阶段变化理论干预对急性心肌梗死患者术后生活质量的影响

Influence of Intervention Based on Transtheoretical Model and Stages of Change on Postoperative Quality of Life in Older Patients with Acute Myocardial Infarction

目的探讨基于阶段变化理论的运动行为干预对老年急性心肌梗死患者经皮冠状动脉介入治疗(PCI)后生活质量的影响。方法选取2019年5月~2020年5月广西柳州市人民医院心血管内科住院的急性心肌梗死实施PCI术的老年患者100例,按随机数表法分为对照组(50例)和观察组(50例)。对照组采用常规护理,观察组在常规护理的基础上实施阶段变化理论干预,观察组由心血管内科医护团队根据阶段变化理论为不同行为阶段患者制定运动治疗计划,干预期均为1年,评估两组患者自我管理能力、生活质量、焦虑、抑郁和再入院情况。结果干预1年后,观察组的冠心病自我管理量表总分及不良嗜好管理、症状管理、急救管理、疾病知识管理、治疗依从性管理维度的评分均高于对照组,生活质量评价中生理功能、生理职能、一般健康状况、精力、情感职能、精神健康评分均高于对照组,差异均有统计学意义(P<0.05);两组干预前后的焦虑、抑郁评分比较,差异均无统计学意义(P>0.05);观察组主要心血管不良事件再入院率低于对照组(P<0.05)。结论基于阶段变化理论干预急性心肌梗死PCI术后老年患者的运动行为效果好,提升患者的自我管理能力,提升患者生活质量,降低心血管不良事件发生,不增加患者病后的负性情绪。

Objective To investigate the effect of exercise behavior intervention based on transtheoretical model and stages of change(TTM)on the quality of life of older patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods One hundred of AMI patients undergoing PCI in Liuzhou People’s Hospital of Guangxi from May 2019 to May 2020 were enrolled in this study.The patients were divided into a control group(50 cases)and an observation group(50 cases)according to the random number table.The control group received routine nursing,the observation group received routine nursing and intervention based on TTM for 1 year.The self-management ability,quality of life,anxiety and depression,and readmission were evaluated in the two groups.Results After 1 year of intervention,the total score of Coronary Heart Disease Self-management Scale,the scores of bad habit management,symptom management,emergency management,disease knowledge management,and treatment compliance management were higher in the observation group than in the control group.In the assessment of quality of life,the scores of physical functioning,role-physical,general health,vitality,role-emotional and mental health were higher in the observation group than in the control group.The differences were statistically significant between the two groups(P<0.05).There were no significant differences in anxiety and depression scores between the two groups before and after the intervention(P>0.05).The rate of readmission due to major adverse cardiovascular events was lower in the observation group than in the control group(P<0.05).Conclusion The exercise behavior intervention based on TTM may enhance the self-management ability,improve the quality of life,reduce MACE,and does not increase the negative emotions in older patients with AMI after PCI.