上海市冠心病患者门诊心脏康复参与行为影响因素的路径分析

doi:10.3969/j.issn.1674-8115.2022.08.016

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (8): 1110-1115.doi: 10.3969/j.issn.1674-8115.2022.08.016

• 论著 · 公共卫生 • 上一篇

上海市冠心病患者门诊心脏康复参与行为影响因素的路径分析

刘霞(), 温弗乐(), 章雅青()

上海交通大学护理学院，上海 200025

收稿日期:2022-04-04 接受日期:2022-08-12 出版日期:2022-08-28 发布日期:2022-10-08
通讯作者: 章雅青 E-mail:liuxia@xinhuamed.com.cn;zhangyqf@shsmu.edu.cn
作者简介:刘霞（1978—），女，副主任护师，博士生；电子信箱：liuxia@xinhuamed.com.cn
刘霞（1978—），女，副主任护师，博士生；电子信箱：liuxia@xinhuamed.com.cn第一联系人：（刘霞、温弗乐并列第一作者）
基金资助:
上海市教育委员会护理高原学科项目(Hlgy15005yjx)

Path analysis of influencing factors of outpatient cardiac rehabilitation program participation of patients with coronary heart disease in Shanghai

LIU Xia(), WEN Fule(), ZHANG Yaqing()

Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China

Received:2022-04-04 Accepted:2022-08-12 Online:2022-08-28 Published:2022-10-08
Contact: ZHANG Yaqing E-mail:liuxia@xinhuamed.com.cn;zhangyqf@shsmu.edu.cn
Supported by:
Shanghai Municipal Education Commission—Gaoyuan Nursing Grant Support(Hlgy15005yjx)

摘要/Abstract

摘要：

目的·了解当前上海市冠心病（coronary heart disease，CHD）患者参与门诊心脏康复的现状并探讨其影响因素。方法·2017年10月—12月采用方便抽样抽取上海市7家三级甲等医院心血管内科门诊就诊的CHD患者为研究对象，采用一般资料问卷、中文版心脏康复障碍量表（Chinese/Mandarin Cardiac Rehabilitation Barriers Scale，CRBS-C/M）及心脏康复相关信息知晓度调查问卷（Cardiac Rehabilitation Information Awareness Questionnaire，CRIAQ）对其进行调研。采用单因素分析、Spearman相关分析以及结构方程模型对患者心脏康复信息、感知心脏康复障碍及门诊心脏康复参与行为三者之间的关系进行分析。结果·共发放问卷273份，回收有效问卷234份，有效回收率为85.7%。调查对象平均年龄（66.78±10.42）岁；仅17例（7.26%）患者自我报告出院后至少参加过1次门诊心脏康复。患者心脏康复参与比率在不同社会人口学特征上差异无统计学意义。Spearman相关分析显示患者的心脏康复相关信息知晓度、感知心脏康复障碍与其门诊心脏康复参与行为三者之间呈显著相关（均P=0.000）。路径分析显示心脏康复相关信息知晓度对门诊心脏康复参与行为具有直接促进作用（β=0.384，P=0.000）；感知心脏康复障碍在患者心脏康复信息知晓度与门诊心脏康复参与行为之间起部分中介作用。结论·CHD患者心脏康复信息知晓度可以直接促进其门诊心脏康复参与行为，也可以部分缓解患者感知心脏康复障碍对门诊心脏康复参与行为的不利作用。医务人员应从提升患者心脏康复相关信息着手，采取多种形式的健康教育，提高其心脏康复认知，减少患者感知的心脏康复障碍，最终促进CHD患者参与门诊心脏康复。

关键词: 冠心病, 心脏康复, 信息, 障碍

Abstract:

Objective ·To understand the current situation of outpatient cardiac rehabilitation participation of patients with coronary heart disease (CHD) in Shanghai and explore its influencing factors. Methods ·From October to December 2017, by using the convenience sampling method, a cross-sectional study was conducted to obtain information of CHD patients who visited the cardiovascular outpatient departments from 7 tertiary hospitals in Shanghai, concerning sociodemographics, Chinese/Mandarin Cardiac Rehabilitation Barriers Scale (CRBS-C/M) and Cardiac Rehabilitation Information Awareness Questionnaire (CRIAQ). The viarate analysis and Spearman analysis were applied to correlation analysis and the structural equation model was applied to path analysis. Results ·A total of 273 questionnaires were distributed and 234 valid questionnaires were collected with the effective rate of recovery at 85.7%. The average age of the respondents was (66.78±10.42) years. Only 17 (7.26%) patients self-reported that they participated in the outpatient cardiac rehabilitation at least once after discharge. There was no significant difference in participation rates in different sociodemographics. The Spearman correlation analysis demonstrated that cardiac rehabilitation information awareness, perceived cardiac rehabilitation barriers, and participation in outpatient cardiac rehabilitation were significantly correlated (all P=0.000). Path analysis showed that the cardiac rehabilitation information had a direct promoting effect on the behavior of participating in outpatient cardiac rehabilitation (β=0.384, P=0.000), and could also be partially mediated by cardiac rehabilitation barriers. Conclusion ·Regarding the patients with CHD, the awareness of cardiac rehabilitation information can directly promote their participation in outpatient cardiac rehabilitation, and can also partially alleviate the adverse effect of perceived cardiac rehabilitation barriers. Health care providers should start with improving patients' cardiac rehabilitation information and adopt various forms of health education to improve their cardiac rehabilitation cognition and overcome perceived cardiac rehabilitation barriers. Ultimately, the participation in outpatient cardiac rehabilitation programs will be facilitated for patients with CHD.

