疾病感知和慢性病资源利用在心脏瓣膜置换术后患者社会限制与抗凝治疗依从性间的链式中介效应  

Chain-mediated effects of illness perception and utilization of chronic disease resources in the relationship of social constraints and anticoagulant therapy adherence in patients after heart valve replacement surgery

作　　者：陈晴晴 管玉珍 CHEN Qingqing;GUAN Yuzhen(Department of Cardiovascular Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院心脏大血管外科,江苏南京210000

出　　处：《护士进修杂志》2025年第8期791-796,共6页Journal of Nurses Training

摘　　要：目的 了解心脏瓣膜置换术后患者抗凝治疗依从性水平,并探讨疾病感知与慢性病资源利用在社会限制与抗凝治疗依从性中的链式中介作用。方法 采用便利抽样法,选取2020年10月—2023年12月我院收治的215例心脏瓣膜置换术后患者,采用一般资料调查表、Morisky服药依从性量表(Morisky medication adherence scale, MMAS)、社会限制量表(social constraint scale, SCS)、简易疾病感知问卷(brief illness perception questionnarie, BIPQ)及慢性病资源调查问卷(chronic illness resources survey, CIRS)进行问卷调查。结果 心脏瓣膜置换术后患者BIPQ得分为(46.57±5.36)分,CIRS得分为(56.78±7.55)分,SCS得分为(28.64±3.57)分,MMAS得分为(5.18±0.54)分。Pearson相关分析显示:心脏瓣膜置换术后患者抗凝治疗依从性与社会限制呈显著正相关(r=0.865,P<0.01),与疾病感知呈正相关(r=0.564~0.874,P<0.01),与慢性病资源利用呈正相关(r=0.225~0.887,P<0.05);社会限制与疾病感知呈正相关(r=0.552~0.876,P<0.05),与慢性病资源利用呈负相关(r=-0.869~-0.221,P<0.05);疾病感知与慢性病资源利用呈负相关(r=-0.869~-0.204,P<0.05)。中介效应结果分析显示:疾病感知与慢性病资源利用在社会限制与抗凝治疗依从性之间的总间接效应为42.51%,其中疾病感知的中介效应占19.03%,慢性病资源利用的中介效应占17.14%,疾病感知-慢性病资源利用的链式中介效应占6.34%。结论 疾病感知和慢性病资源利用在心脏瓣膜置换术后患者社会限制与抗凝治疗依从性之间的链式中介效应成立,表明社会限制可通过调节疾病感知和慢性病资源利用,间接影响患者抗凝治疗依从性。Objective To understand the level of adherence to anticoagulant therapy in patients after heart valve replacement surgery,and to explore the mediating roles of disease perception and chronic disease resource utilization in the relationship between social constraints and adherence to anticoagulant therapy.Methods A total of 215 patients who underwent heart valve replacement surgery at our hospital from October 2020 to December 2023 were selected by a convenience sampling method and were surveyed by a questionnaire survey using a general information survey form,the Morisky medication adherence scale(MMAS),the social constraint scale(SCS),the brief disease perception questionnaire(BIPQ),and the chronic illness resource survey(CIRS).Result The scores of patients after heart valve replacement surgery on the brief disease perception questionnaire were(46.57±5.36)points,on the chronic disease resource utilization survey questionnaire were(56.78±7.55)points,on the social limitation scale were(28.64±3.57)points,and on the Morisky medication adherence scale were(5.18±0.54)points.Pearson correlation analysis showed that adherence to anticoagulant therapy in patients after heart valve replacement surgery was significantly positively correlated with social limitations(r=0.865,P<0.01),significantly positively correlated with disease perception(r=0.564-0.874,P<0.01),and positively correlated with chronic disease resource utilization(r=0.225-0.887,P<0.05);Social limitations were significantly positively correlated with disease perception(r=0.552-0.876,P<0.05)and negatively correlated with chronic disease resource utilization(r=-0.221--0.869,P<0.05);Disease perception was negatively correlated with chronic disease resource utilization(r=-0.204--0.869,P<0.05).Analysis of the mediating effect showed that the total indirect effect of disease perception and chronic disease resource utilization between social limitations and adherence to anticoagulant therapy was 42.51%,with the mediating effect of disease perception accounting fo

关 键 词：心脏瓣膜置换术 慢性病资源利用 疾病感知 社会限制 抗凝治疗依从性 中介效应 

分 类 号：R473.54[医药卫生—护理学]