北京市石景山地区冠心病患者心脏康复依从性研究

doi:10.12183/j.scjpm.2022.0173

摘要/Abstract

摘要： 目的探讨冠心病（CHD）患者心脏康复依从性及其影响因素。方法以2018年5月至2020年9月于北京某康复医院治疗的CHD患者为研究对象,在出院时由康复科医师对患者出院后的康复行为进行指导,并在出院后6个月时由研究组成员对患者进行康复行为依从性的跟踪随访,采用描述性分析方法对结果进行分析,并采用单、多因素分析方法对心脏康复依从性影响因素进行分析。结果出院6个月时完成随访2 115例。患者中男性占55.08%。平均年龄为（55.32±1.52）岁,最小38岁,最大72岁。心脏康复行为中完全依从者821例,部分依从者921例,不依从者373例,分别占38.82%、43.55%、17.64%,总体依从率为82.36%。二分类Logistic回归分析结果显示,文化程度为初中及高中（OR=2.543）、大专及以上（OR=4.274）、月收入3 000~4 999（OR=3.304）、月收入≥5 000元（OR=2.785）、抑郁（OR=0.301）、心脏康复认知评分≥17（OR=6.475）、冠心病健康信念评分≥101分（OR=11.100）、社会支持评分≥36分（OR=8.836）、自我管理效能感评分≥62分（OR=12.417）、中文版疾病感知问卷修订（IPQ-R）评分≥131分（OR=6.412）均为CHD患者心脏康复依从性的影响因素。结论北京市石景山地区CHD患者的心脏康复依从性相对较差,与文化程度、月收入情况、抑郁、疾病感知、心脏康复认知水平、冠心病健康信念、社会支持、自我管理效能有关。

关键词: 冠心病, 心脏康复, 依从性, 健康信念, 社会支持, 自我管理效能

Abstract: Objective To investigate the compliance and influencing factors of cardiac rehabilitation in patients with coronary heart disease （CHD）. Methods CHD patients who were treated in a rehabilitation hospital in Beijing from May 2018 to September 2020 were selected as the research objects. Rehabilitation physicians gave guidance to the patients on their rehabilitation behavior after discharge. The members of the group followed up on the patients' compliance with rehabilitation behaviors, used descriptive analysis methods to analyze the results, and used univariate and multivariate analysis methods to analyze the influencing factors of cardiac rehabilitation compliance. Results A total of 2 115 cases were followed up 6 months after discharge. Males accounted for 55.08% of the patients. The average age was （55.32±1.52） years old, the youngest was 38 years old and the oldest was 72 years old. Among the cardiac rehabilitation behaviors, 821 were fully compliant, 921 were partially compliant, and 373 were non-compliant, accounting for 38.82%, 43.55%, and 17.64%, respectively. The overall compliance rate was 82.36%. Binary Logistic regression analysis showed that the educational level was junior middle school or senior high school （OR=2.543）, college degree or above （OR=4.274）, monthly income 3 000-4 999 yuan （OR=3.304）, monthly income ≥5 000 yuan （OR=2.785）, depression （OR=0.301）, cognitive score of cardiac rehabilitation≥17 （OR=6.475）, health belief score of CHD ≥101 （OR=11.100）, social support score ≥36 （OR=8.836）, self-management efficacy score ≥62 （OR=12.417） and illness perception questionnaire-revised （IPQ-R） score ≥131 （OR=6.412） were the influencing factors of compliance of cardiac rehabilitation in CHD patients. Conclusion Patients with CHD in Shijingshan District of Beijing have relatively poor compliance with cardiac rehabilitation, which is related to education level, monthly income, depression, disease perception, cognitive level of cardiac rehabilitation, health beliefs in CHD, social support, and self-management efficacy.

Key words: Coronary heart disease, Cardiac rehabilitation, Compliance, Health belief, Social support, Self-management efficacy

中图分类号:

R541.4

郭雅楠, 杨柳, 崔慢飞. 北京市石景山地区冠心病患者心脏康复依从性研究[J]. 华南预防医学, 2022, 48(2): 173-177.

