Abstract:

Objective　To study the value of trans-theoretical model (TTM)-based early cardiac rehabilitation nursing in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods　This study was a randomized controlled trial. A total of 82 patients with AMI who underwent PCI in Shangqiu First People's Hospital from March 2021 to March 2023 were selected as the study objects, and the patients were divided into a routine group (41 cases) and a TTM group (41 cases) by the random number table method. There were 18 males and 23 females in the TTM group, aged 48-85 (60.23±3.86) years, the time from onset to operation was 2-12 (6.41±1.26) h, and the diseased vessels were left anterior descending branch in 19 cases, right circumflex branch in 5 cases, and right coronary artery in 17 cases. In the routine group, there were 16 males and 25 females, aged 47-85 (59.98±3.72) years, the time from onset to operation was 2-12 (6.38±1.32) h, and the diseased vessels were left anterior descending branch in 16 cases, right circumflex branch in 7 cases, and right coronary artery in 18 cases. The routine group received routine early cardiac rehabilitation nursing, and the TTM group received TTM-based early cardiac rehabilitation nursing based on the routine group. Both groups were intervened until 6 months after discharge. The compliance, cardiac function [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD)], health belief level [Coronary Artery Disease Health Belief Scale (CADHBS)], self-management ability [Coronary Heart Disease Self-management Scale (CSMS)] before and after intervention, and incidence of cardiac adverse events were compared between the two groups. Independent sample t test and χ² test were used. Results　The total compliance rate in the TTM group [97.56% (40/41)] was higher than that in the routine group [80.49% (33/41)] (P<0.05). After intervention, the LVEF in the TTM group was higher than that in the routine group [(61.69±3.58)% vs. (55.06±3.15)%], but the LVESD and LVEDD were lower than those in the routine group [(34.16±2.13) mm vs. (39.74±2.61) mm, (52.47±2.35) mm vs. (61.85±3.27) mm] (all P<0.05). The scores of CADHBS and CSMS in the TTM group were higher than those in the routine group [(69.85±4.59) points vs. (51.38±4.12) points, (98.76±6.89) points vs. (87.41±5.02) points] (both P<0.05). During the intervention period, the total incidence of cardiac adverse events in the TTM group [4.88% (2/41)] was lower than that in the routine group [24.39% (10/41)] (P<0.05). Conclusion　TTM-based early cardiac rehabilitation nursing in AMI patients undergoing PCI can improve the patients' compliance and self-management ability, improve their cardiac function, and reduce the incidence of cardiac adverse events.

Key words:

Acute myocardial infarction, Percutaneous coronary intervention, Early cardiac rehabilitation nursing, Trans-theoretical model

摘要：

目的　研究基于跨理论模型（TTM）的早期心脏康复护理用于经皮冠状动脉介入（PCI）治疗急性心肌梗死（AMI）患者的价值。方法　本研究为随机对照试验。选取2021年3月至2023年3月商丘市第一人民医院行PCI治疗的82例AMI患者作为研究对象，采用随机数字表法，将患者分为常规组（41例）和TTM组（41例）。TTM组男18例，女23例；年龄48～85（60.23±3.86）岁；发病至手术时间2～12（6.41±1.26）h；病变血管：左前降支19例，右回旋支5例，右冠状动脉17例。常规组男16例，女25例；年龄47～85（59.98±3.72）岁；发病至手术时间2～12（6.38±1.32）h；病变血管：左前降支16例，右回旋支7例，右冠状动脉18例。常规组采用常规早期心脏康复护理，TTM组在常规组基础上采用基于TTM的早期心脏康复护理。两组均干预至出院后6个月。比较两组依从性，干预前后心功能［左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室舒张末内径（LVEDD）］、健康信念水平［冠心病健康信念量表（CADHBS）］、自我管理能力［冠心病自我管理量表（CSMS）］，干预期间心脏不良事件发生情况。采用独立样本t检验和χ²检验进行统计学分析。结果　TTM组总依从率［97.56%（40/41）］高于常规组［80.49%（33/41）］（P<0.05）。干预后，TTM组LVEF高于常规组［（61.69±3.58）%比（55.06±3.15）%］，LVESD、LVEDD均低于常规组［（34.16±2.13）mm比（39.74±2.61）mm、（52.47±2.35）mm比（61.85±3.27）mm］（均P<0.05）；TTM组CADHBS和CSMS评分均高于常规组［（69.85±4.59）分比（51.38±4.12）分、（98.76±6.89）分比（87.41±5.02）分］（均P<0.05）。干预期间，TTM组心脏不良事件总发生率［4.88%（2/41）］低于常规组［24.39%（10/41）］（P<0.05）。结论　基于TTM的早期心脏康复护理用于PCI治疗AMI患者中，可提高患者依从性、健康信念水平和自我管理能力，改善心功能，降低心脏不良事件发生率。

关键词:

急性心肌梗死, 经皮冠状动脉介入, 早期心脏康复护理, 跨理论模型