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广州医药杂志服务号
论著

综合性口腔护理干预方案在机械通气患儿中的应用

Application of comprehensive oral nursing intervention scheme in children with mechanical ventilation

:619-624
 
      目的 探究综合性口腔护理干预方案在机械通气患儿中的应用效果。方法 将2023年5月—12月泉州市妇幼保健院重症监护科接收的66例机械通气患儿选为研究对象。以密封信封抽签法分为综合干预组(n=33)及常规干预组(n=33)。常规干预组实施常规口腔护理,综合干预组实施综合性口腔护理模式干预。对比两组患儿口腔情况、并发症、静态全唾液流率(UWS)及机械通气时间。结果 干预后综合干预组Beck总分为(6.33±1.05)分,低于常规干预组的(8.55±1.85)分(t=6.069,P<0.001)。综合干预组出现呼吸机相关肺炎(VAP)发生率较常规干预组更低(3.03% vs 18.18%)(χ2=3.995,P=0.046)。干预后综合干预组UWS为(0.37±0.09)mg/min,高于常规干预组的(0.29±0.09)mg/min(t=3.611,P=0.001)。结论 综合性口腔护理模式能较大程度改进机械通气患儿的口腔卫生问题,对菌斑、口腔异味及牙龈情况均有改善作用;也能减少并发症发生率,提升UWS,维持口腔卫生健康。

      Objective To explore the effect of comprehensive oral nursing intervention in children with mechanical ventilation.Methods A total of 66 mechanically ventilated children admitted to the intensive care department of the hospital from May 2023 to December 2023 were selected as the study objects.They were divided into comprehensive intervention group(n=33)and routine intervention group(n=33)by sealed envelope lottery method.The routine intervention group implemented routine oral care,and the comprehensive intervention group implemented comprehensive oral care mode intervention.Oral conditions,complications,unstimulated whole saliva(UWS)and mechanical ventilation time were compared between the two groups.Results After the intervention,the total Beck score of the comprehensive intervention group was(6.33±1.05),which was lower than that of the conventional intervention group([8.55±1.85],t=6.069,P<0.001).The incidence of ventilator-associated pneumonia(VAP)in the comprehensive intervention group was lower than that in the conventional intervention group(3.03% vs 18.18%)(χ2=3.995,P=0.046).After the intervention,the UWS of the comprehensive intervention group was(0.37±0.09)mg/min,which was higher than that of the conventional intervention group([0.29±0.09] mg/min,t=3.611,P=0.001).Conclusions The comprehensive oral care mode can improve the oral health of children with mechanical ventilation to a great extent,and can improve the plaque,oral odor and gingiva condition.It can also reduce the incidence of complications,improve UWS,and maintain oral health.

论著

基于Caprini量表评估的干预模式联合充气加压泵预防慢性阻塞性肺疾病急性加重期患者静脉血栓的效果

Effect of intervention mode based on Caprini score combined with inflatable pump in preventing VTE in patients with AECOPD

