老年冠心病患者冠状动脉搭桥术后恐动症水平变化轨迹及核心影响因素决策树分析  

Longitudinal trajectories of kinesiophobia level in elderly patients with coronary heart disease after coronary artery bypass grafting and decision tree analysis of core influencing factors

作　　者：赵彩萍 陆真[1] 周春雷 蒋伟[1] 杨洁[1] 陈晴晴[1] 樊小倩 ZHAO Caiping;LU Zhen;ZHOU Chunlei;JIANG Wei;YANG Jie;CHEN Qingqing;FAN Xiaoqian(Department of Cardiology and Macrovascular Surgery,Jiangsu Province Hospital,Nanjing,210000,China)

机构地区：[1]江苏省人民医院心脏大血管外科,南京市210000

出　　处：《护理管理杂志》2024年第10期829-833,共5页Journal of Nursing Administration

基　　金：中国博士后科学基金(2021M691649)。

摘　　要：目的了解老年冠心病患者冠状动脉搭桥术后1周至3个月恐动症变化轨迹,分析不同恐动症变化轨迹亚型的影响因素。方法选择164例行冠状动脉搭桥手术治疗的老年冠心病患者为研究对象,采用心脏恐动症量表分别于患者术后1周、术后2周、术后1个月、术后3个月进行恐动症水平调查,使用潜变量增长混合模型识别老年冠心病患者冠状动脉搭桥术后恐动症轨迹亚型,应用决策树模型分析影响恐动症变化轨迹亚型的核心影响因素。结果老年冠心病患者术后不同时段恐动症得分水平呈回升降低趋势。通过模型拟合识别出两条恐动症变化轨迹。决策树模型显示,预测变量重要性依次为年龄、运动益处认知、性别、高血压、自我感受负担、术后疼痛、术后并发症,其中年龄是最为重要的预测因素。结论老年冠心病患者术后分为持续下降和回升下降两条恐动症变化轨迹,年龄是其核心影响。应根据上述因素辨别术后可能进展为恐动症回升下降人群,并构建以提高运动益处认知和自我感受负担水平为侧重点的干预方案,以降低其恐动症水平。Objective To explore longitudinal trajectories of kinesiophobia in elderly patients who underwent coronary artery bypass grafting(CABG)from one week to three months after surgery,and analyze the influencing factors of different kinesiophobia subtypes.Methods A total of 164 elderly patients who underwent CABG surgery were investigated using the Tampa Scale for Kinesiophobia Heart at one week,two weeks,one month and three months after surgery,respectively.Latent growth mixture modeling was used to identify the longitudinal trajectories of kinesiophobia in elderly patient with CABG.A decision tree model was used to analyze the core factors affecting the subtypes of kinesiophobia.Results Two trajectories of kinetophobia were identified according to the rising and decreasing trend of kinetophobia score level in the elderly patients with coronary heart disease at different periods after surgery.The decision tree modeling showed that the importance of predictive variables was ranked by age,perception of exercise benefits,gender,hypertension,self-perceived burden,postoperative pain and postoperative complications,with the age being the foremost.Conclusion Postoperative kinesiophobia in elderly patients with CABG can be divided into two trajectories:continuous decline and rebound decline,and age is the foremost factor.According to the above factors,we should identify the people who may progress to the rebound dedine of kinesiophobia after surgery.Intervention plans focusing on improving the awareness of the benefits of exercise and the level of self-perceived burden should be constructed to reduce the level of kinesiophobia.

关 键 词：冠心病 冠状动脉搭桥 恐动症 老年人 护理 自我感受负担 运动益处认知 变化轨迹 

分 类 号：R473.5[医药卫生—护理学]