基于结构方程分析冠心病患者术后健康行为在正念水平与生活质量的中介效应及护理方案

doi:10.3760/cma.j.cn441417-20250114-15033

摘要/Abstract

摘要：

目的　分析冠心病患者术后健康行为在正念水平与生活质量的中介效应及护理方案。方法　本研究为横断面研究。选取2022年5月至2023年6月阜外华中心血管病医院收治的96例冠心病患者作为研究对象。其中男61例，女35例；年龄37～64（53.59±4.86）岁；病程2～4（3.48±0.61）年；文化程度：初中及以下46例，高中35例，大专及以上15例。比较患者术后24 h、1个月正念水平［正念注意觉知量表（MAAS）］、生活质量［世界卫生组织生存质量测定简表（WHOQOL-BREF）］、术后健康行为（慢性病患者主动健康行为量表）。采用配对t检验、Wilcoxon符号秩检验和χ²检验进行统计学分析。采用双变量相关性Person分析冠心病患者术后健康行为与正念水平、生活质量的关系。采用结构方程模型分析术后健康行为在正念水平与生活质量的中介效应。结果　冠心病患者术后1个月MAAS评分高于术后24 h［（58.74±6.49）分比（45.63±5.01）分］（P<0.05）。冠心病患者术后1个月WHOQOL-BREF各维度评分、总体生存质量评分和总分均高于术后24 h（均P<0.05）。冠心病患者术后1个月慢性病患者主动健康行为量表各维度评分及总分均高于术后24 h（均P<0.05）。冠心病患者慢性病患者主动健康行为量表总分与MAAS评分呈正相关（r=0.890，P<0.001），慢性病患者主动健康行为量表总分与WHOQOL-BREF总分呈正相关（r=0.885，P<0.001），MAAS评分与WHOQOL-BREF总分呈正相关（r=0.892，P<0.001）。结构方程结果显示，方程Y=cX+e₁的回归效应显著，c=0.885，P<0.001。方程M=aX+e₂的回归效应显著，a=0.890，P<0.001。方程Y=c’X+bM+e₃的回归效应显著，b=0.504，P<0.001；c’=0.436，P<0.001，为部分中介效应模型。中介效应对总效应的贡献率：ab/c×100%=50.68%。结论　冠心病患者术后健康行为与正念水平、生活质量具有一定相关性，且术后健康行为在正念水平与生活质量之间存在中介效应。临床可通过改善患者术后健康行为，提高正念水平和生活质量。

关键词:

冠心病, 术后健康行为, 正念水平, 生活质量, 中介效应

Abstract:

Objective　To analyze the mediating effect of postoperative health behavior on mindfulness level and quality of life in patients with coronary heart disease, as well as nursing plans. Methods　This study is a cross-sectional study. A total of 96 patients with coronary heart disease who were admitted to Fuwai Central China Cardiovascular Hospital from May 2022 to June 2023 were selected as the study subjects. Among them, 61 were male and 35 were female; the age ranged from 37 to 64 (53.59±4.86) years; the disease duration was 2 to 4 (3.48±0.61) years; educational level: 46 had a junior high school education or below, 35 had a high school education, and 15 had a college degree or above. The patients' mindfulness level [Mindful Attention Awareness Scale (MAAS)] was compared at 24 hours and 1 month after surgery, as well as their quality of life [World Health Organization quality of life-BREF (WHOQOL-BREF)] and postoperative health behavior (Active Health Behavior Scale for Patients with Chronic Diseases). Paired t test, Wilcoxon signed-rank test, and χ² test were used for statistical analysis. The relationship between postoperative health behavior and mindfulness level, as well as quality of life in patients with coronary heart disease, was analyzed using bivariate correlation Person method. The mediating effect of postoperative health behavior on the relationship between mindfulness level and quality of life was analyzed using the structural equation model. Results　The MAAS score of patients with coronary heart disease one month after surgery was higher than that 24 hours after surgery [(58.74±6.49) points vs. (45.63±5.01) points] (P<0.05). The scores of each dimension of the WHOQOL-BREF, the overall quality of life score and the total score of the patients with coronary heart disease one month after surgery were all higher than those at 24 hours after surgery (all P<0.05). The scores of each dimension and the total score of the Active Health Behavior Scale for Patients with Chronic Diseases of the patients with coronary heart disease one month after surgery were all higher than those at 24 hours after surgery (all P<0.05). The total score of the Active Health Behavior Scale for Patients with Chronic Diseases for coronary heart disease patients was positively correlated with the MAAS score (r=0.890, P<0.001), and the total score of the Active Health Behavior Scale for Patients with Chronic Diseases was positively correlated with the total score of the WHOQOL-BREF (r=0.885, P<0.001). The MAAS score was positively correlated with the total score of the WHOQOL-BREF (r=0.892, P<0.001). The results of the structural equation analysis show that the regression effect of equation Y=cX+e₁ is significant, with c=0.885, P<0.001. The regression effect of equation M=aX+e₂ is also significant, with a=0.890, P<0.001. The regression effect of equation Y=c'X+bM+e₃ is also significant, with b=0.504, P<0.001; c'=0.436, P<0.001, representing a partial mediation effect model. The contribution rate of the mediating effect to the total effect is: ab/c×100%=50.68%. Conclusion　The postoperative health behavior of patients with coronary heart disease has a certain correlation with the level of mindfulness and quality of life. Moreover, the postoperative health behavior has a mediating effect between the level of mindfulness and the quality of life. Clinically, improving the postoperative health behavior of patients can enhance the level of mindfulness and the quality of life.

Key words:

Coronary heart disease, Postoperative health behavior, Mindfulness level, Quality of life, Mediating effect

李红艳.

基于结构方程分析冠心病患者术后健康行为在正念水平与生活质量的中介效应及护理方案 [J]. 国际医药卫生导报, 2025, 31(15): 2630-2635.

Li Hongyan.

Mediating effect and nursing plan of postoperative health behavior of coronary heart disease patients on mindfulness level and quality of life based on structural equation analysis [J]. International Medicine and Health Guidance News, 2025, 31(15): 2630-2635.

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