:507-512
 
      目的 观察慢性阻塞性肺疾病急性加重期(AECOPD)患者应用基于Caprini量表评估的干预模式联合充气加压泵(IPC)预防静脉血栓(VTE)的效果。方法 选取河南省人民医院在2023年11月—2024年11月收入的82例AECOPD患者作为研究对象,经随机数表法分为对照组41例予以VTE常规干预,观察组41例在对照组的基础上接受基于Caprini量表评估的干预模式联合IPC预防。比较两组AECOPD患者肢体情况及深静脉血栓(VTE)发生情况、凝血指标及股静脉血流速度。结果 观察组肢体肿胀率、肢体疼痛率及VTE发生率均低于对照组(P<0.05)。干预前,两组AECOPD患者凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体水平比较差异无统计学意义(P>0.05);干预后,两组患者TT、PT、APTT、D-二聚体水平均降低,观察组较低(P<0.05)。干预前,两组AECOPD患者平均流速、血流峰速及阻力指数比较差异无统计学意义(P>0.05);干预后,两组患者平均流速、血流峰速均升高,观察组高于对照组(P<0.05);阻力指数均降低,观察组低于对照组(P<0.05)。结论 AECOPD患者应用基于Caprini量表评估的干预模式联合IPC能有效降低肢体肿胀率、肢体疼痛率及VTE发生率,改善凝血指标与股静脉血流速。
   Objective To observe the effect of a Caprini score?based intervention model combined with intermittent pneumatic compression(IPC)in preventing venous thromboembolism(VTE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 82 AECOPD patients admitted to Henan Provincial People’s Hospital from November 2023 to November 2024 were selected as subjects and randomly divided into a control group(41 cases)and an observation group(41 cases)using a random number table.The control group received routine VTE prevention,while the observation group received the Caprini score?based intervention combined with IPC in addition to the routine care.The extremity conditions,occurrence of VTE,coagulation parameters,and femoral venous blood flow velocity were compared between the two groups.Results The rates of extremity swelling,extremity pain,and VTE incidence in the observation group were lower than those in the control group(P<0.05).Before the intervention,there were no statistically significant differences in thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),or D?dimer levels between the two groups(P>0.05).After the intervention,TT,PT,APTT,and D?dimer levels decreased in both groups,with lower values in the observation group(P<0.05).Before the intervention,there were no statistically significant differences in mean flow velocity,peak flow velocity,or resistance index between the two groups(P>0.05).After the intervention,mean flow velocity and peak flow velocity increased in both groups,with higher values in the observation group(P<0.05),while the resistance index decreased,with a lower value in the observation group(P<0.05).Conclusions The application of a Caprini score?based intervention model combined with IPC in AECOPD patients can effectively reduce the rates of extremity swelling,extremity pain,and VTE incidence,and improve  coagulation parameters and femoral venous blood flow velocity.
论著

舒肝解郁胶囊联合体外反搏对冠心病介入术后患者焦虑抑郁疗效及心肺功能的影响

Effects of Shugan Jieyu Capsule combined with external counterpulsation on anxiety and cardiopulmonary function in patients with coronary artery disease after percutanous coronary intervention

:888-892
 
       目的 分析舒肝解郁胶囊联合体外反搏治疗冠心病介入术后焦虑抑郁患者的效果。方法 选择2023年1月—2025年1月平顶山市第一人民医院收治的86例冠心病介入术后患者,随机分为对照组(43例)、舒肝解郁胶囊组(43例),均进行常规治疗及体外反搏治疗,舒肝解郁胶囊组加用舒肝解郁胶囊,测量并比较两组患者治疗前后心肺功能,评估患者焦虑和抑郁情绪、临床疗效及生活质量。结果 治疗后舒肝解郁胶囊组左心室射血分数(LVEF)和最大摄氧量(VO2max)均显著高于对照组(P<0.05);治疗后舒肝解郁胶囊组汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分均低于对照组(P<0.05);舒肝解郁胶囊组总有效率高于对照组(P<0.05);治疗后舒肝解郁胶囊组生活质量综合评定问卷(GQOLI-74)各维度评分均显著高于对照组(P<0.05)。结论 舒肝解郁胶囊联合体外反搏治疗冠心病介入术后焦虑抑郁效果显著,可减轻患者负面情绪,改善其心肺功能及生活质量。

     Objective To analyze the effect of Shugan Jieyu Capsule combined with external counterpulsation in the treatment of anxiety and depression in patients with coronary artery disease after percutaneous coronary intervention(PCI).Methods From January 2023 to January 2025,86 patients with coronary heart disease who had undergone PCI in our hospital were enrolled and randomly divided into a control group(43 cases) and a Shugan Jieyu Capsule group(43 cases).All patients received conventional treatment and external counterpulsation.The Shugan Jieyu Capsule group was given Shugan Jieyu Capsule in addition.Cardiopulmonary function was measured and compared before and after treatment between the two groups,and anxiety and depression,clinical efficacy,and quality of life were evaluated.Results After treatment,the left ventricular ejection fraction(LVEF) and maximum oxygen uptake(VO2max) in the Shugan Jieyu Capsule group were significantly higher than those in the control group(P<0.05).The Hamilton Anxiety Rating Scale(HAMA) and Hamilton Depression Rating Scale(HAMD) scores in the Shugan Jieyu Capsule group were significantly lower than those in the control group(P<0.05).The total effective rate in the Shugan Jieyu Capsule group was significantly higher than that in the control group(P<0.05).After treatment,the scores on all dimensions of the General Quality of Life Assessment Questionnaire-74(GQOLI-74) in the Shugan Jieyu Capsule group were significantly higher than those in the control group(P<0.05).Conclusions Shugan Jieyu Capsule combined with external counterpulsation is effective in treating anxiety and depression after PCI,alleviating negative emotions and improving cardiopulmonary function and quality of life.