Key words: coronary heart disease (CHD), cardiac rehabilitation, information, barrier

中图分类号:

刘霞, 温弗乐, 章雅青. 上海市冠心病患者门诊心脏康复参与行为影响因素的路径分析[J]. 上海交通大学学报（医学版）, 2022, 42(8): 1110-1115.

LIU Xia, WEN Fule, ZHANG Yaqing. Path analysis of influencing factors of outpatient cardiac rehabilitation program participation of patients with coronary heart disease in Shanghai[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(8): 1110-1115.

图/表 4

表1 CHD患者心脏康复信息知晓度及感知心脏康复障碍得分（ n=234）

Tab 1 Scores of CRIAQ and CRBS-C/M in patients with CHD （n=234）

Item	Score	Maximum
CRIAQ	47.56±12.26	93
CRBS-C/M	3.05 （2.67， 3.43）	5
External logistical factor	3.50 （3.00， 4.00）	5
Comorbidities/functional status	3.00 （2.50， 3.50）	5
Program and health system-level factor	3.00 （2.33， 3.67）	5
CR need	3.00 （2.33， 3.50）	5
Time conflict	3.00 （2.00， 3.50）	5

表2 测量模型的拟合指数（WLSMV法）

Tab 2 Fitting index of the measurement model （WLSMV）

Model	χ²	df	CFI	TLI	WRMR	RMSEA （90%CI）
Measurement	23.167	13	0.958	0.932	0.468	0.058 （0.012‒0.095）
Recommendation	‒	‒	>0.90	>0.90	≤1.00	<0.08

表3 结构方程模型的拟合指数（WLSMV法）

Tab 3 Fitting index of the structural model（WLSMV）

Model	χ²	df	CFI	TLI	WRMR	RMSEA （90%CI）
Structural	18.832	13	0.976	0.962	0.526	0.044 （0‒0.084）
Recommendation	‒	‒	>0.90	>0.90	≤1.00	<0.08

图1 CHD患者心脏康复信息知晓度、感知心脏康复障碍和门诊心脏康复参与行为的标准化路径图（ n=234）Note：Oval represents latent variable. Rectangle represents observable variable. Single-headed arrow represents regression path. CR—cardiac rehabilitation. ①P=0.000, ②P=0.002.

Fig 1 CR information awareness, CR barriers, and outpatient CR participation standardization path map of patients with CHD (n=234)

