意义。结论 AMI患者从急性入院至出院后4个月内,大部分患者的疲劳能得到良好的改善,其疲劳轨迹存在群体异质性,护士应根据疲劳变化轨迹及其影响因素,给予患者阶段性及特异性的护理干预。

关键词: 急性心肌梗死, 疲劳, 轨迹, 潜类别增长模型, 护理

Abstract:

Objective To explore the fatigue development trajectory and influencing factors of postoperative patients with acute myocardial infarction（AMI）. Methods From December 2019 to January 2021,206 patients with first AMI in the cardiology department of a tertiary hospital in Huzhou were selected by convenience sampling method. The multidimensional fatigue scale-20 was used to investigate the patient’s fatigue level on the second day after admission and 1,2,4 months after discharge,and the latent class growth model and single factor analysis were used for data processing. Results It is recognized that the fatigue trajectory of AMI patients is divided into 3 potential categories,namely,the obvious improvement group（15.2%）,the slow remission group（62.8%）,and the continuous fatigue group（22.0%）;single factor analysis shows that the 3 trajectory categories are different with statistical significance in gender （χ²=29.384,P<0.001）,marital status （χ²=6.774,P=0.034）,number of comorbidi-ties（χ²=27.131,P<0.001） and cardiac function classification（χ²=20.416,P<0.001）. Conclusion The fatigue of most patients with AMI can be improved within 4 months from acute admission to discharge. There is group heterogeneity in fatigue trajectory. Medical staff should formulate staged and specific full-course nursing interventions according to different trajectory categories.

Key words: Acute Myocardial Infarction, Fatigue, Trajectory, Latent Class Growth Model, Nursing Care

龚莉, 林茜, 董铭琦, 杜金磊, 诸帆, 蒋建萍, 赵红星, 邵圣文. 急性心肌梗死患者疲劳发展轨迹的调查研究[J]. 中华护理杂志, 2022, 57(2): 176-181.

GONG Li, LIN Xi, DONG Mingqi, DU Jinlei, ZHU Fan, JIANG Jianping, ZHAO Hongxing, SHAO Shengwen. The investigation of fatigue development trajectory in patients with acute myocardial infarction[J]. Chinese Journal of Nursing, 2022, 57(2): 176-181.

图/表 4

表1 急性心肌梗死患者4个时间点的疲劳得分及相关性分析（r值）

Table 1 Fatigue scores and correlation analysis of AMI patients at 4 time points（r value）

表2 急性心肌梗死患者疲劳应用潜类别增长模型拟合情况

Table 2 Fitting of the LCGM of fatigue in AMI patients

图1 急性心肌梗死患者疲劳潜类别增长模型轨迹图注：T1为入院后第2天,T2为出院后1个月,T3为出院后2个月,T4为出院后4个月。

Figure 1 LCGM trajectory diagram of fatigue in AMI patients

表3 急性心肌梗死患者疲劳轨迹的单因素分析 [例（百分比,%）]

Table 3 Univariate analysis of fatigue trajectory in AMI patients [cases,percentage（%）]

