目的 分析永久性心脏起搏器术后患者存在运动恐惧感的潜在影响因素,为改善患者运动康复效果、提升生存质量提供参考。方法 选取2023-06至2024-12联勤保障部队第980医院收治的永久性心脏起搏器置入患者162例为研究对象。通过系统收集患者一般资料、运动恐惧感(TSK量表)、自我效能(SEE量表)、自我感受负担(SPBS量表)及疼痛程度(VAS量表)等多维度数据,运用单因素分析筛选潜在影响因素,进一步通过Logistics回归模型明确独立影响因素,并探讨各因素与运动恐惧感的相关性,提出针对性干预策略。结果 162例永久性心脏起搏器术后患者中TSK量表得分>37分49例,占比为30.25%;TSK量表得分<37分113例,占比为69.75%。永久性心脏起搏器术后运动恐惧感者表现形式以恐惧对象为主,占比为59.18%;其次为自我设限,占比为38.78%。单因素分析及Logistics回归分析结果显示,文化程度(初中及以下)、家庭人均收入(<3000元)、医疗费用支付方式(自费)、心功能分级(Ⅲ级)、低水平自我效能、中重度自我感受负担及重度疼痛为运动恐惧感的独立影响因素(P＜0.05)。结论 永久性心脏起搏器术后患者运动恐惧感受多因素交互影响,临床需基于患者个体特征,整合知识宣传教育、经济支持、心功能管理、心理干预及疼痛控制等多维度策略,以降低运动恐惧感,促进运动康复依从性与生存质量提升。
Abstract
Objective To analyze the potential influencing factors of exercise fear in patients after permanent cardiac pacemaker implantation, and to provide references for improving the exercise rehabilitation effect and enhancing the quality of life of patients. Methods A total of 162 patients who underwent permanent cardiac pacemaker implantation at the 980th Hospital of PLA Joint Logistics Support Force from June 2023 to December 2024 were selected as research subjects. The study involved systematically collecting data on patients’ general information, fear of exercise(using the TSK scale), self-efficacy(using the SEE scale), perceived burden(using the SPBS scale), and pain level(using the VAS scale). Univariate analysis was used to screen potential influencing factors, and a multiple logistic regression model was employed to determine the independent influencing factors. The study also explored the correlation between these factors and the fear of exercise, and targeted intervention strategies were proposed. Results Among the 162 patients after permanent cardiac pacemaker implantation, 49 cases had a TSK scale score >37, accounting for 30.25%, and 113 cases had a TSK scale score <37, accounting for 69.75%. The manifestation of postoperative exercise fear was mainly fear of the object, accounting for 59.18% reported object fear, followed by self-limitation, accounting for 38.78%. The results of univariate analysis and Logistic regression analysis showed that educational level (junior high school or below), per capita household income (<3000 yuan), payment method for medical expenses (self-funded), heart function grade (Grade Ⅲ), low self-efficacy, moderate to severe self-perceived burden, and severe pain were independent factors influencing exercise fear (P＜0.05). Conclusions The exercise fear perception of patients after permanent cardiac pacemaker implantation is influenced by multiple factors interactively. In clinical practice, it is necessary to integrate multidimensional strategies such as knowledge education and publicity, economic support, heart function management, psychological intervention and pain control based on individual characteristics of patients, so as to reduce exercise fear, promote exercise rehabilitation compliance and improve quality of life.
关键词
永久性心脏起搏器 /
运动恐惧感 /
影响因素 /
干预策略 /
自我效能 /
自我感受负担
Key words
permanent cardiac pacemaker /
exercise fear /
influencing factors /
intervention strategy /
self-efficacy /
self-perceived burden
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参考文献
[1] Servito M, Khoury W, Payne D, et al. Long-term impact of permanent cardiac pacing after surgical aortic valve replacement: systematic review and meta-analysis[J]. Expert Rev Cardiovasc Ther, 2022,20(1):81-86.
[2] 李 娜. 基于健康信念模式的健康教育对永久性心脏起搏器植入术患者自我效能感及心理状态的影响[J]. 临床与病理杂志,2021,41(6):1369-1375.
[3] 涂颉洪,戴 月,江小杰,等. 预防性使用抗菌药物方案对老年植入永久性心脏起搏器术后感染的预防效果[J]. 中华医院感染学杂志,2022,32(12):1794-1797.
