经皮冠状动脉介入治疗术后患者恐动症水平变化轨迹研究

doi:10.3761/j.issn.0254-1769.2022.09.002

摘要/Abstract

摘要：

目的探讨急性心肌梗死（acute myocardial infarction,AMI）患者经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后恐动症现状及变化轨迹,为探寻该类患者恐动症最佳干预时间提供依据。方法采用便利取样,选取杭州市某三级甲等综合医院2020年11月—2021年6月心内科收治的105例PCI术后的AMI患者作为调查对象,使用一般资料调查表、心脏恐动症量表、心因性焦虑问卷,分别在住院1周内（T1）、出院2周后（T2）、出院3个月后（T3）3个时间点,测评患者恐动症和心因性焦虑程度。结果 AMI患者PCI术后3个时间点恐动症得分分别为（40.82±5.40）、（41.90±4.60）、（37.40±3.35）分,高于常模（32.20±7.40）分。重复测量方差分析结果显示,时间、年龄及心因性焦虑程度是PCI患者术后恐动症的影响因素（P=0.022,P=0.048,P<0.001）。进行协变量控制后,时间与年龄交互作用显著（P=0.013）,T1和T2时间点与心因性焦虑交互作用显著（P=0.001,P<0.001）。结论受到时间、年龄和心因性焦虑的交互影响,AMI患者PCI术后及出院3个月内恐动症水平均较高,且T2时间点内中青年组恐动症程度与心因性焦虑程度显著高于老年组;恐动症整体变化轨迹显示,在急性康复期小幅增高,之后随时间延长逐步降低。AMI患者PCI术后恐动症持续时间长,有必要早期进行干预。

关键词: 急性心肌梗死, 恐动症, 前瞻性队列研究, 康复护理

Abstract:

Objective To explore the status and development trend of kinesiophobia after percutaneous coronary intervention（PCI） in patients with acute myocardial infarction（AMI）,and to provide evidence for the best intervention time point of kinesiophobia. Methods From November 2020 to June 2021,a total of 105 patients with AMI after PCI admitted to the Department of Cardiology of tertiary A general hospitals in Hangzhou were selected by convenience sampling method. The general data questionnaire,tampa scale of kinesiophobia-heart and cardiac anxiety questionnaire were used to investigate and observe the degree of kinetophobia and psychogenic anxiety at 3 time points（within 1 week of hospitalization,2 weeks after discharge and 3 months after discharge）. Results The kinesiophobia scores of AMI patients at 3 time points after PCI were（40.82±5.40）,（41.90±4.60）,（37.40±3.35）,which were higher than the norm（32.20±7.40）. The results of repeated measure ANOVA showed that different time,different age groups and cardiac anxiety significantly affected the score of kinesiophobia（P=0.022,P=0.048,P<0.001）. After the control for covariates,different time had a significant interaction with age（P=0.013）,T1 and T2 time had significant interaction with cardiac anxiety（P=0.001,P<0.001）. Conclusion Due to the interaction of time, age and cardiac anxiety, the level of kinetophobia in AMI patients was higher after PCI and within 3 months after discharge. At T2 time point, the score of kinesiophobia and cardiac anxiety in the young and middle-age groups was significantly higher than those in the elderly group. The trajectory of kinesiophobia showed a slight increase in acute convalescence period,and a natural trend of gradual decrease in middle and post convalescence period. The kineophobia kinesiophobia of AMI patients after PCI lasts for a long time with a wide impact,so it is necessary to timely carry out interventions.

Key words: Acute Myocardial Infarction, Kinesiophobia, Prospective Cohort Study, Rehabilitation Nursing

王子安, 刘欣, 张茜, 俞梦盈, 郑贝贝, 陆骏, 陈婷婷. 经皮冠状动脉介入治疗术后患者恐动症水平变化轨迹研究[J]. 中华护理杂志, 2022, 57(9): 1035-1041.

WANG Zian, LIU Xin, ZHANG Qian, YU Mengying, ZHENG Beibei, LU Jun, CHEN Tingting. Longitudinal study of kinesiophobia trajectory in patients with acute myocardial infarction after percuta-neous coronary intervention[J]. Chinese Journal of Nursing, 2022, 57(9): 1035-1041.

图/表 4

表1 调查对象的一般资料（n=105）

Table 1 Descriptive of the participants（n=105）

表2 两组不同时间点恐动症水平的比较（分,$\bar{x}\pm s$）

Table 2 Comparison of scores of kenisophobia in different groups at different time（scores,$\bar{x}\pm s$）

表3 不同时间点恐动症得分成对比较及边界值估计

Table 3 Pairwise comparison and marginal estimation for kinesiophobia over time

表4 两组不同时间点恐动症得分成对比较及边界值估计

Table 4 Pairwise comparison and marginal estimation for Tsk scores at different time between two groups

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