介入术期间戒烟的冠心病患者1年内复吸的现状和影响因素

发布时间：2018-03-20 01:19

本文选题：冠心病　切入点：PCI　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景经皮冠状动脉介入术(percutaneous coronary intervention,PCI)是冠心病的主要治疗方法。但PCI仅疏通了冠状动脉,不能去除冠心病的死亡危险因素。我国冠心病的死亡率居高不下,原因之一是死亡危险因素没有得到有效控制。吸烟是冠心病死亡的第一危险因素,可显著增加PCI患者支架内再狭窄和死亡的风险。明确复吸的发生特点和相关因素,有利于采取相应的戒烟干预,但暂时未见有关PCI患者戒烟后复吸的发生率随时间的变化特点及影响因素的报道。目的第一,调查介入术期间戒烟的冠心病患者1年内复吸的现状;第二,分析和探讨戒烟后复吸发生的特点和影响因素。方法本研究采取便利抽样的方法,选取在介入术期间戒烟的冠心病患者进行调查和随访,调查了患者的人口学资料、疾病相关资料、吸烟相关资料和心理认知特点。使用的问卷包括:尼古丁依赖量表(FTND)、流调用抑郁自评量表(CES-D)、戒烟自我效能量表(SEQ-12)。在患者出院后3、6、9、12个月时,通过电话对患者和家属进行随访,调查患者是否出现复吸,以及复吸开始的时间。结果共有221例在介入术期间戒烟的冠心病患者完成了全部研究。介入术1年内,51.1%(n=113)出现复吸,48.9%(n=108)戒烟成功。复吸者中,将近一半的患者(n=56)在介入术后3个月内复吸,而后复吸率随术后时间的延长逐渐增长。就业状态、尼古丁依赖水平、抑郁与复吸呈正相关。就业的患者复吸的可能性是非就业患者的3倍(OR:2.98,95%CI:1.15～7.73);尼古丁依赖程度较高的患者比较低者更容易复吸(OR:1.23,95%CI:1.03～1.46);抑郁患者比非抑郁患者复吸的可能性更高(OR:1.14,95%CI:1.05～1.24)。此外,戒烟自我效能与复吸呈负相关(OR:0.94,95%CI:0.91～0.97),即戒烟自我效能水平高的患者复吸的可能性低。结论介入术期间戒烟的冠心病患者1年内出现复吸的现象比较普遍。术后3个月内是复吸发生的高危时期和戒烟干预的重要时期。影响PCI患者戒烟后复吸的因素包括就业状态、抑郁水平、尼古丁依赖程度和戒烟自我效能。戒烟干预时应评估复吸的风险,对复吸风险较高的患者应给予针对性的戒烟指导和帮助。
[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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

【参考文献】