不同治疗方式对急性心肌梗死患者疾病认知及二级预防结局的影响

The influence of treatment modality on illness perception and secondary prevention outcomes among patients with acute myocardial infarction

目的确定接受不同治疗方式的急性心肌梗死患者的疾病认知及二级预防结局的差异。方法采用重复测量设计,对接受3种不同治疗方式的心肌梗死患者进行比较。3种治疗方式包括:对ST段抬高心肌梗死患者进行经皮冠状动脉介入治疗;对ST段抬高心肌梗死患者进行溶栓治疗;对非ST段抬高心肌梗死患者进行药物治疗。采用便利抽样法在安曼国际心脏研究所选取206例急性心肌梗死患者,他们均同意参加此次研究。在患者入院及出院6个月时收集其疾病认知、体力活动、人口统计学及临床资料。结果共有186例患者完成了此项研究。经皮冠状动脉介入治疗组与溶栓治疗组、非ST段抬高心肌梗死药物治疗组患者比较,具有较高的疾病敏感性(P=0.034),较低的自我管理(P=0.032),较高的治疗管理(P=0.025),较高的对疾病认知的一致性(P=0.022)。同时,经皮冠状动脉介入治疗组对血压控制较差(P=0.013),体力活动较少(P=0.001)。结论与溶栓治疗组及非ST段抬高心肌梗死药物治疗组患者比较,经皮冠状动脉介入治疗组患者出院6个月后具有消极的疾病认知及有限的行为改变。应进行更深入的研究了解延长随访时间和不同文化背景下治疗方式与心肌梗死患者疾病认知和二级预防的关系。

Objectives:This study aims to determine if patients with acute myocardial infarction differ in illness perception and secondary prevention outcomes depending on the treatment they received.Methods:A repeated measures design was used to compare patients with acute myocardial infarction receiving three different treatment modalities:ST-elevation myocardial infarction treated by primary percutaneous coronary intervention,ST-elevation myocardial infarction treated by thrombolytic therapy,and non ST-elevation myocardial infarction treated by medication.A convenient sampling technique was used to recruit 206 patients with acute myocardial infarction who agreed to participate in the current study.Patients'illness perception,physical activity,and demographical and clinical data were collected during hospital admission and again at 6 months.Results:A total of 186 patients completed the study.Results showed that the primary percutaneous coronary intervention group perceived their illness as acute rather than chronic(P=0.034)and has lower personal control(P=0.032),higher treatment control(P=0.025),and higher perception of illness coherence(P=0.022)compared with patients receiving thrombolytic therapy and treated after non-ST segment infarction.Moreover,they report low control of their blood pressure(P=0.013)and less physical activity(P=0.001).Conclusion:The results of this study revealed that patients'treated with primary percutaneous coronary intervention had negative illness perception and limited behavioral changes 6 months after hospitalization in comparison with other treatment modalities such as percutaneous coronary intervention and thrombolytic treatment.Further research is recommended to confirm this association with longer follow-up study and among different cultures.