护理研究

预后营养指数对脓毒症合并心力衰竭共病患者谵妄的预测作用及精准护理干预

The predictive role of the prognostic nutritional index for delirium in sepsis patients with heart failure and precise nursing intervention

:767-777
 
      目的 探讨预后营养指数(PNI)对脓毒症合并心力衰竭患者发生谵妄的预测价值,并评估其在指导护理风险分层中的作用。方法 采用回顾性队列研究,纳入2022年2月—2024年9月广东省第二中医院收治的162例脓毒症合并心力衰竭患者。通过ROC曲线确定PNI预测谵妄的最佳截断值,并以此将患者分为高低PNI组。比较两组基线特征,采用Kaplan-Meier曲线分析谵妄累积发生率和28天院内死亡率,通过Cox比例风险模型评估PNI与谵妄及预后的独立关联,并利用ROC曲线评价其预测性能。最后利用亚组分析技术进一步评估PNI预测价值的普适性。结果 低PNI(≤35.72)是谵妄发生的独立危险因素。竞争风险模型显示,低PNI组10 d谵妄累积发生率达37.8%,高于高PNI组的10.0%。多因素分析表明,PNI每降低一个单位,谵妄风险增加约17.2%。限制性立方样条分析提示PNI与谵妄风险呈线性负相关。ROC曲线分析显示PNI预测谵妄的AUC为0.721,其预测效能优于白蛋白和SOFA评分。亚组分析进一步证实PNI的保护效应在不同临床特征患者中具有一致性。结论 PNI是脓毒症合并心力衰竭患者谵妄风险的独立预测指标,其预测效能优于传统单一指标。基于PNI的风险分层有助于早期识别谵妄高危患者,为实现精准护理干预提供重要依据。

      Objective To explore the predictive value of the prognostic nutritional index(PNI)for delirium in patients with sepsis complicated by heart failure,and to evaluate its role in guiding nursing risk stratification.Methods A retrospective cohort study was conducted,including 162 patients with sepsis and heart failure admitted to Guangdong Provincial Second Hospital of Traditional Chinese Medicine between February 2022 and September 2024.The optimal PNI cut-off value for predicting delirium was determined using ROC curve analysis,and patients were divided into high and low PNI groups accordingly.Baseline characteristics of the two groups were compared.Kaplan-Meier curves were used to analyze the cumulative incidence of delirium and 28-day in-hospital mortality.Cox proportional hazards models were employed to assess the independent association between PNI and delirium as well as prognosis,and ROC curves were used to evaluate its predictive performance.Subgroup analysis was further utilized to assess the generalizability of PNI’s predictive value.Results A low PNI(≤35.72)is an independent risk factor for delirium.The competing risk model showed that the cumulative incidence of delirium in the low PNI group was 37.8% at 10 days,significantly higher than the 10.0% in the high PNI group.Multivariate analysis indicated that for each unit decrease in PNI,the risk of delirium increased by 17.2% approximately.Restricted cubic spline analysis suggested a linear negative correlation between PNI and delirium risk.ROC curve analysis demonstrated that the AUC of PNI for predicting delirium was 0.721,with its predictive performance surpassing that of albumin and SOFA score.Subgroup analysis further confirmed that the protective effect of PNI was consistent across patients with different clinical characteristics.Conclusions PNI is an independent predictor of delirium risk in patients with sepsis and heart failure,with superior predictive performance compared to traditional single indicators.Risk stratification based on PNI aids in the early identification of patients at high risk for delirium,providing an important basis for precise nursing interventions.