GUO Ya-nan, YANG Liu, CUI Man-fei. Compliance of cardiac rehabilitation in patients with coronary heart disease in Shijingshan District, Beijing[J]. South China Journal of Preventive Medicine, 2022, 48(2): 173-177.

参考文献

[1] 毛越,徐剑锋,陈昊天,等. 同伴教育对冠心病患者心脏康复锻炼依从性的影响[J]. 中国实用护理杂志,2020,36(30):2348-2353.
[2] GBD 2015 Eastern Mediterranean Region Cardiovascular Disease Collaborators. Burden of cardiovascular diseases in the Eastern Mediterranean Region,1990-2015: Findings from the Global Burden of Disease 2015 stease 2015 stease 2015 study[J]. Int J Public Health, 2018,63(1):137-149.
[3] 高保林,王庆莲,赵敏毅,等. 汉中农村人口18年冠心病和脑卒中死亡率变动趋势[J]. 心脏杂志,2004,16(2):124-126.
[4] 吴坚,桂沛君,高飞,等. 急性冠脉综合征患者PCI后恢复期心脏康复依从性相关影响因素分析[J]. 中国循证心血管医学杂志,2019,11(8):964-967.
[5] 沈迎,张瑞岩,沈卫峰. 稳定性冠心病血运重建策略进展——2018中国稳定性冠心病诊断与治疗指南解读[J]. 心脑血管病防治,2019,19(2):107-111.
[6] 王卫兵. 酒精对乙肝病毒相关性肝癌的影响[D]. 杭州:浙江大学,2011:1-29.
[7] 朱军红,钟宝亮,刘艳. 美沙酮维持治疗患者吸烟行为及影响因素分析[J]. 中国公共卫生,2012,28(5):673-676.
[8] 龚梅恩,刘军,苏程,等. 症状自评量表焦虑与抑郁分比值对焦虑症和抑郁症诊断价值的探讨[J]. 中国行为医学科学,2008,17(11):993-995.
[9] 毛贵如,王丽姿,许桢桢,等. 多次住院冠心病病人疾病感知状况及服药依从性调查分析[J]. 护理研究,2016,30(27):3344-3347.
[10] 赵杰刚,尤炎丽,李春燕,等. 个体化心脏康复教育模式对冠状动脉介入术后患者心脏康复认知及行为的影响[J]. 中国实用护理杂志,2019,35(12):901-906.
[11] Mullen PD, Hersey JC, Iverson DC.Health behavior models compared[J]. Soc Sci Med, 1987, 24(11):973-981.
[12] 刘继文,李富业,连玉龙. 社会支持评定量表的信度效度研究[J]. 新疆医科大学学报,2008,31(1):1-3.
[13] 钱会娟,袁长蓉. 中文版癌症自我管理效能感量表的信效度测评[J]. 中华护理杂志,2011,46(1):87-89.
[14] 冯琴,郑桂香,王娣,等. 互联网+心脏康复延续性护理对冠心病经皮冠状动脉介入术后康复效果的研究[J]. 中国数字医学,2019,14(6):7-9.
[15] 陈佳,李丽辉. 心脏康复理念指导下的护理对急性心肌梗死患者心率变异性及运动依从性的影响[J]. 贵州医药,2019,43(4):636-638.
[16] Li XX, Fan ZJ, Cui J, et al.Cardiac rehabilitation of Baduanjin exercise in coronary heart disease after PCI: A protocol for systematic review and meta-analysis of randomized controlled trials[J]. Medicine. 2021,100(15):25501.
[17] 林雪琴,黄文娟. 经皮冠状动脉介入术后冠心病患者健康促进行为与健康信念的相关性研究[J]. 华南预防医学,2019,45(4):309-313.
[18] 王丽娜,李娜,莫文平,等. 冠心病住院患者自我管理行为与社会支持现状及相关因素[J]. 中国老年学杂志,2020,40(20):4451-4455.