摘要
目的探讨PCI术后患者认知评价、应对方式在知觉压力与术后主要心脏不良事件(major adverse cardiac events,MACE)间的潜在中介作用,并明确其相关作用路径。方法采用方便抽样法,于2018年7—9月选取哈尔滨医科大学附属第二医院心内科首次行PCI的383例冠心病患者作为研究对象,使用知觉压力量表(CPSS)、健康认知评价量表(CAHS)及医学应对问卷(MCMQ)对其进行调查,术后1年随访其MACE发生情况。采用Mplus 7.0进行路径分析并检验认知评价及应对方式的中介效应。结果共364例患者完成问卷调查及术后1年电话随访。364例PCI术后患者CPSS得分为(29.09±11.07)分,PCI术后1年MACE发生率为13.7%。知觉压力与MACE间共存在4条显著路径,分别为知觉压力→MACE[OR=1.023,95%置信区间为(1.010~1.347),P=0.031],路径效应占总效应29.6%;知觉压力→威胁评价→MACE[OR=1.039,95%置信区间为(1.026~1.379),P=0.010],路径效应占总效应48.9%;知觉压力→威胁评价→屈服应对→MACE[OR=1.010,95%置信区间为(1.004~1.096),P=0.019],路径效应占总效应12.1%;知觉压力→挑战评价→屈服应对→MACE[OR=1.026,95%置信区间为(1.003~1.042),P<0.050],路径效应占总效应4%。结论知觉压力可直接或通过中介变量间接作用于MACE,挑战评价、威胁评价及屈服应对为PCI患者知觉压力与MACE的中介因素。
Objective To explore the potential mediating effects of cognitive appraisal and coping style between perceived stress and major adverse cardiac events(MACE)in patients after percutaneous coronary intervention(PCI).Methods Using the convenient sampling method,a total of 383 patients with coronary heart disease who underwent PCI for the first time in the Department of Cardiology in the Second Affiliated Hospital of Harbin Medical University were selected as the research objects from July 2018 to September 2018.They were investigated with Chinese Perceived Stress Scale(CPSS),Cognitive Appraisal of Health Scale(CAHS)and Medical Coping Modes Questionnaire(MCMQ).The occurrence of MACE was followed up 1 year after operation.Mplus 7.0 was used for path analysis and to examine the mediating effects of cognitive appraisal and coping style.Results A total of 364 patients completed the questionnaire survey and 1-year telephone follow-up.The CPSS score of 364 patients after PCI was(29.09±11.07),and the incidence of MACE was 13.7%in 1 year after PCI.There were 4 significant paths between perceived stress and MACE.The first path was from perceived stress to MACE[OR=1.023,95%CI=(1.010-1.347),P=0.031],and path effect accounted for 29.6%of the total effect.The second path was from perceived stress to threat appraisal to MACE[OR=1.039,95%CI=(1.026-1.379),P=0.010],and acceptance-resignation coping effect accounted for 48.9%of the total effect.The third path was from perceived stress to threat appraisal to yielding response to MACE[OR=1.010,95%CI=(1.004-1.096),P=0.019],and the path effect accounted for 12.1%of the total effect.The fourth path was from perceived stress to challenge appraisal to acceptance-resignation coping to MACE[OR=1.026,95%CI=(1.003-1.042),P<0.050],and the path effect accounted for 4%of the total effect.Conclusions Perceived stress can act on MACE directly or indirectly through intermediary variables.Challenge appraisal,threat appraisal and acceptance-resignation coping are the intermediary factors of perceived stress and MACE of patients undergoing PCI.
作者
吕涵
林平
赵振娟
Lyu Han;Lin Ping;Zhao Zhenjuan(School of Nursing,Harbin Medical University,Harbin 150001,China;Department of Cardiology,the Second Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《中华现代护理杂志》
2020年第23期3138-3143,共6页
Chinese Journal of Modern Nursing
基金
国家自然科学基金资助面上项目(31971015)。
关键词
冠状动脉疾病
经皮冠状动脉介入治疗
主要心脏不良事件
知觉压力
认知评价
应对方式
路径分析
Coronary artery disease
Percutaneous coronary intervention
Major adverse cardiac events
Perceived stress
Cognitive appraisal
Coping style
Path analysis