专题:体重管理

老年人肌少症性肥胖的诊断标准共识与综合干预进展

Consensus on diagnostic criteria and advances in comprehensive interventions for sarcopenic obesity in the elderly

:701-709
 
       目的 探讨肌少症性肥胖(SO)诊断标准的演进及其在中国老年人群中的本土化综合干预路径。方法 评述ESPEN/EASO最新共识,结合我国老年人代谢特征,系统分析“筛查-诊断-分期”流程及运动营养协同干预的临床效能。结果 SO诊断核心在于识别“隐性肥胖”,建议在AWGS2019标准基础上,叠加中国特异性腰围切点(男≥90 cm,女≥85 cm)或体脂率指标,并应用ALM/BMI校正肌肉质量。研究证实,以渐进式抗阻训练联合高蛋白营养(1.2~1.5 g·kg-1·d-1)为核心的协同模式,通过激活mTOR通路可显著逆转肌肉流失并改善胰岛素抵抗。融入八段锦等传统功法及乳清蛋白补充,能有效重塑中国患者“高碳水、低蛋白”的膳食习惯,提升依从性。结论 构建护士主导、社区依托的多学科管理模式,并借助远程健康工具实现闭环监测,是提升我国SO精准诊疗水平的关键路径。
      Objective To explore the evolution of diagnostic criteria for sarcopenic obesity(SO)and its localized comprehensive intervention pathways tailored to the metabolic characteristics of the Chinese elderly population.Methods The latest ESPEN/EASO consensus was reviewed.Combined with the metabolic profile of Chinese older adults,the “screening-diagnosis-staging” workflow and the clinical efficacy of synergistic exercise and nutrition interventions were systematically analyzed.Results The core of SO diagnosis lies in identifying “hidden obesity.”It is recommended to incorporate Chinese-specific waist circumference cut-offs(male≥90 cm,female≥85 cm)or body fat percentage into the AWGS2019 framework,utilizing ALM/BMI for muscle mass calibration.Evidence suggests that a synergistic model,centered on progressive resistance training(PRT)and high-protein nutrition(1.2~1.5 g·kg-1·d-1),can significantly reverse muscle loss and improve insulin resistance by activating the mTOR pathway.Integrating traditional Chinese exercises(e. g. ,Baduanjin)and whey protein supplementation effectively reshapes the “high-carbohydrate,low-protein” dietary habits of Chinese patients,thereby enhancing intervention adherence.Conclusions Establishing a nurse-led,community-based multidisciplinary management model,integrated with digital health tools for closed-loop monitoring,is a pivotal strategy for enhancing the precision of SO diagnosis and treatment in China.
论著

个性化营养干预联合分级步行运动方案对肺癌化疗患者癌因性疲乏及生活质量的影响

Effects of personalized nutritional intervention combined with graded walking exercise treatment on cancer-related fatigue and quality of life in lung cancer patients during chemotherapy

