多水平模型在射频消融术后心房颤动病人心理弹性纵向研究中的应用

Application of multilevel model in resilience of patients with atrial fibrillation after radiofrequency ablation:a longitudinal study

目的:探讨心房颤动病人射频消融术后6个月内心理弹性的变化趋势以及影响该趋势的因素。方法:采用一般资料调查表、心理弹性量表、领悟社会支持量表和正负情绪量表对2018年11月—2019年3月在天津市某三级甲等医院心内科住院的射频消融术后的140例心房颤动病人进行调查,术后1个月、3个月、6个月时对其进行随访调查,运用多水平模型对纵向数据进行分析。结果:控制个体水平变量后,男性、本科及以上、家庭人均月收入3 001~4 999元和≥5 000元比参照组病人射频消融术后住院期间的心理弹性水平高(P<0.05),丧偶、持续性心房颤动比参照组病人射频消融术后住院期间的心理弹性水平低(P<0.05)。病人心理弹性的平均增长速率为2.324分(P<0.01),文化程度为专科和本科及以上的病人与小学及以下的病人心理弹性增长速率的差值分别为0.903分(P<0.05)和1.632分(P<0.001),丧偶比配偶健在的病人心理弹性增长速率低1.081分(P<0.01)。领悟社会支持对心理弹性的平均效应为0.150(P<0.05),正性情绪和负性情绪对心理弹性的平均效应分别为0.046(P<0.01)和-0.037(P<0.05),正负情绪对心理弹性的影响随着时间变化而变化(β=0.047,P<0.05;β=-0.046,P<0.05)。结论:心房颤动病人射频消融术后6个月内心理弹性呈缓慢上升趋势,文化程度和婚姻状况影响病人心理弹性的增长速率,领悟社会支持和正负情绪均影响病人的心理弹性,但是正负情绪对心理弹性的影响随时间推移而变化。

Objective:To explore the change trend of resilience in patients with atrial fibrillation after radiofrequency ablation for six months and the factors influencing the trend.Methods:A total of 140 patients with atrial fibrillation after radiofrequency ablation were investigated by general information questionnaire,The Connor-Davidson Resilience Scale,The Perceived Social Support Scale and The Positive and Negative Affect Scale from November 2018 to March 2019 in the department of cardiology of a tertiary grade A hospital in Tianjin.The patients were followed up 1,3 and 6 months after radiofrequency ablation.Multilevel model was used to analyze the longitudinal data.Results:After controlling the individual level variables,during hospitalization after radiofrequency ablation,the level of resilience in male,bachelor or above,monthly income per capita of family(3 001-4 999 RMB and ≥5 000 RMB) was higher than that of the reference group(P<0.05),and the level of resilience in the widowed and persistent AF patients was lower than that in the reference group(P<0.05).The average growth rate of resilience was 2.324(P<0.01),and the difference of resilience growth rate between the patients with "junior college" and "undergraduate degree" and those with "elementary school or below" was 0.903 points(P<0.05) and1.632(P<0.001),respectively.The growth rate of resilience in widowed patients was 1.081,lower than those of surviving spouses(P<0.01).The average effect of perceived social support on resilience was 0.150(P<0.05),and the average effect of positive and negative emotions on resilience was 0.046(P<0.01) and-0.037(P<0.05),respectively.The influence of positive and negative emotions on resilience changed with time(β=0.047,P<0.05;β=-0.046,P<0.05).Conclusions:Resilience of patients with atrial fibrillation increased slowly six months after radiofrequency ablation.Educational level and marital status affected the growth rate of patients’ resilience.Perceived social support and positive and negative emotions affected patients’ resilience.However,the influence of positive and negative emotions on resilience changed over time.