参考文献 21

1	胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告2018》概要[J]. 中国循环杂志, 2019, 34(3): 209-220.
	HU S S, GAO R L, LIU L S, et al. Summary of the 2018 report on cardiovascular diseases in China[J]. Chin Circ J, 2019, 34(3): 209-220.
2	JI H, FANG L, YUAN L, et al. Effects of exercise-based cardiac rehabilitation in patients with acute coronary syndrome: a meta-analysis[J]. Med Sci Monit, 2019, 25: 5015-5027.
3	GARDINER F W, REGAN E, NWOSE E U, et al. Outpatient cardiac rehabilitation: effects on patient improvement outcomes[J]. Diabetes Metab Syndr, 2017, 11(Suppl 2): S1025-S1030.
4	DIBBEN G O, DALAL H M, TAYLOR R S, et al. Cardiac rehabilitation and physical activity: systematic review and meta-analysis[J]. Heart, 2018, 104(17): 1394-1402.
5	刘雨, 李娜, 张家菁, 等. 患者参与心脏康复的现状及其影响因素[J]. 中国康复, 2020, 35(12): 664-667.
	LIU Y, LI N, ZHANG J J, et al. The status quo and influencing factors of patients' participation in cardiac rehabilitation[J]. Chin J Rehabili, 2020, 35(12): 664-667.
6	刘伟静, 孙玉玺, 沈建颖, 等. 心脏康复的发展现状[J]. 中国研究型医院, 2020, 7(1): 82-85, 207.
	LIU W J, SUN Y X, SHEN J Y, et al. Development status of cardiac rehabilitation[J]. J Chin Res Hosp, 2020, 7(1): 82-85, 207.
7	LYNGGAARD V, NIELSEN C V, ZWISLER A D, et al. The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): a randomised controlled trial[J]. Int J Cardiol, 2017, 236: 65-70.
8	祝海香, 叶志弘, 陈启荣. 急性心肌梗死患者参与心脏康复阻力因素及干预策略研究进展[J]. 护理与康复, 2019, 18(9): 34-38.
	ZHU H X, YE Z H, CHEN Q R. Research progress on resistance factors and intervention strategies of patients with acute myocardial infarction participating in cardiac rehabilitation[J]. J Nurs Rehabili, 2019, 18(9): 34-38.
9	杜若飞, 王盼盼, 田丽, 等. 冠心病患者心脏康复依从性的研究进展[J]. 中华护理杂志, 2017, 52(10): 1246-1251.
	DU R F, WANG P P, TIAN L, et al. Research progress on compliance of cardiac rehabilitation in patients with coronary heart disease[J]. Chin J Nurs, 2017, 52(10): 1246-1251.
10	陈晓苏, 骆骅, 刘春影, 等. 居家自助式心脏康复方案对PCI术后急性冠脉综合征病人预后的影响[J]. 中西医结合心脑血管病杂志, 2021, 19(4): 636-638.
	CHEN X S, LUO Y, LIU C Y, et al. Effect of home self-help cardiac rehabilitation program on prognosis of patients with acute coronary syndrome after PCI[J]. Chin J Integr Med Cardio-Cerebrovasc Dis, 2021, 19(4): 636-638.
11	冷敏, 荣山伟, 曹国荣, 等. 居家自助式心脏康复方案在急性冠脉综合征行经皮冠状动脉介入术术后出院患者中的应用[J]. 解放军护理杂志, 2019, 36(1): 47-50.
	LENG M, RONG S W, CAO G R, et al. Application of home-based self-service cardiac rehabilitation in patients with acute coronary syndrome after PCI[J]. Nurs J Chin PLA, 2019, 36(1): 47-50.
12	SHANMUGASEGARAM S, GAGLIESE L, OH P, et al. Psychometric validation of the cardiac rehabilitation barriers scale[J]. Clin Rehabil, 2012, 26(2): 152-164.
13	LIU X, FOWOKAN A, GRACE S L, et al. Translation, cross-cultural adaptation, and psychometric validation of the Chinese/Mandarin cardiac rehabilitation barriers scale (CRBS-C/M)[J]. Rehabil Res Pract, 2021, 2021: 5511426.
14	李婧. 冠心病患者心脏康复相关信息知晓状况及其影响因素分析[D]. 保定: 河北大学, 2015.
	LI J. Analysis of the awareness of information related to cardiac rehabilitation in patients with coronary heart disease and its influencing factors[D]. Baoding: Hebei University, 2015.
15	王阳, 温忠麟, 李伟, 等. 新世纪20年国内结构方程模型方法研究与模型发展[J]. 心理科学进展, 2022, 30(8): 1715-1733.
	WANG Y, WEN Z L, LI W, et al. Research and development of structural equation modeling in China in the 20 years of the new century[J]. Adv in Psychol Sci, 2022, 30(8): 1715-1733.
16	FLORA D B, CURRAN P J. An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data[J]. Psychol Methods, 2004, 9(4): 466-491.
17	吴明隆. 问卷统计分析实务: SPSS操作与应用[M]. 重庆: 重庆大学出版社, 2010.
	WU M L. Practice of questionnaire statistical analysis: SPSS operation and application[M]. Chongqing: Chongqing University Press, 2010.
18	梁婷, 都冬梅. 康复路径教育在冠心病介入治疗患者心脏康复中的应用[J]. 中华老年心脑血管病杂志, 2013, 15(11): 1155-1158.
	LIANG T, DU D M. Application of heart rehabilitation pathway education in coronary heart disease patients after PCI[J]. Chin J Geriatr Heart Brain Vessel Dis, 2013, 15(11): 1155-1158.
19	刘霞, 章雅青. 上海某三甲医院经皮冠状动脉介入治疗后患者心脏康复知识知晓状况调查[J]. 中国康复医学杂志, 2019, 34(3): 327-329.
	LIU X, ZHANG Y Q. Investigation on the knowledge about cardiac rehabilitation of patients after percutaneous coronary intervention in a tertiary hospital in Shanghai[J]. Chin J Rehabil Med, 2019, 34(3): 327-329.
20	GHISI G L, GRACE S L, THOMAS S, et al. Behavior determinants among cardiac rehabilitation patients receiving educational interventions: an application of the health action process approach[J]. Patient Educ Couns, 2015, 98(5): 612-621.
21	冯雪. 心脏康复可持续发展的医疗模式探索[J]. 中国实用内科杂志, 2017, 37(7): 605-608.
	FENG X. Exploration of the medical model for the sustainable development of cardiac rehabilitation[J]. Chin J of Pract Intern Med, 2017, 37(7): 605-608.