:367-372
 
       目的  分析对肺癌化学治疗(化疗)患者采取个性化营养干预联合分级步行运动方案的应用价值。   将郑州大学附属郑州中心医院2023年7月—2024年7月符合标准的198例肺癌化疗患者作为研究对象,通过随机数字表法分为观察组和对照组各99例。对照组仅采用个性化营养干预方案,观察组则联合分级步行运动方案,两组患者均在同一时间内入组并接受持续干预3个月。对两组干预前后癌因性疲乏[Piper疲乏修订量表(PFS-R)]、营养状况、睡眠质量[匹茨堡睡眠质量指数(PSQI)]、生活质量[生活质量评估量表(SF-36)]水平予以比较。结果  相较于对照组,干预后观察组PFS-R、PSQI评分较低,白蛋白、前白蛋白、血红蛋白、铁转蛋白水平和SF-36评分较高(P<0.05)。结论  对肺癌化疗患者采取个性化营养干预联合分级步行运动方案,有利于促进其癌因性疲乏的减轻和营养状态、睡眠质量及生活质量水平的提高。
       Objective  To analyze the effects of personalized nutritional intervention combined with graded walking exercise treatment on cancer-related fatigue and quality of life in lung cancer patients during chemotherapy.Methods  A total of 198 lung cancer patients undergoing chemotherapy who met the criteria in our hospital from July 2023 to July 2024 were selected as the research subjects.They were divided into an observation group and a control group,with 99 cases in each group,by the random number table method.The control group only received individualized nutritional intervention,while the observation group received graded walking exercise additionally.Both groups of patients were enrolled at the same time and received continuous intervention for three months.Cancer-related fatigue(Piper’s Fatigue Scale-Revised[PFS-R]),nutritional status,sleep quality(Pittsburgh Sleep Quality Index[PSQI]),and quality of life(Quality of Life Scale[SF-36]) before and after the intervention were compared between the two groups.Results  Compared with the control group,the observation group had lower PFS-R and PSQI scores and higher albumin,prealbumin,hemoglobin,transferrin levels and SF-36 scores after the intervention(P<0.05).Conclusions  Adopting personalized nutritional intervention combined with graded walking exercise for lung cancer patients during chemotherapy is beneficial to promote the reduction of cancer-caused fatigue and the improvement of their nutritional status,sleep quality and quality of life.
综述

脑卒中后认知障碍患者早期干预模式的研究现状与进展

Research status and progress of early intervention methods for patients with cognitive impairment after stroke

:286-292
 
       脑卒中后认知障碍(PSCI)是脑卒中患者常见的并发症,严重影响患者的生活质量和社会功能。近年来,随着认知储备理论的发展和早期干预理念的普及,PSCI的早期干预模式逐渐成为研究热点。文章综述了PSCI早期干预模式的研究现状与进展,包括干预的理论基础、具体措施及未来发展方向,以期为临床实践和科研提供参考。
       Post-stroke cognitive impairment(PSCI)is a common complication among stroke patients.It seriously affects the patients’ quality of life and social functions.In recent years,with the development of the cognitive  reserve theory and the popularization of the concept of early intervention,the early intervention model for PSCI has gradually become a research hotspot.This article reviews the current research status and progress of the early intervention model for PSCI,including the theoretical basis of the intervention,specific measures,and future development directions,aiming to provide  references for clinical practice and scientific research.
论著

多组分运动干预联合多学科指导下营养干预应用于老年慢性心力衰竭并发衰弱患者的效果

The effect of multi-component exercise intervention combined with nutritional intervention under multidisciplinary guidance in elderly patients with chronic heart failure and frailty