[4] Brindisino F, Garzonio F, DI Giacomo G, et al. Depression, fear of re-injury and kinesiophobia resulted in worse pain, quality of life, function and level of return to sport in patients with shoulder instability: a systematic review[J]. J Sports Med Phys Fitness, 2023,63(4):598-607.
[5] Mansell G, den Hollander M, Lotzke H, et al. A person-centred prehabilitation program based on cognitive behavioural physical therapy for patients scheduled for lumbar fusion surgery: a mediation analysis to assess fear of movement(kinesiophobia), self-efficacy and catastrophizing as mediators of health outcomes[J]. Eur J Pain, 2022,26(8):1790-1799.
[6] Kusumoto F M, Schoenfeld M H, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[J]. J Am Coll Cardiol, 2019,74(7):51-56.
[7] 蒋巧明,肖迎春. 血液透析患者运动自我效能与运动恐惧、体力活动相关自我管理行为的相关性分析[J]. 现代医学,2024,52(11):1708-1714.
[8] 温高芹,孙国珍,高 敏,等. 应对方式和焦虑在射血分数保留心力衰竭患者运动自我效能与运动恐惧间的链式中介作用[J]. 中华全科医学,2024,22(10):1648-1651.
[9] 朱亚男,朱 娇,卜 素.老年慢性心力衰竭患者负面情绪及自我感受负担与生活质量的相关性[J]. 中华老年多器官疾病杂志,2024,23(10):729-733.
[10] 史超雄,王素英,高春红,等. 老年起搏器植入患者术后自制加压包扎气囊式背心的应用[J]. 实用临床医药杂志,2022,26(3):17-20.
[11] 张 月,许方蕾,任鹏娜,等. 急性缺血性脑卒中合并心房颤动患者运动恐惧现状及其影响因素分析[J]. 重庆医科大学学报,2022,47(7):821-827.
[12] Ünlüer N Ö, Ozkan T, Sari Y A, et al. Investigation of the relationship between trunk position sense and balance, functional mobility, fear of falling, and disease stage in Parkinson’s disease[J]. Ir J Med Sci, 2023,192(4):1889-1894.
[13] 李 洁,邓 念,石国凤,等. 基于5G物联网的认知行为疗法对老年冠心病经皮冠状动脉介入术后患者康复效果及运动恐惧的影响[J]. 实用医学杂志,2024,40(23):3384-3388.
[14] Fu Y, Zhu L J, Li D C, et al. Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture[J]. World J Clin Cases, 2022,10(10):3069-3077.
[15] 陈琰琰,吕 畅,刘晓莉,等. 影响前交叉韧带重建术后运动恐惧心理的危险因素分析及相关干预措施[J]. 中华全科医学,2022,20(12):2147-2150.
[16] 李闪闪,王新敏,董万里,等. 永久性心脏起搏器植入术后患者运动恐惧的潜在剖面分析[J]. 中国医药导报,2024,21(24):180-185.
[17] 王文杰,杨丽娟,刘金钰,等. 急性冠脉综合征患者经皮冠状动脉介入术后运动恐惧的潜在剖面分析[J]. 广西医学,2024,46(4):486-494.
[18] 韦 静,林 桦,李春燕,等. 急性心肌梗死后心力衰竭患者运动能力的影响因素及列线图预测模型的构建[J]. 广西医学,2023,45(19):2335-2342.
[19] 郑宇娟,赵 华,王晓云,等. 冠心病患者经皮冠状动脉介入治疗术后运动恐惧现状及影响因素分析[J]. 山西医药杂志,2022,51(6):611-614.
[20] Zhang S, Wang Z, Lin X, et al. Kinesiophobia and self-management behaviour related to physical activity in Chinese patients with coronary heart disease: the mediating role of self-efficacy[J]. Nurs Open, 2023,10(1):105-114.
[21] 于甜栖,孙国珍,高 敏,等. 运动自我效能在慢性心力衰竭患者运动恐惧与运动康复依从性间的中介效应[J]. 现代预防医学,2022,49(22):4163-4168.
[22] 李果林,孙冬冬,邓琼伟,等. 自我感受负担在心脏介入手术患者疾病感知与术后恐动症间的中介作用[J]. 中国医药导报,2022,19(28):162-165.
[23] 苟艳君,王锐霞,夏 琴,等. 运动恐惧在全膝关节置换术后患者疼痛灾难化与锻炼依从性间的中介作用[J]. 现代医学,2023,51(9):1257-1262.
基金
河北省医学科学研究课题计划项目(编号:20242103)
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