基于健康行动过程取向理论的心脏运动康复在老年冠心病PCI后患者中的应用效果

Application Effect of Cardiac Exercise Rehabilitation Based on Health Action Process Approach Theory in Elderly Patients with Coronary Artery Disease after PCI

目的探讨基于健康行动过程取向(HAPA)理论的心脏运动康复在老年冠心病经皮冠状动脉介入治疗(PCI)后患者中的应用效果。方法选取2023年8月—2024年1月中国医学科学院北京协和医院收治的90例老年冠心病PCI后患者作为研究对象,采用随机数字表法将患者分为对照组和试验组,各45例。根据剔除标准,对照组最终纳入42例,试验组最终纳入40例。对照组患者接受常规心脏运动康复,试验组患者接受基于HAPA理论的心脏运动康复,两组均持续干预3个月。比较两组患者干预前及出院后1、3个月心脏病患者运动恐惧量表(TSK-Heart)、多维度运动自我效能量表(MSES)各维度评分及其总分,焦虑自评量表(SAS)评分。结果干预方法与时间在功能紊乱、运动恐惧维度评分及TSK-Heart总分上存在交互作用(P<0.05);干预方法与时间在危险感知、运动回避维度评分上不存在交互作用(P>0.05)。干预方法在功能紊乱、运动恐惧、危险感知、运动回避维度评分及TSK-Heart总分上主效应不显著(P>0.05);时间在功能紊乱、运动恐惧、危险感知、运动回避维度评分及TSK-Heart总分上主效应显著(P<0.05)。试验组出院后1、3个月功能紊乱维度评分、TSK-Heart总分及出院后3个月运动恐惧维度评分低于对照组(P<0.05)。干预方法与时间在任务效能维度评分及MSES总分上存在交互作用(P<0.05);干预方法与时间在应对效能、时间安排效能维度评分上不存在交互作用(P>0.05)。干预方法在应对效能、时间安排效能、任务效能评分及MSES总分上主效应不显著(P>0.05);时间在应对效能、时间安排效能、任务效能评分及MSES总分上主效应显著(P<0.05)。试验组出院后3个月任务效能维度评分、MSES总分高于对照组(P<0.05)。干预方法与时间在SAS评分上不存在交互作用(P>0.05);干预方法在SAS评分上主效应不显著(P>0.05);时间在SAS评分上主效应显著(P<0.05)。结论基于HAPA理论的心脏运动康复可有效降低老年冠心病PCI后患者的运动恐惧水平,提高其运动自我效能感。

Objective To investigate the application effect of cardiac exercise rehabilitation based on health action process approach(HAPA)theory in elderly patients with coronary artery disease after percutaneous coronary intervention(PCI).Methods A total of 90 elderly patients with coronary artery disease after PCI admitted to the Peking Union Medical College Hospital,Chinese Academy of Medical Sciences from August 2023 to January 2024 were selected as the study subjects.Patients were divided into the control group and the experimental group by random number table method,with 45 cases in each group.According to the exclusion criteria,42 cases were finally included in the control group,and 40 cases were finally included in the experimental group.The control group were received routine cardiac exercise rehabilitation,while the experimental group were given cardiac exercise rehabilitation based on HAPA theory,both groups were intervented for 3 months.The different dimensions scores and total score of Tampa Scale for Kinesiophobia Heart(TSK-Heart)and Multidimensional Self-Efficacy for Exercise Scale(MSES),and Self-Rating Anxiety Scale(SAS)score before intervention and at 1,3 months after discharge were compared between the two groups.Results There was an interaction between intervention method and time on scores of dysfunction and kinesiophobia dimension and TSK-Heart total score(P<0.05);there was no interaction between intervention method and time on scores of danger perception and motor avoidance dimension(P>0.05).There was no main effect of intervention method on scores of dysfunction,kinesiophobia,danger perception and motor avoidance dimension,and TSK-Heart total score(P>0.05);there was main effect of time on scores of dysfunction,kinesiophobia,danger perception and motor avoidance dimension,and TSK-Heart total score(P<0.05).Compared with those in the control group,the experimental group had lower dysfunction dimension score and TSK-Heart total score at 1,3 months after discharge,and lower kinesiophobia dimension score at 3 months after discharge(P<0.05).There was an interaction between intervention method and time on task efficacy dimension score and MSES total score(P<0.05);there was no interaction between intervention method and time on scores of coping efficacy and scheduling efficacy dimension(P>0.05).There was no main effect of intervention method on scores of coping efficacy,scheduling efficacy and task efficacy dimension,and MSES total score(P>0.05);there was main effect of time on scores of coping efficacy,scheduling efficacy and task efficacy dimension,and total MSES score(P<0.05).Compared with those in the control group,the experimental group had higher task efficacy dimension score and MSES total score at 3 months after discharge(P<0.05).There was no interaction between intervention method and time on SAS score(P>0.05);there was no main effect of intervention method on SAS score(P>0.05);there was main effect of time on SAS score(P<0.05).Conclusion Cardiac exercise rehabilitation based on HAPA theory can reduce the level of kinesiophobia in elderly patients with coronary artery disease after PCI,and improve their exercise self-efficacy.