:202-208
 
       目的 探讨多组分运动干预联合多学科指导下营养干预应用于老年慢性心力衰竭(CHF)并发衰弱患者的效果。方法 选择郑州市第七人民医院收治的CHF并衰弱患者102例, 纳入时间为2023年11月—2024年10月, 按照随机数表法分为对照组51例给予常规运动干预+多学科指导下营养干预,观察组51例给予多组分运动干预+多学科指导下营养干预,观察两组衰弱状态、心功能指标、营养状况、生活质量、不良事件发生率。结果 与对照组相比,观察组干预后身体、心理、社会及总分明显更低(P<0.05)。与对照组相比,观察组干预后左室射血分数(LVEF)水平明显更高,超敏心肌肌钙蛋白T(hs-cTnT)、N末端B型利钠肽前体(NT-proBNP)、左室舒张末期内径(LVEDD)水平更低(P<0.05)。与对照组相比, 观察组干预后主观整体营养状况评价表(PG-SGA)评分明显更低,血红蛋白(Hb)、前白蛋白(PA)、白蛋白(ALB)水平更高(P<0.05)。与对照组相比,观察组干预后症状、身体、情感及总分更低(P<0.05)。观察组不良事件发生率(1.96%)低于对照组(15.69%)(P<0.05)。结论 对CHF并发衰弱患者应用多组分运动干预联合多学科指导下营养干预,能够减轻衰弱状态, 改善心功能及营养状况,促进生活质量的提升, 并降低不良事件发生率。
       Objective To explore the effect of multi-component exercise intervention combined with nutritional intervention under multidisciplinary guidance in elderly patients with chronic heart failure(CHF)and frailty.Methods From November 2023 to October 2024, 102 CHF patients with frailty admitted to Zhengzhou Seventh People's Hospital were selected and included. According to the computer grouping method, they were divided into a control group with 51 patients, received routine exercise intervention and multidisciplinary nutrition intervention,and an observation group with 51 patients, received multi-component exercise intervention and multidisciplinary nutrition intervention.The frailty status, cardiac function indicators, nutritional status, quality of life and incidence of adverse events were observed in both groups.Results Compared with the control group,the observation group showed significantly lower physical, psychological, social, and total scores after intervention(P<0.05).Compared with the control group, the observation group showed significantly higher levels of left ventricular ejection fraction and lower levels of high-sensitivity cardiac troponin N-terminal pro-B-type natriuretic peptide, and left ventricular end-diastolic dimension after intervention(P<0.05).Compared with the control group,the observation group had significantly lower Patient-Generated Subjective Global Assessment scores and higher levels of hemoglobin, prealbumin, and albumin after intervention(P<0.05).Compared with the control group, the observation group had significantly lower symptoms, physical, emotional, and total scores after intervention(P<0.05).The incidence of adverse events in the observation group(1.96%)was lower than that in the control group(15.69%)(P<0.05).Conclusions Multi-component exercise intervention combined with multidisciplinary nutritional intervention in patients with CHF and frailty can alleviate frailty, improve cardiac function and nutritional status,quality of life, and reduce the incidence of adverse events.
论著

桂枝加芍药汤个体化干预治疗儿童功能性腹痛的临床效果观察

Clinical effect observation of individualized intervention of Guizhi plus Shaoyao Decoction in the treatment of functional abdominal pain disorders in children

:95-99
 
        目的   观察桂枝加芍药汤个体化干预治疗儿童功能性腹痛的临床疗效。方法   选取2023年100名在广东省妇幼保健院门急诊就诊确诊为儿童功能性腹痛患儿。100名儿童随机分为两组,益生菌组50名、益生菌+中药个体化干预组50名。连续治疗1周。记录两组患儿卧立位心率、卧立位血压、Rutter 儿童行为量表和中医临床症状的改善情况。结果   益生菌+中药个体化干预组患儿治疗后卧立位心率和Rutter儿童行为量表中N行为评分比益生菌组下降,中医临床症状评分的有效率优于益生菌组。结论   桂枝加芍药汤个性化干预治疗儿童功能性腹痛疗效显著。
    Objective  To observe the clinical efficacy of individualized intervention with Guizhi plus Shaoyao Decoction in children with functional abdominal pain disorders(FAPDs).Methods  A total  of  100  children  diagnosed with  FAPDs at the outpatient and emergency departments of Guangdong Women and Children Hospital were selected.These children were randomly divided into two groups:the probiotics group(50 cases)and the probiotics+traditional Chinese medicine individualized intervention group(50 cases).Both groups received continuous treatment for 1 week.Parameters including  supine/upright heart rates,supine/upright blood pressure,Rutter Children’s Behavior Questionnaire,and improvements in traditional Chinese clinical symptom scores were recorded.Results  The probiotics+traditional Chinese medicine individualized intervention group exhibited significantly greater reductions in supine/upright heart rates and N-behavior scores compared to the probiotics group.The effective rate of Chinese clinical symptom scores was also significantly higher in the individualized intervention group.Conclusions  Individualized intervention of Guizhi plus Shaoyao Decoction has a remarkable efficacy in treating FAPDs in children.
论著

经皮冠状动脉介入治疗后恐动症患者不良心理健康状态的影响因素分析

Analysis of the influencing factors of adverse psychological health status in patients with kinesiophobia after percutaneous coronary intervention

