心肌梗死介入术后衰弱患者积极度影响因素分析及其在病耻感与心理社会适应间的中介效应  

Influencing factors of positivity in frailty patients with myocardial infarction after intervention and its mediating effect between illness-related shame and psychosocial adjustment

作　　者：刘明 刘静静 孙亚召 LIU Ming;LIU Jing-jing;SUN Ya-zhao(Department of Cardiology,Cangzhou People's Hospital,Cangzhou,Hebei,061000,China)

机构地区：[1]沧州市人民医院心内科,河北沧州061000

出　　处：《心血管康复医学杂志》2025年第2期211-216,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨中青年急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后积极度的影响因素,同时检验其在病耻感与心理社会适应间的中介效应。方法:选择2021年10月至2022年12月于沧州市人民医院诊断为AMI行PCI且术后被定义为衰弱的178例患者作为研究对象。应用一般资料调查表和积极度量表(PAM)、社会影响量表(SIS)、心理社会适应自评量表(PAIS-SR)对患者进行调查,分析患者的临床数据特征;采用Pearson相关性分析调查PAM得分、SIS得分及PAIS-SR得分之间的相关性;采用多重线性回归分析积极度的影响因素;采用Process插件中Bootstrap程序对积极度在病耻感与心理社会适应间的中介效应进行验证。结果:本研究中,PAM得分为(57.87±7.02)分,SIS得分为(52.07±12.66)分,PAIS-SR得分为(61.07±10.58)分。Pearson相关分析显示,PAM得分与SIS得分、PAIS-SR得分均呈负相关(r=-0.439、-0.504,P均<0.001),SIS得分与PAIS-SR得分呈正相关(r=0.722,P<0.001)。多重线性回归分析显示,男性(B=2.226,P=0.020)、受教育程度(B=2.194,P=0.005)、病耻感(B=-0.210,P<0.001)可以影响患者术后的积极度。中介效应分析显示,病耻感对心理社会适应具有直接效应,占总效应的85.92%,积极度在病耻感与心理社会适应间起部分中介作用,效应量为14.08%。结论:病耻感不仅直接影响患者的心理社会适应情况,还可通过积极度间接影响病人的心理社会适应。医护人员应采取针对性策略提高其积极度,以减少病耻感对心理社会适应的负面影响。Objective:To explore the influencing factors of post-percutaneous coronary intervention(PCI)positivity in young and middle-aged patients with acute myocardial infarction(AMI)and simultaneously assess its mediating effect in the relationship between illness-related shame and psychosocial adjustment.Methods:A total of 178 patients,who admitted in Cangzhou People's Hospital between October 2021 and December 2022 for AMI,underwent PCI,and were subsequently defined as frailty after PCI,were selected.General demographic information survey forms,Patient Activation Measure(PAM),Social Impact Scale(SIS),and Psychosocial Adjustment to Illness Scale Self-Report(PAIS-SR)were applied to investigate the patients.Clinical data characteristics of the patients were analyzed.Pearson correlation analysis was conducted to investigate the association among PAM score,SIS score and PAIS-SR score.Multivariate linear stepwise regression analysis was employed to identify the influencing factors of positivity.The Bootstrap procedure in the Process plugin was used to validate the mediating effect of positivity between illness-related shame and psychosocial adjustment.Results:In this study,PAM score was(57.87±7.02)points,SIS score was(52.07±12.66)points,and PAIS-SR score was(61.07±10.58)points.Pearson correlation analysis indicated that PAM score was significant negatively correlated with SIS score and PAIS-SR score(r=-0.439,-0.504,P<0.001 all),and SIS score was significant positively correlated with PAIS-SR score(r=0.722,P<0.001).Multivariate linear stepwise regression analysis indicated that male(B=2.226,P=0.020),educational level(B=2.194,P=0.005)and stigma associated with illness(B=-0.210,P<0.001)can influence the postoperative positivity of patients.Mediation effect analysis indicated that illness-related shame had a direct effect on psychosocial adjustment,accounting for 85.92%of the total effect,while positivity partially mediated the relationship between illness-related shame and psychosocial adjustment with an effect size of 14.08

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 虚弱 

分 类 号：R542.22[医药卫生—心血管疾病]