急性心肌梗死患者Ⅱ期心脏康复体医融合干预方案的构建  

Construction of sports and medical integration intervention program in phaseⅡcardiac rehabilitation for patients with acute myocardial infarction

作　　者：许莉[1] 王喜益 陈菡芬 卜军[1] 杨艳 Xu Li;Wang Xiyi;Chen Hanfen;Pu Jun;Yang Yan(Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Shanghai Jiao Tong University School of Nursing,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200127 [2]上海交通大学护理学院,上海200025

出　　处：《中国实用护理杂志》2023年第1期15-22,共8页Chinese Journal of Practical Nursing

基　　金：国家重点研发计划(2018YFC1312802);上海市"科技创新行动计划"扬帆计划(21YF 1422400);上海交通大学医学院护理学科建设项目(沪交医护〔2022〕1号);2021年高水平地方高校创新团队建设项目(沪教委人〔2022〕3号)。

摘　　要：目的构建急性心肌梗死(AMI)患者Ⅱ期心脏康复体医融合干预方案,从而为AMI患者Ⅱ期心脏康复过程中运动行为转变的有效落实提供参考。方法本研究为试验性研究。通过查阅2016年7月至2021年6月发表的相关文献、指南,在前期对AMI患者参与心脏康复行为的影响因素进行回顾性分析,对患者心脏康复的认知和依从动机进行质性访谈,并基于跨理论模型,初步拟订AMI患者Ⅱ期心脏康复体医融合干预方案,形成专家函询表。于2022年2—4月,采用德尔菲法对全国4个省市的10所医院和1所护理学院的16名专家进行2轮专家函询,最终确定干预方案。结果2轮专家函询问卷的有效回收率均为16/16,专家权威系数均为0.90,判断依据系数均为0.96,熟悉程度均为0.84。第2轮专家咨询后各条目重要性的变异系数为(0.0~13.4)%,可操作性变异系数为(0.0~18.1)%。最终形成的AMI患者Ⅱ期心脏康复体医融合干预方案包括前意向阶段8个条目、意向阶段7个条目、准备阶段5个条目、行动阶段9个条目、维持阶段8个条目,共计37个条目。结论AMI患者Ⅱ期心脏康复体医融合干预方案构建过程科学、可行,构建内容围绕以患者为中心的全程管理模式,对提高AMI患者Ⅱ期心脏康复运动实施过程中的安全性、可行性、参与性和依从性具有指导意义,建议推广使用。Objective To construct an intervention program of sports and medical integration for patients with acute myocardial infarction(AMI)in phaseⅡcardiac rehabilitation,so as to provide reference for the effective implementation of physical activity behavior change in AMI patients during phaseⅡcardiac rehabilitation.Methods Before the research,we browsed relevant literature and guidelines published from July 2016 to June 2021,made a retrospective study on the influencing factors of cardiac rehabilitation behavior for AMI patients,and carried out a qualitative interview on cognitive and compliance motivations for AMI patients.Furthermore based on trans-theoretical model,the first draft of the intervention program was developed and and the expert consultation questionnaire was formed.From February to April 2022,Delphi method was used in 16 experts from 10 hospitals and 1 nursing college in 4 provinces.After 2 rounds of expert consultations on the importance and operability of items,the intervention program was finally determined.Results The effective recovery rates of the 2 rounds of expert consultations questionnaires were both 16/16.The authority coefficient of expert consultation was 0.90,the judgment basis coefficient was 0.96,and the familiarity degree was 0.84.After the second round of expert consultation,the coefficient of variation of the importance of each item was(0.0-13.4)%,and the coefficient of variation of operability was(0.0-18.1)%.The final intervention program of sports and medical integration for patients with AMI in phaseⅡcardiac rehabilitation had 37 items,containing precontemplation stage(8 items),contemplation stage(7 items),preparation stage(5 items),action stage(9 items)and maintenance stage(8 items).Conclusions The construction process of the intervention program of sports and medical integration for patients with AMI in phaseⅡcardiac rehabilitation is scientific and feasible.The content is focused on the patient-centred conception and the whole-process management for the exercise rehabil

关 键 词：心肌梗死 心脏康复 跨理论模型 体医融合 

分 类 号：R473.5[医药卫生—护理学]