PCI术后患者心脏康复依从性现状及影响因素

Analysis of current status and influencing factors of cardiac rehabilitation adherence among patients after PCI

摘要

目的 探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者心脏康复依从性及相关影响因素。方法 选取2024年9月至2025年3月于安徽省某三甲医院两个心内科病区和CCU收治的PCI术后患者216例为研究对象,采用心脏康复量表(Cardiac Rehabilitation Inventory,CRI)评估PCI术后患者心脏康复依从性,通过单因素分析与多因素logistic回归分析探讨其影响因素。结果 本组PCI术后患者心脏康复依从性总体处于中等偏下水平,依从性高(CRI总分≥45分)99例(45.8%),依从性低(CRI总分＜45分)117例(54.2%)。多因素logistic回归分析显示,文化程度初中及以下、农村居住、子女数量＞2个、家庭人均月收入＜3 000元、周边无心脏康复中心或医院以及运动习惯少或无是影响患者依从性低的独立危险因素(P＜0.05);退休(vs无工作)与依从性呈负相关联(P＜0.05),其中无运动习惯的关联强度最大。结论 临床医护人员应重点关注依从性低风险人群,并实施针对性干预,以提升PCI术后患者心脏康复依从性。

Abstract

Objective To explore cardiac rehabilitation adherence and its influencing factors in patients after PCI. Methods A total of 216 post-PCI patients admitted to two cardiology wards and the CCU of a tertiary hospital in Anhui Province from September 2024 to March 2025 were selected as the study subjects.Cardiac rehabilitation adherence was assessed using the Cardiac Rehabilitation Inventory (CRI),and potential influencing factors were analyzed using univariate analysis and multivariate logistic regression. Results The overall cardiac rehabilitation adherence of post-PCI patients was at a moderately low level,with 99 patients (45.8%) having high adherence and 117 patients (54.2%) having low adherence.Multivariate logistic regression analysis indicated that lower education level (junior high school or below),rural residence,having more than two children,monthly per capita income less than 3 000 RMB,lack of nearby cardiac rehabilitation centers or hospitals,and little to no exercise habits were independently associated with adherence (P＜0.05).Regarding employment status,retirement (vs. unemployed) was negatively associated with low adherence (P＜0.05),with the absence of exercise habits showing the strongest association. Conclusion Clinical healthcare providers should focus on populations at higher risk of low adherence and implement targeted interventions to improve cardiac rehabilitation adherence in post-PCI patients.

关键词

经皮冠状动脉介入治疗 / 心脏康复 / 依从性 / 影响因素

Key words

Percutaneous coronary intervention / Cardiac rehabilitation / Adherence / Influencing factors

[1]Lawton JS,Tamis-Holland JE,Bangalore S,et al.2021 ACC/AHA/SCAI guideline for coronary artery revascularization:executive summary:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J].Circulation,2022,145(3):e4-e17.DOI:10.1161/CIR.0000000000001039.Epub 2021 Dec 9.
[2]刘庆荣,吴永健.冠心病介入治疗术后心脏康复的综合评估[J].中国医刊,2020,55(1):1-4.DOI:10.3969/j.issn.1008-1070.2020.01.001.
[3]Dibben G,Faulkner J,Oldridge N,et al.Exercise-based cardiac rehabilitation for coronary heart disease[J].Cochrane Database Syst Rev,2021,11(11):CD001800.DOI:10.1002/14651858.CD001800.pub4.
[4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.经皮冠状动脉介入治疗指南(2025)[J].中华心血管病杂志,2025,53(7):717-745.DOI:10.3760/cma.j.cn112148-20250422-00302.
[5]赖彩萍,辜晓纯,杨冰琪.急性心肌梗死PCI术后患者心脏康复依从性现状调查及其影响因素分析[J].心血管病防治知识,2024,14(20):56-59.DOI:10.3969/j.issn.1672-3015(x).2024.20.014.
[6]倪平,陈京立,刘娜.护理研究中量性研究的样本量估计[J].中华护理杂志,2010,45(4):378-380.DOI:10.3761/j.issn.0254-1769.2010.04.037.
[7]安徽省人民代表大会常务委员会.安徽省实施《中华人民共和国老年人权益保障法》办法[N].安徽日报,2024-06-20(07).
[8]国家心血管病中心,中国心血管健康与疾病报告编写组,胡盛寿.中国心血管健康与疾病报告2024概要[J].中国循环杂志,2025,40(6):521-559.DOI:10.3969/j.issn.1000-3614.2025.06.001.
[9]Micklewright D,Northeast L,Parker P,et al.The cardiac rehabilitation inventory:a new method of tailoring patient support[J].J Cardiovasc Nurs,2016,31(2):175-185.DOI:10.1097/JCN.0000000000000220.
[10]王俊红,张振香,杨巧芳,等.心脏康复量表的汉化及信效度评价[J].中华护理杂志,2019,54(4):632-636.DOI:10.3761/j.issn.0254-1769.2019.04.033.
[11]Zweig MH,Campbell G.Receiver-operating characteristic(ROC) plots:a fundamental evaluation tool in clinical medicine[J].Clin Chem,1993,39(4):561-577.
[12]马丽媛,王增武,樊静,等.《中国心血管健康与疾病报告2022》概要[J].中国介入心脏病学杂志,2022,30(7):481-496.DOI:10.3969/j.issn.1004-8812.2023.07.002.
[13]陈轶琳,林平,韩永奎,等.经皮冠状动脉介入治疗患者Ⅰ期心脏康复依从性及影响因素模型的构建研究[J].中国全科医学,2023,26(18):2209-2216.DOI:10.12114/j.issn.1007-9572.2022.0790.
[14]张雪芹,吕云霞,尹升华,等.经皮冠状动脉介入术后患者心脏康复依从性现状及影响因素分析[J].当代护士(中旬刊),2022,29(8):94-97.DOI:10.19792/j.cnki.1006-6411.2022.23.030.
[15]黄春艳,吴丹丹,汪晓敏.急性心肌梗死患者心脏康复依从性的影响因素分析[J].中国医药导报,2024,21(18):26-30.DOI:10.20047/j.issn1673-7210.2024.18.06.
[16]木楠.冠心病患者PCI术后心脏康复依从性影响因素研究及预测模型构建[D].广州:广州中医药大学,2023.
[17]Sumner J,Grace SL,Doherty P.Predictors of cardiac rehabilitation utilization in England:results from the national audit[J].J Am Heart Assoc,2016,5(10):e003903.DOI:10.1161/JAHA.116.003903.
[18]李洪坤,王新生,李江峰,等.冠心病经皮冠状动脉介入治疗患者住院费用影响因素分析[J].精准医学杂志,2022,37(4):332-336,341.DOI:10.13362/j.jpmed.202204010.
[19]刘梦坛,高文君,周丹.老年冠心病患者经皮冠状动脉介入术后康复锻炼依从性与锻炼行为感知的差异性研究[J].护士进修杂志,2025,40(14):1462-1469.DOI:10.16821/j.cnki.hsjx.2025.14.002.

基金资助

皖南医学院横向课题(H202502)