老年急性心肌梗死患者经皮冠状动脉介入术后心脏康复认知水平及其影响因素分析

Analysis of cognitive level of cardiac rehabilitation and its influencing factors in elderly patients with acute myocardial infarction after percutaneous coronary intervention

目的调查老年急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)术后心脏康复认知情况,并分析心脏康复认知水平的影响因素。方法回顾性分析2019年5月—2023年5月于张家口市第二医院收治的PCI术后的120例老年AMI患者的临床资料。采用调查问卷与量表对心脏康复认知水平进行评估,根据评估结果将120例受试者分为低认知水平组与高认知水平组,并对2组心脏康复认知水平影响因素进行单因素及多元线性回归分析。结果120例受试对象中,自主性评分≥16分有51例(42.50%),评分<16分有69例(57.50%),过程焦虑评分≥19分有55例(45.83%),过程焦虑评分<19分有65例(54.17%),结果焦虑维度≥10分有63例(52.50%),结果焦虑维度<10分有57例(47.50%);按照CDI量表的结果作为行PCI术的AMI患者CR认知水平的评估依据,将同时满足自主性评分≥16分、过程焦虑评分<19分、结果焦虑评分<10分的42例(35.00%)患者纳入高认知水平组,其余78例(65.00%)纳入低认知水平组。低认知水平组与高认知水平组性别、婚姻状况、医疗费用支付方式、家庭人均月收入、心血管病病程、植入支架数以及合并高血压差异均无统计学意义(P>0.05)。低认知水平组与高认知水平组年龄、文化程度、心脏康复意愿、PCI手术经历、是否接受过相关知识宣教差异均有统计学意义(P<0.05)。年龄75~85岁、文化程度小学以下、首次接受PCI手术是影响心脏康复认知水平的独立危险因素(P<0.05),心脏康复意愿较高、植入支架数大于2枚、接受过相关知识宣教为影响心脏康复认知水平的保护因素(P<0.05)。结论行PCI的老年AMI患者对心脏康复认知现状处于中低水平,医护人员应对康复意愿、文化水平、自我管理能力较低,以及无相关手术经历的患者加强针对性的健康宣教,以提高患者对心脏康复的认知水平,进而提高康复效果。

Objective To investigate the cognitive level of cardiac rehabilitation in elderly patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),and analyze its related influencing factors.Methods The clinical data of 120 elderly patients with AMI after PCI admitted to Second Hospital of Zhangjiakou City from May 2019 to May 2023 were retrospectively analyzed.The cognitive level of cardiac rehabilitation was assessed by questionnaire and scale.According to the assessment results,120 subjects were divided into low cognitive level group and high cognitive level group.The factors influencing the cognitive level of cardiac rehabilitation were analyzed by univariate and multiple linear regressions.Results Among 120 study subjects,there were 51 ones(42.50%)with autonomy score≥16 points and 69 ones(57.50%)with score<16 points;there were 55 ones(45.83%)with process anxiety score≥19 points and 65 ones(54.17%)with process anxiety score<19 points;there were 63 ones(52.50%)with outcome anxiety dimension score≥10 points and 57 ones(47.50%)with outcome anxiety dimension score<10 points.The result of CDI scale was taken as assessment basis of CR cognitive level of AMI patients after PCI.According to the results of the CDI scale,42 patients(35.00%)who simultaneously met the criteria of autonomy score≥16 points,process anxiety score<19 points,and outcome anxiety score<10 points were included in the high cognitive level group,while the remaining 78 ones(65.00%)were included in the low cognitive level group.There were no significant differences between the two groups in gender,marital status,payment method of medical expenses,family per capita monthly income,course of cardiovascular disease,number of stents implanted and combined hypertension(P>0.05).There were statistically significant differences between the two groups in age,educational level,cardiac rehabilitation intention,PCI experience,and whether they had received relevant knowledge education(P<0.05).Age of 75-85 years old,education level below primary school and first time undergoing PCI were independent risk factors for the cognitive level of cardiac rehabilitation(P<0.05),and high intention of cardiac rehabilitation,implanted stent count>2 and receiving related knowledge education were the protective factors for the cognitive level of cardiac rehabilitation(P<0.05).Conclusion The cognitive level of cardiac rehabilitation in elderly AMI patients undergoing PCI is at a low-to-middle level.Medical staff should strengthen targeted health education for patients with low rehabilitation intention,education level and self-management ability and absence of related surgical experience,so as to improve their cognitive level of cardiac rehabilitation and ultimately improve rehabilitation effect.