冠状动脉搭桥术后出院指导与出院准备的中介作用  

The mediating effect of discharge guidance and discharge readiness after coronary artery bypass grafting

作　　者：徐维霞 王娟[1] 付仙兰 王薇 XU Weixia;WANG Juan;FU Xianlan;WANG Wei(Department of Cardiovascular Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang 330008,Jiangxi,China)

机构地区：[1]南昌大学第二附属医院心血管外科,江西南昌330008

出　　处：《中国现代医生》2025年第1期1-5,共5页China Modern Doctor

基　　金：江西省卫生健康委科技计划项目(202410263)。

摘　　要：目的探讨负性情绪与反刍性沉思在冠状动脉搭桥术后患者的出院指导质量与出院准备度之间的链式中介作用。方法选取2022年2月至2024年2月于南昌大学第二附属医院接受冠状动脉搭桥手术的288例患者为研究对象,采用一般资料调查表、焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)、中文版事件相关反刍性沉思问卷(Chinese version of event related rumination inventory,CERRI)、出院指导质量量表(quality of discharge teaching scale,QDTS)、出院准备度量表(readiness for hospital discharge scale,RHDS)进行调查,Amos 24.0结构方程模型分析链式中介效应。结果共发放问卷288份,收回有效问卷280分,有效回收率97.22%。患者的SAS评分(57.83±5.32)分,SDS评分(63.31±4.97)分,CERRI总分(31.03±4.76)分,QDTS总分(116.78±9.22)分,RHDS总分(79.30±7.21)分;出院后独居、自费支付、心功能分级Ⅲ级患者的RHDS评分显著低于出院后有看护、医保支付、心功能分级Ⅰ级患者(P<0.05);焦虑与抑郁、侵入性反刍性沉思呈正相关,与目的性反刍性沉思、出院指导质量、出院准备度呈负相关;抑郁与侵入性反刍性沉思呈正相关,与目的性反刍性沉思、出院指导质量、出院准备度呈负相关;侵入性反刍性沉思与目的性反刍性沉思、出院指导质量、出院准备度呈负相关;目的性反刍性沉思与出院指导质量、出院准备度呈正相关;出院指导质量与出院准备度呈正相关(P<0.05);链式中介模型拟合良好,结果显示患者出院指导质量可影响出院准备度,同时负性情绪与反刍性沉思路径也影响患者的出院准备度(P<0.05)。结论出院指导质量可直接或间接通过负性情绪与反刍性沉思影响冠状动脉搭桥术后患者的出院准备度,存在链式中介作用。Objective To explore the mediating effect of negative emotion and rumination on the quality of discharge guidance and discharge readiness of patients after coronary artery bypass grafting.Methods A total of 288 patients who underwent coronary artery bypass surgery in the Second Affiliated Hospital of Nanchang University from February 2022 to February 2024 were selected as study objects.General data questionnaire,self-rating anxiety scale(SAS),self-rating depression scale(SDS),Chinese version of event related rumination inventory(CERRI),quality of discharge teaching scale(QDTS),readiness for hospital discharge scale(RHDS)were used to investigate,and Amos 24.0 structural equation model was used to analyze the chain mediation effect.Results A total of 288 questionnaires were sent out,and 280 valid questionnaires were recovered,with an effective recovery rate of 97.22%.The patients’SAS scores were(57.83±5.32)points,SDS scores were(63.31±4.97)points,CERRI total scores were(31.03±4.76)points,QDTS total scores were(116.78±9.22)points,and RHDS total scores were(79.30±7.21)points.The RHDS scores of patients who lived alone after discharge,paid at their own expense and had gradeⅢheart function were significantly lower than those of patients with nursing care,medical insurance payment and gradeⅠheart function after discharge(P<0.05).Anxiety was positively correlated with depression,intrusive rumination,but negatively correlated with purposive rumination,quality of discharge guidance and discharge readiness.Depression was positively correlated with intrusive rumination,but negatively correlated with purposive rumination,quality of discharge guidance and discharge readiness.Invasive rumination was negatively correlated with purposive rumination,quality of discharge guidance and discharge readiness.Purposive rumination was positively correlated with the quality of discharge guidance and discharge readiness.The quality of discharge guidance was positively correlated with discharge readiness(P<0.05).The chain-mediated

关 键 词：负性情绪 反刍性沉思 冠状动脉搭桥手术 出院指导质量 出院准备度 

分 类 号：R473.6[医药卫生—护理学]