[1]	崔培荣, 倪雪萍, 宗明灿, 忻笑, 江雨露, 李贤华. 老年慢性病患者健康信息寻求行为现状及影响因素路径分析[J]. 上海交通大学学报（医学版）, 2022, 42(6): 805-812.
[2]	许莉, 杨艳, 陈菡芬, 姜萌, 卜军. 急性心肌梗死患者于心脏康复中心就诊的影响因素及效果评价[J]. 上海交通大学学报（医学版）, 2022, 42(5): 646-652.
[3]	梁宇璇, 李春波. 基于心跳知觉的内感知研究进展[J]. 上海交通大学学报（医学版）, 2022, 42(5): 660-666.
[4]	吴侠霏, 方婕, 漆洪波, 余昕烊. 妊娠期糖尿病对C57BL/6J子代成年鼠神经精神功能的影响[J]. 上海交通大学学报（医学版）, 2022, 42(4): 422-432.
[5]	靳步, 袁颖, 陈婉玉, 徐浒东, 黄晓蕾, 何佳璐, 于红. 基于GEO数据库探索miRNA靶基因通过泛素化参与食管鳞状细胞癌[J]. 上海交通大学学报（医学版）, 2022, 42(4): 464-471.
[6]	龚其雨, 陈磊. 多组学数据解析循环及浸润性B细胞在结直肠癌免疫微环境中的作用[J]. 上海交通大学学报（医学版）, 2022, 42(4): 472-481.
[7]	张梦吉, 黄琳, 李峥, 马卓然, 魏霖, 袁安彩, 胡刘华, 张薇, 钱昆, 卜军. 基于人群大队列探索心脑血管疾病相关血浆代谢组学特征[J]. 上海交通大学学报（医学版）, 2022, 42(3): 259-266.
[8]	梁存禹, 赵倩, 宋宁, 门莉, 陈清杰, 楚俊昆, 卜军, 李晓梅, 杨毅宁. 基于“互联网+”的可穿戴式心电设备在冠心病患者PCI术后慢病管理中的应用效果评价[J]. 上海交通大学学报（医学版）, 2022, 42(3): 275-281.
[9]	许静轩, 杜少倩, 曹源, 王红霞, 黄伟翼. MMP14在胰腺癌中的表达及其与肿瘤免疫微环境特征的相关性研究[J]. 上海交通大学学报（医学版）, 2022, 42(3): 312-322.
[10]	张蓉, 陆丽, 王亚昕, 董文倩, 张宇, 周健. 糖尿病患者血糖波动异常与认知功能障碍关系的研究进展[J]. 上海交通大学学报(医学版), 2022, 42(2): 235-240.
[11]	韩稷钰, 王衍鸿, 万大千. 下肢外骨骼康复机器人的研究进展及发展趋势[J]. 上海交通大学学报(医学版), 2022, 42(2): 241-246.
[12]	杨辰玲, 周慧芳. PD-1/PD-L1通路在自身免疫性眼病中作用的研究进展[J]. 上海交通大学学报(医学版), 2022, 42(1): 107-112.
[13]	杨富, 方芳, 陈兰, 王秋莉. ICU环境中患者早期康复影响因素的研究进展[J]. 上海交通大学学报(医学版), 2022, 42(1): 119-123.
[14]	王建茹, 彭广操, 朱明军. 基于GEO数据库和生物信息学分析筛选小鼠心肌缺血再灌注损伤相关的潜在枢纽基因[J]. 上海交通大学学报(医学版), 2022, 42(1): 51-62.
[15]	陈锐, 赵云, 赵晓霞, 马东, 韩一江, 赖登明, 顾伟忠, 钭金法. 沉默信息调节因子1在新生儿坏死性小肠结肠炎肠组织中的表达特点[J]. 上海交通大学学报(医学版), 2021, 41(9): 1154-1161.

上海市冠心病患者门诊心脏康复参与行为影响因素的路径分析

Path analysis of influencing factors of outpatient cardiac rehabilitation program participation of patients with coronary heart disease in Shanghai

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 21

相关文章 15

编辑推荐

Metrics