急性心肌梗死患者急性应激障碍的病例对照研究

发布时间：2018-05-07 16:06

本文选题：急性心肌梗死 + 急性应激障碍　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的分析急性心肌梗死患者发生急性应激障碍的影响因素,为制定早期护理干预措施提供理论依据。方法1选取2015年9月至2016年8月期间就诊于唐山工人医院心内科住院治疗的急性心肌梗死患者为研究对象,于患者移出监护室第2天,且在发病后第6~10天,病情稳定期统一经斯坦福急性应激反应问卷(Stanford Acute Stress Reaction Questionnaire,SASRQ)筛选出病例组和对照组,将筛选出的138例急性心肌梗死伴急性应激障碍患者纳入病例组,将同期276例非急性应激障碍的急性心肌梗死患者作为对照组。采用自行设计的一般人口学问卷、家庭功能评估量表、社会支持量表、疼痛视觉模拟评分法等对两组患者进行评价,比较分析两组患者在疾病状况、治疗情况、胸痛程度、睡眠情况、家庭社会支持状况等方面的分布差异。2所有数据使用Excel软件建立数据库,SPSS17.0统计软件进行统计学分析。一般人口学资料采用描述性统计分析;单因素分析采用卡方检验,采用卡方分割法进行组内两两比较;多因素分析采用二元Logistic回归分析。结果1影响急性心肌梗死患者急性应激障碍的单因素分析结果显示性别、年龄、婚姻状况、文化程度、居住地、与谁同住、性格、职业、月收入、医保类型、医药费用支付、病变支数、Gensini积分、CK值、CK-Mb值、CTn I值、接受过除颤与否、住CCU的时间、并发症与否、发病次数、胸痛程度、心功能Killip分级、有被抢救过经历与否、治疗方式、有无冠心病史、频发心绞痛与否、睡眠质量、科室环境影响睡眠与否、疼痛影响睡眠与否、社会支持、家庭功能与急性心肌梗死患者急性应激障碍的发生有关,差异有统计学意义(P0.05)。2影响急性心肌梗死患者急性应激障碍的多因素分析多因素Logistic回归分析显示,年龄、性别、心功能Killip分级、科室环境影响睡眠、疼痛影响睡眠、接受过除颤与否、病变支数、支付医药费用、社会支持、家庭功能是急性心肌梗死患者急性应激障碍的影响因素,其中女性、心功能差、科室环境影响睡眠、疼痛影响睡眠、接受过除颤、多支病变、借钱支付医药费用、家庭功能存在障碍是急性心肌梗死患者发生急性应激障碍的危险因素;年龄在60~75岁、社会支持度高是急性心肌梗死患者发生急性应激障碍的保护因素。结论急性心肌梗死患者急性应激障碍的发生与性别、病变支数、心功能状况、胸痛症状、睡眠状况、家庭社会支持状况等因素有关,且女性、心功能差、科室环境影响睡眠、疼痛影响睡眠、接受过除颤治疗、多支病变、借钱支付医药费用、家庭功能障碍是危险因素;年龄在60~75岁、社会支持度高为保护因素。
[Abstract]:Objective to analyze the influencing factors of acute stress disorder in patients with acute myocardial infarction and to provide theoretical basis for early nursing intervention. Methods 1 patients with acute myocardial infarction who were hospitalized in Department of Cardiology, Tangshan Workers' Hospital from September 2015 to August 2016 were selected as the study subjects. The patients were removed from the intensive care unit on the second day and the 6th to 10th day after the onset of the disease. Patients with acute myocardial infarction with acute stress disorder were selected by Stanford Acute Stress Reaction acute stress response questionnaire (Stanford Acute Stress Reaction questionnaire) and control group. 138 patients with acute myocardial infarction with acute stress disorder were included in the case group. In the same period, 276 patients with non-acute stress disorder acute myocardial infarction were used as control group. The self-designed general demography questionnaire, family function assessment scale, social support scale and pain visual analogue scale were used to evaluate the two groups of patients. 2 the distribution difference of sleep and family social support. 2 all the data were analyzed statistically by using Excel software to establish the database and SPSS 17.0 statistical software. Descriptive statistical analysis was used for general demographic data; chi-square test was used for univariate analysis and intra-group comparison was made by chi-square method; binary Logistic regression analysis was used for multivariate analysis. Results 1 the results of univariate analysis on acute stress disorder in patients with acute myocardial infarction showed that sex, age, marital status, education level, place of residence, who lived with, personality, occupation, monthly income, type of medical insurance, medical expenses; Gensini score, CK value, CK-Mb value and CTN I, duration of defibrillation, time of living in CCU, complications, number of cases, degree of chest pain, Killip grade of cardiac function, experience of being rescued, treatment method, history of coronary heart disease, etc. Frequent angina pectoris or not, sleep quality, department environment influence sleep or not, pain influence sleep or not, social support, family function are related to the occurrence of acute stress disorder in patients with acute myocardial infarction. The multivariate Logistic regression analysis showed that age, sex, cardiac function Killip grade, department environment affected sleep and pain affected sleep. Overtreatment of defibrillation, number of pathological changes, payment of medical expenses, social support, and family function were the influencing factors of acute stress disorder in patients with acute myocardial infarction. Among them, women, poor cardiac function, department environment affected sleep, and pain affected sleep. Overtreatment of defibrillation, multivessel disease, borrowing money to pay for medical expenses, and family dysfunction were risk factors for acute stress disorder in patients with acute myocardial infarction. High degree of social support is the protective factor of acute stress disorder in patients with acute myocardial infarction. Conclusion the occurrence of acute stress disorder in patients with acute myocardial infarction is related to sex, number of pathological changes, cardiac function, chest pain, sleep, family and social support, etc. Pain affects sleep, has been treated with defibrillation, has multivessel disease, borrowed money to pay for medical expenses, and family dysfunction is a risk factor.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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