急性心肌梗死患者PCI术前后生活质量及其影响因素的研究
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摘要
目的：
1．评估和比较行经皮冠状动脉介入治疗术(Percutaneous coronary intervention，PCI)及非PCI术急性心肌梗死(acute myocardial infarction，AMI)患者入院时、出院时及出院后生活质量，了解PCI术对AMI患者生活质量的影响。
2．探讨PCI术AMI患者生活质量的影响因素，以指导临床工作。
方法：
本研究为平行对照的临床实验，从2006年1月-2007年3月选择中南大学湘雅一、二、三医院、长沙市中心医院及省人民医院愿意参与调查的AMI患者129人，分PCI术组(n=66)与非PCI术组(n=63)两组，分别在入院时(急诊PCI为术前)、出院时和出院后3-6月内，运用一般资料问卷及心肌梗死多维度量表(Myocardial Infarction Dimensional Assessment Scale，MIDAS)进行问卷调查。所有资料均采用SPSS11.0统计软件处理。统计方法包括描述性的统计分析、t检验、单因素方差分析、多元线性逐步回归分析。
结果：
1．本研究患者分3个时段次发放问卷，调查中PCI组AMI患者共发送问卷207份，有效问卷198份，有效率为95.6％；非PCI组AMI患者共发送问卷204份，有效问卷为189份，有效率为92.6％。
2．组内比较结果：PCI组AMI患者出院时分别与入院时、出院后3-6月时比较生活质量MIDAS评分差异有统计学意义(P＜0.05)；非PCI组AMI患者出院时与入院时比较生活质量MIDAS评分差异有统计学意义(P＜0.05)，出院后3-6月与出院时比较生活质量MIDAS评分差异无统计学意义(P＞0.05)。
3．组间比较结果：入院时PCI组与非PCI组AMI患者生活质量MIDAS评分比较中，在心功能正常与合并心衰的患者中，其差异均无统计学意义(P＞0.05)；出院时两组AMI患者生活质量MIDAS评分的比较中，在入院时心功能正常的患者中差异无统计学意义(P＞0.05)，但在入院时合并心衰的患者中二者生活质量MIDAS评分差异有统计学意义(P＜0.05)；出院3-6月后两组AMI患者生活质量MIDAS评分的比较中，在就诊时间超过6小时且合并心衰的患者中，PCI组与非PCI组生活质量差异有统计学意义(P＜0.05)，而在就诊时间小于或等于6小时，以及就诊时间超过6小时但入院时心功能正常的患者中，PCI组与非PCI组生活质量差异无统计学意义(P＞0.05)。
4．PCI组与非PCI组AMI患者出院前后生活质量MIDAS评分变化幅度的差异有统计学意义(P＜0.05)。
5．多因素分析显示：入院时是否合并心衰、患者的年龄与行PCI术AMI患者入院时生活质量MIDAS评分存在复相关；患者的性别与行PCI术AMI患者出院时生活质量MIDAS评分存在复相关；出院后的遵医嘱行为与行PCI术AMI患者出院后3-6月生活质量MIDAS评分存在复相关。
结论：
1．PCI术与非PCI术均可提高出院时AMI患者生活质量，但PCI术提高生活质量的幅度高于非PCI术。
2．PCI术可以提高AMI患者出院后3-6月的生活质量，而非PCI术则对出院后3-6月的生活质量无明显改善。
3．PCI术较非PCI术可以显著提高入院时合并心衰的AMI患者的生活质量。
4．影响PCI组AMI患者入院时生活质量的主要因素为入院时是否合并心衰及患者的年龄，影响其出院时生活质量的主要因素是性别，而影响其出院后生活质量的主要因素是出院后的遵医嘱行为。
Objective
1. To understand the effect of PCI on quality of life of patients with acute myocardial infartion(AMI) through evaluating the life quality of patients with AMI undergone PCI or not at admission, at discharge and post discharge.
2. To determine the factors that influenced the quality of life of patients with AMI undergone PCI.
Method
A controlled clinic trail was designed. 129 participants with AMI were selected from the first, second, third Xiangya hospital of central south university, central hospital of Changsha and Hunan People's hospital during January 2006 to March 2007. There were 66 patients in PCI group and 63 patients in non-PCI group. Common information and Myocardial infarction dimensional assessment scale (MIDAS ) questionnaire survey were performed in all the participants at admission, at discharge and 3 to 6 months post discharge. All the data were analyzed using SPSS 11.0 software. Descriptive statistical analysis, T test, 1-way ANOVA analysis and multiple linear regression analysis were performed in this study.