:1712-1723
 
       目的   识别经皮冠状动脉介入治疗(PCI)后恐动症患者抑郁、焦虑和压力的影响因素。方法   采用横断面研究,纳入780例行PCI术后恐动症患者。应用系列量表评估恐动症患者的不良心理健康状况、生活质量、自我感受负担、社会支持和运动自我效能,并通过问卷收集了患者的社会人口学数据。线性回归和Logistic回归用于识别抑郁、焦虑和压力等不良心理状态的影响因素,应用中介分析探索潜在的中介机制。结果  271例(34.7%)、304例(39.0%)和153例(19.6%)恐动症患者存在不同程度的抑郁、焦虑和压力。恐动症患者的抑郁、焦虑和压力水平呈正相关。线性回归和Logistic分析结果表明,较高的家庭月收入与较高的抑郁水平相关(线性回归:β为0.908和1.937;Logistic:OR2.05和5.47),社会支持程度与抑郁水平呈负相关(线性回归:β=-0.079;Logistic:OR=0.93)。单身/离异/寡居患者的焦虑水平显著高于已婚患者(线性回归:β=1.613;Logistic:OR=2.28)。与家庭月收入低于5 000元者相比,家庭月收入为5 000~10 000元之间的患者的压力水平较高(线性回归:β=1.065;Logistic:OR=3.14)。此外,自我感受负担较重的患者具有更高的压力水平(线性回归:β=0.077;Logistic:OR=1.05)。中介分析结果表明,焦虑和压力是社会支持/自我感受负担与抑郁之间关联的潜在中介因子。结论  PCI术后恐动症患者广泛存在心理健康问题,其家庭月收入、年龄、婚姻状况、生活方式和病史等因素对患者的不良心理健康状态具有显著影响。医务人员应关注这些患者的心理健康状况及影响因素,制定综合管理策略以改善其预后。
       Objective  To identify the risk factors associated with depression,anxiety  and  stress in  patients with kinesiophobia after percutaneous coronary intervention(PCI).Methods  In this cross-sectional study,780 patients who developed kinesiophobia after undergoing PCI were enrolled.A series of scales were used to assess the psychological health status,quality of life,self-perceived burden,social support,and exercise self-efficacy of patients with kinesiophobia,and socio-demographic data of the patients were collected through a questionnaire.Linear regression analyses and Logistic regression analyses were used to identify risk factors of adverse psychological outcomes,including depression,anxiety,and stress.Furthermore,mediation analysis was employed to explore the potential mediating mechanisms.Results  Among the 780 patients with kinesiophobia,271(34.7%),304(39.0%)and 153(19.6%)were found to have varying degrees of depression,anxiety,and stress,respectively.The levels of depression,anxiety and stress in patients with kinesiophobia were positively correlated with each other.The results of both linear regression and Logistic regression analyses indicated that higher levels of family monthly income were associated with higher levels of depression(linear:β=0.908 and 1.937;Logistic:OR=2.05 and 5.47),while the degree of social support was negatively correlated with depression levels(linear:β=-0.079;Logistic:OR=0.93).For patients who were single,divorced or widowed,their levels of anxiety were significantly higher than those of married patients(linear:β=1.613;Logistic:OR=2.28).Compared to patients with a monthly household income of less than 5 000 yuan,those with a monthly income between 5 000 and 10 000 yuan reported higher levels of stress(linear:β=1.065;Logistic:OR=3.14).Additionally,patients who perceived a higher personal burden also experienced greater stress(linear:β=0.077;Logistic:OR=1.05).Mediation analysis indicated that anxiety and stress were potential mediating factors in the relationship between social support/self-perceived burden and depression.Conclusions  This study  reported the widespread psychological health issues among patients with kinesiophobia after PCI and the interactions between these issues.Factors such as monthly household income,age,marital status,lifestyle and medical  history were found to  be significantly associated with these negative psychological outcomes.Clinicians and nurses should focus on the psychological health and influencing factors of these patients and develop comprehensive management strategies to improve their prognosis.
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