参考文献 27

[1]	谷雨擎, 朱丽丽, 李庆印, 等. 急诊经皮冠状动脉介入治疗患者早期心脏康复护理方案的构建[J]. 中华护理杂志, 2021, 56(4):502-508.
	Gu YQ, Zhu LL, Li QY, et al. Construction of an early cardiac rehabilitation nursing practice program for patients after emergency percutaneous coronary intervention[J]. Chin J Nurs, 2021, 56(4):502-508.
[2]	王增武, 胡盛寿. 《中国心血管健康与疾病报告2019》要点解读[J]. 中国心血管杂志, 2020, 25(5):401-410.
	Wang ZW, Hu SS. Interpretation of report on cardiovascular health and diseases in China 2019[J]. Chin J Cardiovasc Med, 2020, 25(5):401-410.
[3]	Eckhardt AL, DeVon HA, Piano MR, et al. Fatigue in the presence of coronary heart disease[J]. Nurs Res, 2014, 63(2):83-93. DOI PMID
[4]	Alsén P, Brink E. Fatigue after myocardial infarction-a two-year follow-up study[J]. J Clin Nurs, 2013, 22(11/12):1647-1652. DOI URL
[5]	Fredriksson-Larsson U, Alsén P, Karlson BW, et al. Fatigue two months after myocardial infarction and its relationships with other concurrent symptoms,sleep quality and coping strategies[J]. J Clin Nurs, 2015, 24(15/16):2192-2200. DOI URL
[6]	Zahed FAAAN. The relationship of fatigue and hostility with health in patients with coronary artery disease[J]. J Guilan Uni-versity Med Sci, 2010, 18(2):77-84.
[7]	高倩, 李晓敏, 孙王乐贤, 等. 自我调节疲劳对冠心病患者自我管理行为的影响[J]. 中国慢性病预防与控制, 2019, 27(1):38-42.
	Gao Q, Li XM, Sun WLX, et al. The effect of self-regulation fatigue on self-management behavior of patients with coronary heart disease[J]. Chin J Prev Control Chronic Dis, 2019, 27(1):38-42.
[8]	Johansson I, Karlson BW, Grankvist G, et al. Disturbed sleep,fatigue,anxiety and depression in myocardial infarction patients[J]. Eur J Cardiovasc Nurs, 2010, 9(3):175-180. DOI URL
[9]	金枝, 滕智敏, 豆娟. 急性心肌梗死后患者长期疲劳状态的发生特点及影响因素[J]. 中国老年学杂志, 2014, 34(24):7054-7055.
	Jin Z, Teng ZM, Dou J. Characteristics and influencing factors of long-term fatigue in patients with acute myocardial infarction[J]. Chin J Gerontol, 2014, 34(24):7054-7055.
[10]	李娟, 周兰姝. 慢性疾病轨迹模式及其在脑卒中患者照护中的应用研究进展[J]. 解放军护理杂志, 2018, 35(8):35-38.
	Li J, Zhou LS. Chronic disease trajectory model and its application research progress in the care of stroke patients[J]. Chin J PLA, 2018, 35(8):35-38.
[11]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南（2019）[J]. 中华心血管病杂志, 2019(10):766-783.
	Chinese Society of Cardiovascular Diseases,Chinese Medical Association,Editorial Board of Chinese Journal of Cardiovascular Diseases. Guidelines for the diagnosis and treatment of acute ST-segment elevation myocardial infarction（2019）[J]. Chin J of Cardiovasc Dis, 2019(10):766-783.
[12]	Smets EM, Garssen B, Cull A, et al. Application of the multidimensional fatigue inventory(MFI-20) in cancer patients receiving radiotherapy[J]. Br J Cancer, 1996, 73(2):241-245. DOI URL
[13]	韩秋凤, 田俊. 多维疲劳量表应用于肿瘤患者的信度和效度验证[J]. 中华护理杂志, 2012, 47(6):548-550.
	Han QF, Tian J. The reliability and validity of the Multidimensional Fatigue Inventory-20 in cancer patients[J]. Chin J Nurs, 2012, 47(6):548-550.
[14]	袁丽霞, 丁荣晶. 中国心脏康复与二级预防指南解读[J]. 中国循环杂志, 2019, 34(S1):86-90.
	Yuan LX, Ding RJ. Interpretation of China’s guidelines for cardiac rehabilitation and secondary prevention[J]. Chin Circ J, 2019, 34(S1):86-90.
[15]	胡树罡, 王磊, 郭兰. 《经皮冠状动脉介入治疗术后运动康复专家共识》解读[J]. 上海大学学报(自然科学版), 2018, 24(1):9-15. DOI
	Hu SG, Wang L, Guo L. Interpretation of experts’ consensus for exercise rehabilitation of the post-PCI treatment[J]. J Shang-hai Univ Nat Sci Ed, 2018, 24(1):9-15.
[16]	王孟成, 邓俏文, 毕向阳, 等. 分类精确性指数Entropy在潜剖面分析中的表现:一项蒙特卡罗模拟研究[J]. 心理学报, 2017, 49(11):1473-1482.
	Wang MC, Deng QW, Bi XY, et al. Performance of the entropy as an index of classification accuracy in latent profile analysis:a Monte Carlo simulation study[J]. Acta Psychol Sin, 2017, 49(11):1473-1482.
[17]	叶素静, 唐文清, 张敏强, 等. 追踪研究中缺失数据处理方法及应用现状分析[J]. 心理科学进展, 2014, 22(12):1985-1994.
	Ye SJ, Tang WQ, Zhang MQ, et al. Techniques for missing data in longitudinal studies and its application[J]. Adv Psychol Sci, 2014, 22(12):1985-1994. DOI URL
[18]	Smith OR, Kupper N, de Jonge P, et al. Distinct trajectories of fatigue in chronic heart failure and their association with prognosis[J]. Eur J Heart Fail, 2010, 12(8):841-848. DOI PMID
[19]	Zimmermann-Viehoff F, Wang HX, Kirkeeide R, et al. Women’s exhaustion and coronary artery atherosclerosis progression:The stockholm female coronary angiography study[J]. Psychosom Med, 2013, 75(5):478-485. DOI PMID
[20]	高向辉, 刘彤. 中青年与老年急性心肌梗死临床特征及相关危险因素系统综述[J]. 实用中医内科杂志, 2013, 27(20):3-5,8.
	Gao XH, Liu T. Young and middle-aged and elderly acute myocardial infarction,clinical characteristics and risk factors related to system were reviewed[J]. J Pract Tradit Chin Intern Med, 2013, 27(20):3-5,8.
[21]	Smith OR, Kupper N, Denollet J, et al. Vital exhaustion and cardiovascular prognosis in myocardial infarction and heart failure:predictive power of different trajectories[J]. Psychol Med, 2011, 41(4):731-738. DOI PMID
[22]	Choi HY, Han HJ, Choi JW, et al. Superior effects of high-intensity interval training compared to conventional therapy on cardiovascular and psychological aspects in myocardial infarction[J]. Ann Rehabil Med, 2018, 42(1):145-153. DOI PMID
[23]	Horne CE, Johnson S, Crane PB. Comparing comorbidity measures and fatigue post myocardial infarction[J]. Appl Nurs Res, 2019, 45:1-5. DOI URL
[24]	Alsén P, Eriksson M. Illness perceptions of fatigue and the association with sense of coherence and stress in patients one year after myocardial infarction[J]. J Clin Nurs, 2016, 25(3/4):526-533. DOI URL
[25]	朱彩凤, 张敏. 慢性压力与冠心病的研究进展[J]. 心血管病学进展, 2018, 39(4):611-614.
	Zhu CF, Zhang M. Research progress on chronic stress and coronary heart disease[J]. Adv Cardiovasc Dis, 2018, 39(4):611-614.
[26]	刘东苗, 李鑫, 李殊, 等. 截肢患者创伤后应激障碍与社会支持的纵向研究[J]. 中华护理杂志, 2019, 54(7):965-969.
	Liu DM, Li X, Li S, et al. Longitudinal study of post-traumatic stress disorder and social support in amputated patients[J]. Chin J Nurs, 2019, 54(7):965-969.
[27]	Rydén L, van de Werf F, Armstrong PW, et al. Corrections needed to 2016 ESC guideline and AHA scientific statement on heart failure[J]. Lancet Diabetes Endocrinol, 2017, 5(5):325-326. DOI URL