Result:
1. The questionnaires wrer sent to participants in three stages. At last 207 questionnaires were sent to the participants of PCI group, among which 198 questionnaires (95.6%) were valid. 204 questionnaires were sent to patients of non-PCI group, among which 189 (92.6%) were valid.
2. Intra-group comparisons: In PCI group, the life quality MIDAS score at discharge was significantly different when compared with that at admission and 3 to 6 months post discharge (P<0.05). In non-PCI group, the life quality MIDAS score at discharge was significantly improved in comparison to that at admission (P<0.05), while there were no significant difference existed between that at discharge and 3 to 6 months post discharge (P>0.05).
3. Inter-group comparisons: the life quality MIDAS score of PCI group at admission was not significantly different from that of non-PCI group at admission (P>0.05); the life quality MIDAS score at discharge were not different between PCI and non-PCI group with regard to patients with normal heart function at admission (P>0.05), while such a difference exist between the two groups with regard to patients with heart failure at admission (P<0.05); After discharge in 3-6 months, there is a significant difference among the patients who were treated more than 6 hours after AMI and complicated with heart failure. (P<0.05). There is no significant difference among the patients treated in 6 hours or more than 6 hours but without complication of heart failure in both groups (P>0.05).
4. Variations of the life quality MIDAS score between prior to and post discharge were significantly different in PCI group compared with that of non-PCI group (P<0.05).
5. Whether complicated with heart failure or not and age were the major factors that influenced the life quality of patients of PCI group at admission. Sex was major factor that influenced the life quality at discharge, while compliance was the major factor that influenced the life quality of PCI group 3 to 6 months post discharge.
Conclusion:
1. Both PCI and non-PCI therapy can improve the life quality of patients with AMI at discharge, while PCI have more significant effect than non-PCI therapy.
2. PCI can improve the life quality of AMI patients 3 to 6 months post discharge, while non-PCI therapy has no such effect.
3. As compared with non-PCI therapy, PCI can significantly improve the life quality of AMI patients complicated with heart failure at admission.
4. Whether complicated with heart failure or not and age were the major factors that influenced the life quality of patients of PCI group at admission. Sex was major factor that influenced the life quality at discharge, while compliance was the major factor that influenced the life quality of PCI group 3 to 6 months post discharge.
1．评估和比较行经皮冠状动脉介入治疗术(Percutaneous coronary intervention，PCI)及非PCI术急性心肌梗死(acute myocardial infarction，AMI)患者入院时、出院时及出院后生活质量，了解PCI术对AMI患者生活质量的影响。
2．探讨PCI术AMI患者生活质量的影响因素，以指导临床工作。
方法：
本研究为平行对照的临床实验，从2006年1月-2007年3月选择中南大学湘雅一、二、三医院、长沙市中心医院及省人民医院愿意参与调查的AMI患者129人，分PCI术组(n=66)与非PCI术组(n=63)两组，分别在入院时(急诊PCI为术前)、出院时和出院后3-6月内，运用一般资料问卷及心肌梗死多维度量表(Myocardial Infarction Dimensional Assessment Scale，MIDAS)进行问卷调查。所有资料均采用SPSS11.0统计软件处理。统计方法包括描述性的统计分析、t检验、单因素方差分析、多元线性逐步回归分析。
结果：
1．本研究患者分3个时段次发放问卷，调查中PCI组AMI患者共发送问卷207份，有效问卷198份，有效率为95.6％；非PCI组AMI患者共发送问卷204份，有效问卷为189份，有效率为92.6％。
2．组内比较结果：PCI组AMI患者出院时分别与入院时、出院后3-6月时比较生活质量MIDAS评分差异有统计学意义(P＜0.05)；非PCI组AMI患者出院时与入院时比较生活质量MIDAS评分差异有统计学意义(P＜0.05)，出院后3-6月与出院时比较生活质量MIDAS评分差异无统计学意义(P＞0.05)。
3．组间比较结果：入院时PCI组与非PCI组AMI患者生活质量MIDAS评分比较中，在心功能正常与合并心衰的患者中，其差异均无统计学意义(P＞0.05)；出院时两组AMI患者生活质量MIDAS评分的比较中，在入院时心功能正常的患者中差异无统计学意义(P＞0.05)，但在入院时合并心衰的患者中二者生活质量MIDAS评分差异有统计学意义(P＜0.05)；出院3-6月后两组AMI患者生活质量MIDAS评分的比较中，在就诊时间超过6小时且合并心衰的患者中，PCI组与非PCI组生活质量差异有统计学意义(P＜0.05)，而在就诊时间小于或等于6小时，以及就诊时间超过6小时但入院时心功能正常的患者中，PCI组与非PCI组生活质量差异无统计学意义(P＞0.05)。
