本文選題：冠心病　切入點(diǎn)：PCI　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景經(jīng)皮冠狀動(dòng)脈介入術(shù)(percutaneous coronary intervention,PCI)是冠心病的主要治療方法。但PCI僅疏通了冠狀動(dòng)脈,不能去除冠心病的死亡危險(xiǎn)因素。我國(guó)冠心病的死亡率居高不下,原因之一是死亡危險(xiǎn)因素沒(méi)有得到有效控制。吸煙是冠心病死亡的第一危險(xiǎn)因素,可顯著增加PCI患者支架內(nèi)再狹窄和死亡的風(fēng)險(xiǎn)。明確復(fù)吸的發(fā)生特點(diǎn)和相關(guān)因素,有利于采取相應(yīng)的戒煙干預(yù),但暫時(shí)未見(jiàn)有關(guān)PCI患者戒煙后復(fù)吸的發(fā)生率隨時(shí)間的變化特點(diǎn)及影響因素的報(bào)道。目的第一,調(diào)查介入術(shù)期間戒煙的冠心病患者1年內(nèi)復(fù)吸的現(xiàn)狀;第二,分析和探討戒煙后復(fù)吸發(fā)生的特點(diǎn)和影響因素。方法本研究采取便利抽樣的方法,選取在介入術(shù)期間戒煙的冠心病患者進(jìn)行調(diào)查和隨訪(fǎng),調(diào)查了患者的人口學(xué)資料、疾病相關(guān)資料、吸煙相關(guān)資料和心理認(rèn)知特點(diǎn)。使用的問(wèn)卷包括:尼古丁依賴(lài)量表(FTND)、流調(diào)用抑郁自評(píng)量表(CES-D)、戒煙自我效能量表(SEQ-12)。在患者出院后3、6、9、12個(gè)月時(shí),通過(guò)電話(huà)對(duì)患者和家屬進(jìn)行隨訪(fǎng),調(diào)查患者是否出現(xiàn)復(fù)吸,以及復(fù)吸開(kāi)始的時(shí)間。結(jié)果共有221例在介入術(shù)期間戒煙的冠心病患者完成了全部研究。介入術(shù)1年內(nèi),51.1%(n=113)出現(xiàn)復(fù)吸,48.9%(n=108)戒煙成功。復(fù)吸者中,將近一半的患者(n=56)在介入術(shù)后3個(gè)月內(nèi)復(fù)吸,而后復(fù)吸率隨術(shù)后時(shí)間的延長(zhǎng)逐漸增長(zhǎng)。就業(yè)狀態(tài)、尼古丁依賴(lài)水平、抑郁與復(fù)吸呈正相關(guān)。就業(yè)的患者復(fù)吸的可能性是非就業(yè)患者的3倍(OR:2.98,95%CI:1.15～7.73);尼古丁依賴(lài)程度較高的患者比較低者更容易復(fù)吸(OR:1.23,95%CI:1.03～1.46);抑郁患者比非抑郁患者復(fù)吸的可能性更高(OR:1.14,95%CI:1.05～1.24)。此外,戒煙自我效能與復(fù)吸呈負(fù)相關(guān)(OR:0.94,95%CI:0.91～0.97),即戒煙自我效能水平高的患者復(fù)吸的可能性低。結(jié)論介入術(shù)期間戒煙的冠心病患者1年內(nèi)出現(xiàn)復(fù)吸的現(xiàn)象比較普遍。術(shù)后3個(gè)月內(nèi)是復(fù)吸發(fā)生的高危時(shí)期和戒煙干預(yù)的重要時(shí)期。影響PCI患者戒煙后復(fù)吸的因素包括就業(yè)狀態(tài)、抑郁水平、尼古丁依賴(lài)程度和戒煙自我效能。戒煙干預(yù)時(shí)應(yīng)評(píng)估復(fù)吸的風(fēng)險(xiǎn),對(duì)復(fù)吸風(fēng)險(xiǎn)較高的患者應(yīng)給予針對(duì)性的戒煙指導(dǎo)和幫助。
[Abstract]:Background Percutaneous coronary interventionation (PCI) is the main treatment for coronary artery disease (CHD), but PCI can not remove the death risk factors of coronary artery disease (CHD). The mortality of coronary heart disease (CHD) remains high in China. One of the reasons is that the risk factors of death have not been effectively controlled. Smoking is the first risk factor of coronary heart disease death, which can significantly increase the risk of restenosis and death in PCI patients. It is helpful to take corresponding smoking cessation intervention, but there is no report on the change of relapse rate and influencing factors after smoking cessation in patients with PCI for the time being. To investigate the status of relapse in coronary heart disease patients who quit smoking during interventional operation within one year; second, to analyze and explore the characteristics and influencing factors of relapse after quitting smoking. To investigate and follow up the patients with coronary heart disease who quit smoking during interventional surgery, we investigated the demographics and disease related data of the patients. Smoking related data and psychological cognitive characteristics. The questionnaires used included: nicotine dependence scale (FTNDN), Self-Rating Depression scale (CES-DN), Self-efficacy scale for quitting smoking (SEQ-12). Patients and their families were followed up by telephone at 12 months after discharge. Results A total of 221 patients with coronary heart disease who gave up smoking during interventional surgery completed a complete study. Nearly half of the patients received relapse within 3 months after interventional surgery, and the relapse rate gradually increased with the increase of postoperative time. Depression is positively correlated with relapse. The likelihood of relapse in employed patients is 3 times as high as that in non-employed patients. The odds of relapse are 3 times as high as that of non-employed patients. Patients with higher nicotine dependence are more likely to relapse into OR1. 2395 CI: 1.031.46 than those with higher nicotine dependence. Depression patients are more likely to relapse than non-depressive patients. There was a negative correlation between smoking cessation self-efficacy and relapse. There was a negative correlation between smoking cessation self-efficacy and relapse. It is the high risk period of relapse and the important period of smoking cessation intervention. The factors that influence the relapse after smoking cessation in PCI patients include employment status. Depression level, nicotine dependence and smoking cessation self-efficacy. The risk of relapse should be evaluated during smoking cessation intervention, and targeted smoking cessation guidance and help should be given to patients with higher risk of relapse.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541.4

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