冠心病患者经皮冠状动脉介入术后恐动症的影响因素和预测

Factors influencing and predicting agoraphobia after percutaneous coronary intervention in patients with coronary artery disease

目的 探讨冠心病经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后患者发生恐动症的危险因素,并构建相关预测模型,为临床早期识别和干预PCI术后恐动症提供依据。方法 收集141例冠心病PCI术后患者的临床资料,根据是否发生恐动症将其分为恐动症组(47例)和非恐动症组(94例),比较2组患者资料;采用多因素Logistic回归,分析冠心病PCI术后患者发生恐动症的危险因素,并构建相关预测模型,用受试者工作特征曲线(ROC)分析预测模型对冠心病PCI术后患者发生恐动症的预测价值。结果 恐动症组与非恐动症组的心力衰竭、家庭功能、自我感受负担情况,及疼痛程度、疲劳程度、社会支持程度比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,心力衰竭(OR=4.104)、家庭功能严重障碍(OR=8.542)、重度自我感受负担(OR=4.043)、重度/极重度疼痛(OR=6.600)、重度/极重度疲劳(OR=4.702)、社会支持程度低(OR=3.963),是冠心病PCI术后患者发生恐动症的独立危险因素(均P<0.05)。ROC曲线分析结果显示,构建的预测模型对冠心病患者PCI术后发生恐动症的预测价值较好:当logit(P)>11.23时,曲线下面积(AUC)值为0.926,敏感度为87.23%,特异度为89.36%。结论 冠心病PCI术后患者发生恐动症与心力衰竭、家庭功能、自我感受负担、疼痛程度、疲劳程度、社会支持程度有关,临床可据此给予针对性的干预措施,以预防冠心病患者PCI术后发生恐动症。

Objective To investigate the risk factors for the occurrence of agoraphobia in patients after Percutaneous coronary intervention(PCI)for coronary artery disease,and to construct a relevant prediction model to provide a basis for early clinical identification and intervention of agoraphobia after PCI.Methods This paper was a cross-sectional survey,the clinical data of 141 post-coronary PCI patients were collected,and they were divided into the agoraphobia group(47 cases)and the non-agoraphobia group(94 cases)according to whether or not agoraphobia occurred,and the data of the 2 groups of patients were compared.Multivariate Logistic regression analysis was utilized to identify the risk factors associated with the development of agoraphobia post-PCI.A predictive model was developed,and the predictive value of this model for agoraphobia in post-PCI patients was assessed using the receiver operating characteristic(ROC)curve analysis.Results Comparison of heart failure,family functioning,and self-perceived burden,as well as pain level,fatigue level,and social support level between the agoraphobia group and the non-agoraphobia group showed statistically significant differences(P<0.05).Logistic regression analysis showed that heart failure(OR=4.104),severe family dysfunction(OR=8.542),severe self-perceived burden(OR=4.043),severe/very severe pain(OR=6.600),severe/very severe fatigue(OR=4.702),and low social support(OR=3.963),were independent risk factors for the occurrence of agoraphobia in patients with coronary artery disease after PCI(all P<0.05).The ROC curve analysis indicated that the predictive model had a good predictive value for agoraphobia in post-PCI patients:when logit(P)>11.23,the Area Under the Curve(AUC)value was 0.926,the sensitivity was 87.23%,and the specificity was 89.36%.Conclusions The occurrence of agoraphobia in patients after PCI for coronary artery disease were related to heart failure,family dysfunction,self-perceived burden,pain level,fatigue level,and social support level.Clinically,targeted intervention measures can be developed based on these factors to prevent the onset of agoraphobia in patients with coronary artery disease after PCI.