4．PCI组与非PCI组AMI患者出院前后生活质量MIDAS评分变化幅度的差异有统计学意义(P＜0.05)。
5．多因素分析显示：入院时是否合并心衰、患者的年龄与行PCI术AMI患者入院时生活质量MIDAS评分存在复相关；患者的性别与行PCI术AMI患者出院时生活质量MIDAS评分存在复相关；出院后的遵医嘱行为与行PCI术AMI患者出院后3-6月生活质量MIDAS评分存在复相关。
结论：
1．PCI术与非PCI术均可提高出院时AMI患者生活质量，但PCI术提高生活质量的幅度高于非PCI术。
2．PCI术可以提高AMI患者出院后3-6月的生活质量，而非PCI术则对出院后3-6月的生活质量无明显改善。
3．PCI术较非PCI术可以显著提高入院时合并心衰的AMI患者的生活质量。
4．影响PCI组AMI患者入院时生活质量的主要因素为入院时是否合并心衰及患者的年龄，影响其出院时生活质量的主要因素是性别，而影响其出院后生活质量的主要因素是出院后的遵医嘱行为。
Objective
1. To understand the effect of PCI on quality of life of patients with acute myocardial infartion(AMI) through evaluating the life quality of patients with AMI undergone PCI or not at admission, at discharge and post discharge.
2. To determine the factors that influenced the quality of life of patients with AMI undergone PCI.
Method
A controlled clinic trail was designed. 129 participants with AMI were selected from the first, second, third Xiangya hospital of central south university, central hospital of Changsha and Hunan People's hospital during January 2006 to March 2007. There were 66 patients in PCI group and 63 patients in non-PCI group. Common information and Myocardial infarction dimensional assessment scale (MIDAS ) questionnaire survey were performed in all the participants at admission, at discharge and 3 to 6 months post discharge. All the data were analyzed using SPSS 11.0 software. Descriptive statistical analysis, T test, 1-way ANOVA analysis and multiple linear regression analysis were performed in this study.
Result:
1. The questionnaires wrer sent to participants in three stages. At last 207 questionnaires were sent to the participants of PCI group, among which 198 questionnaires (95.6%) were valid. 204 questionnaires were sent to patients of non-PCI group, among which 189 (92.6%) were valid.
2. Intra-group comparisons: In PCI group, the life quality MIDAS score at discharge was significantly different when compared with that at admission and 3 to 6 months post discharge (P<0.05). In non-PCI group, the life quality MIDAS score at discharge was significantly improved in comparison to that at admission (P<0.05), while there were no significant difference existed between that at discharge and 3 to 6 months post discharge (P>0.05).
3. Inter-group comparisons: the life quality MIDAS score of PCI group at admission was not significantly different from that of non-PCI group at admission (P>0.05); the life quality MIDAS score at discharge were not different between PCI and non-PCI group with regard to patients with normal heart function at admission (P>0.05), while such a difference exist between the two groups with regard to patients with heart failure at admission (P<0.05); After discharge in 3-6 months, there is a significant difference among the patients who were treated more than 6 hours after AMI and complicated with heart failure. (P<0.05). There is no significant difference among the patients treated in 6 hours or more than 6 hours but without complication of heart failure in both groups (P>0.05).
4. Variations of the life quality MIDAS score between prior to and post discharge were significantly different in PCI group compared with that of non-PCI group (P<0.05).
5. Whether complicated with heart failure or not and age were the major factors that influenced the life quality of patients of PCI group at admission. Sex was major factor that influenced the life quality at discharge, while compliance was the major factor that influenced the life quality of PCI group 3 to 6 months post discharge.
Conclusion:
1. Both PCI and non-PCI therapy can improve the life quality of patients with AMI at discharge, while PCI have more significant effect than non-PCI therapy.
