疾病感知对急性心肌梗死患者出院后的影响

Effect of illness perception on discharge of patients with acute myocardial infarction

目的通过健康教育提高急性心肌梗死患者对急性心肌梗死的疾病感知,探讨疾病感知对患者出院后的影响。方法选取首次急性心肌梗死患者107例,随机分为对照组53例及试验组54例,试验组根据心内科专业书籍及相关指南制作的幻灯片对其进行教育;对照组根据护士平时的健康教育内容制作幻灯片进行健康教育;于教育前及出院后1,3,6个月使用医院焦虑抑郁量表(Hospital Anxiety Depression Scale,HADS)、世界卫生组织生存质量测定量表简表(the World Health Organization Quality of Life Questionnaire,WHOQOL-BREF)、疾病感知问卷简化版(Brief Illness Perceptions Questionnaire-Revised,BIPQ-R)进行评估,统计出院后患者再梗死、再住院及死亡例数。结果对照组HADS焦虑和抑郁评分呈逐渐升高的趋势,试验组HADS焦虑和抑郁评分呈逐渐降低的趋势,试验组HADS焦虑和抑郁评分低于对照组,2组WHOQOL-BREF生理领域、心理领域、社会关系领域、环境领域评分和BIPQ-R评分均呈逐渐降低的趋势,试验组WHOQOL-BREF生理领域、心理领域、社会关系领域、环境领域评分高于对照组,BIPQ-R评分低于对照组,其组间、时点间、时间·时点间交互作用差异均有统计学意义(P<0.05)。2组出院后1,3,6个月再梗死例数及总数,出院后1,3,6个月再住院例数差异均无统计学意义(P>0.05),试验组再住院总数明显低于对照组(P<0.05)。随访期间未出现死亡例数。结论由心内科专科医师对急性心肌梗死患者进行健康教育可进一步提高患者疾病感知,改善急性心肌梗死患者的焦虑、抑郁、生活质量并减少再入院率,但对患者再梗死率及病死率无明显影响。

Objective To enhance disease perception of acute myocardial infarction in patients with acute myocardial infarction through health education,and to explore the impact of disease perception on patient discharge. Methods The 107 patients with the first acute myocardial infarction were randomly divided into control group（53 cases） and experimental group（54 cases）. Patients in the experimental group were educated according to the slides drawn up by the special books of the cardiology department and related guidelines. However, the control group was educated based on the nurses usual health education contents. The Hospital Anxiety Depression Scale（HADS）, the World Health Organization Quality of Life Questionnaire（WHOQOL-BREF）, and the Brief Illness Perceptions Questionnaire-Revised（BIPQ-R） were used to assess patients before education and in the first, third, and sixth months after discharge. Also, the number of re-infarctions, rehospitalizations, and deaths after discharge were counted.Results The HADS anxiety and depression scores in the control group showed a gradually increasing trend. The HADS anxiety and depression scores in the experimental group showed a tendency to decrease gradually. The HADS anxiety and depression scores in the experimental group were lower than those in the control group. Two groups of WHOQOL-BREF physiology, psychology, social relations, environmental field scores and BIPQ-R scores showed a trend of decreasing gradually. The WHOQOL-BREF of the experimental group scored was higher in the physiological field, psychological field, social relations field, and environmental field than the control group, while the BIPQ-R score was lower than the control group. There was a statistically significant difference between groups, time points, time and time points（ P 〈 0.05）. The number of re-infarction cases at 1, 3 and 6 months after discharge from the two groups and the number of rehospitalization cases at 1, 3 and 6 months after discharge were not statistically significant（ P 〉 0.05）. The total number of rehospitalization in the experimental group was significantly lower than that in the control group（ P 〈 0.05）. No deaths were found during follow-up.Conclusion The health education of patients with acute myocardial infarction by a cardiology specialist can improve the patient′s perception of disease, improve anxiety, depression, quality of life and reduce the readmission rate in patients with acute myocardial infarction, but has no significant effect on reinfarction rate and mortality.