2. PCI can improve the life quality of AMI patients 3 to 6 months post discharge, while non-PCI therapy has no such effect.
3. As compared with non-PCI therapy, PCI can significantly improve the life quality of AMI patients complicated with heart failure at admission.
4. Whether complicated with heart failure or not and age were the major factors that influenced the life quality of patients of PCI group at admission. Sex was major factor that influenced the life quality at discharge, while compliance was the major factor that influenced the life quality of PCI group 3 to 6 months post discharge.
引文
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[1] 陈方，贾三庆，胡大一，等．急性心肌梗死经皮冠状动脉腔内成形术[J]．中华心血管杂志，1999，27：87．
[2] Waldecker B,Waas W, Haberbosch W, et al.Long-term fol-low-up after direct percutaneous transluminal coronary angio-plasty for acute myocardial infarction[J].J Am Coil Cardial,1998,32:1320.
[3] 李芝峰，袁正强，刘霞洪，等．不同方法治疗急性心肌梗死的疗效观察[J]．临床医学，2005，25(7)：38-39．
[4] 沈莹，夏勇，潘德峰，等．吸氧减轻急性心肌梗死缺氧性损伤的实验研究[J]．护理学杂志，2002，17(1)：9．
[5] 周薇，冯秀兰．急诊经皮冠状动脉腔内成形加支架植入术治疗老年人急性心肌梗死的护理[J]．现代护理，2002，7(8)：9．
[6] 刘建立，姚荣国，李敬田，等．急性心肌梗死直接冠状动脉成形术后再灌注心律失常分析[J]．临床心电学杂志，2003，12(8)：165-167．
[7] 李敬旭．急性心肌梗死患者心律失常的分析和监护[J]．齐鲁护理杂志，2002，8(9)：69．
[8] 邱月红，翟莹，王伟民，等．急性心肌梗死急诊介入治疗时心电图监测护理的临床意义[J]．中国介入心脏病学杂志，2006，14(1)：37-39．
[9] 程敏．经皮冠状动脉腔内成形术术中术后低血压原因分析及护理[J]．护士进修杂志，2001，16(1)：48-50．
[10] 张建军，胡大一．心脏介入性治疗引起低血压和心率减慢的原因[J]．中华心律失常学杂志，2002，6(6)：337-339．
[11] 姜兆秀，薛伟珍．急性心肌梗死介入治疗术后低血压的临床分析[J]．中西医结合心脑血管病杂志，2006，4(4)：355．
[12] 刘玉丽，陈发伟．PTCA术中、术后低血压原因及护理[J]．齐鲁护理杂志，2002，8(3)：188-189．
[13] 李影．介入心脏学与护理和康复[J]．实用护理学杂志，2000，43(5)：37．
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[1] 陈方，贾三庆，胡大一，等．急性心肌梗死经皮冠状动脉腔内成形术[J]．中华心血管杂志，1999，27：87．
[2] Waldecker B,Waas W, Haberbosch W, et al.Long-term fol-low-up after direct percutaneous transluminal coronary angio-plasty for acute myocardial infarction[J].J Am Coil Cardial,1998,32:1320.
[3] 李芝峰，袁正强，刘霞洪，等．不同方法治疗急性心肌梗死的疗效观察[J]．临床医学，2005，25(7)：38-39．
[4] 沈莹，夏勇，潘德峰，等．吸氧减轻急性心肌梗死缺氧性损伤的实验研究[J]．护理学杂志，2002，17(1)：9．
[5] 周薇，冯秀兰．急诊经皮冠状动脉腔内成形加支架植入术治疗老年人急性心肌梗死的护理[J]．现代护理，2002，7(8)：9．
[6] 刘建立，姚荣国，李敬田，等．急性心肌梗死直接冠状动脉成形术后再灌注心律失常分析[J]．临床心电学杂志，2003，12(8)：165-167．
[7] 李敬旭．急性心肌梗死患者心律失常的分析和监护[J]．齐鲁护理杂志，2002，8(9)：69．
[8] 邱月红，翟莹，王伟民，等．急性心肌梗死急诊介入治疗时心电图监测护理的临床意义[J]．中国介入心脏病学杂志，2006，14(1)：37-39．
[9] 程敏．经皮冠状动脉腔内成形术术中术后低血压原因分析及护理[J]．护士进修杂志，2001，16(1)：48-50．
[10] 张建军，胡大一．心脏介入性治疗引起低血压和心率减慢的原因[J]．中华心律失常学杂志，2002，6(6)：337-339．
[11] 姜兆秀，薛伟珍．急性心肌梗死介入治疗术后低血压的临床分析[J]．中西医结合心脑血管病杂志，2006，4(4)：355．
[12] 刘玉丽，陈发伟．PTCA术中、术后低血压原因及护理[J]．齐鲁护理杂志，2002，8(3)：188-189．
[13] 李影．介入心脏学与护理和康复[J]．实用护理学杂志，2000，43(5)：37．
[14] 杨省利．冠状动脉内支架植入患者术后护理[J]．中华护理学杂志，2000，35(2)：82．
[15] 方盈．冠状动脉内支架术后拔管综合征的预防[J]．护理学杂志，2001，16(5)：282．
[16] 朱秀勤．心血管病介入治疗致反射性低血压的观察与护理[J]．中华护理杂志，2001，36(3)：192．
[17] 何文艳，唐良春，邓碧坚，等．长期氧疗对慢性阻塞性肺病患者的疗效分析及护理[J]．现代护理，2005，11(19)：1582-1583．
[18] 杨晶，高媛．慢性阻塞性肺疾病患者氧疗依从性的调查及护理[J]．中华护理学杂志，2003，38(8)：624．
[19] 叶德琴，刘贤珍．急性心肌梗死病人氧疗知识认知状况调查[J]．护理学杂志，2004，19(6)：16-17．
[20] Kelly RF, Hursey TL, Panillo JE, et al.Effect of 100% oxygenadministration on infart size and left ventricular function in acanine model of myocardial infarction and reperfusion[J].AM heart J,1995,130:957.
[21] 钱觉贤．现代冠心病监护治疗学[M]．北京：人民军医出版社，1993：138-151．
[22] 沈莹．急性心肌梗死病人缺氧性损伤及其吸氧护理[J]．护士进修杂志．2003，18(10)：902-903．
[23] 李丽，徐红霞．急诊冠状动脉内介入治疗40例急性心肌梗塞的护理体会[J]．贵州医药，2006，30(4)：376-377．
[24] 姚景鹏，董慰慈，吕探云．内科护理学[M]．北京：人民卫生出版社，2001：111-123．
[25] Gonzalez-Jaimes EI,Turnbull-Plaza B.Selection of psycho-therapeutic treatment for adjustment disorder with depressivemood due to acute myocardial infarction[J].Arch Med Res, 2003,34(4):298-304.
[26] Rankin SH, Fukuoka Y.Predictors of quality of life in women lyear after myocardial infarction [J]. Prog Cardiovasc Nurs,2002,18(1):6-12.
[27] Goetzel RZ,Hawkins K, Ozminkowski RJ,et al.The healthand productivity cost burden of the"top 10"physical and men-tal health conditions affecting six large U.S. employers in 1999[J].J Occup Environ Med,2003,45(1):5-14.
[28] 程艳春，邹文华，巢检化，等．急性心肌梗塞病人的负性情绪研究[J]．中国临床心理学杂志，2003，11(3)：204-205．
[29] 周晓荣，李津，赵玲．急性心肌梗死病人焦虑状况调查[J]．护理研究，2004，18(1)：29-31．
[30] Ramos I, Fernandez-Palacin F, Failde I.Predictive factors ofmental disorder in patients with suspected ischaemic cardiopa-thy[J].Eur J Epidemiol,2001,17(9):835-40.
[31] Simpson T, Shaver J.Cardiovascular response to family visitsin CCU patients[J].Heart Lung,1990,19:344-351.
[32] 周晓荣，刘美丽，赵玲，等．渐进性肌肉放松训练对急性心肌梗死病人焦虑状态的影响[J]．护理学杂志，2003，18(10)：746-747．
[33] 周晓荣，刘美丽，高春燕，等．心理干预中放松训练的研究进展[J]．护理学杂志，2003，18(5)：399-400．
[34] 张海燕，邸春敬．运用需求论护理急性心肌梗死患者的体会[J]．实用护理杂志，2000，16(5)：49．
[35] 王蓓，周立，徐建红，等．急性心肌梗死患者分级等长收缩运动训练对心功能的影响[J]．中国临床康复，2004，21(8)：4148-4149．
[36] 李素芝．急性心肌梗死六级法早期活动的心脏康复护理[J]．右江医学，2003，31(4)：406-407．