急性冠脉综合征患者的社会支持现况及其对心血管预后的影响

发布时间：2018-04-30 23:01

本文选题：急性冠脉综合征 + 社会支持　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:调查急性冠状动脉综合征(acute coronary syndrome,ACS)患者的社会支持现况及相关影响因素,随访患者社会支持的一年变化,健康状况的转归及心血管事件发生情况,分析社会支持对心血管预后的影响,为制定针对社会支持的治疗策略提供依据。方法:2013年1月至2014年6月,于北京大学人民医院、首都医科大学附属北京朝阳医院、首都医科大学附属北京友谊医院、北京中医药大学东直门医院、北京市垂杨柳医院心血管内科筛选并纳入符合标准的ACS住院患者778例,分别在入院7天内、6月和12月完成调查问卷,包括ENRICHD社会支持评定量表(ENRICHD Social Support Inventory,ESSI)、广泛性焦虑量表(general anxiety disorder scale,GAD-7)、患者健康问卷(patient health questionnaire,PHQ-9)、生活质量量表(short-form 12 health survey questionnaire,SF-12)、睡眠问卷和社会人口信息学资料。随访一年,调查患者死亡、心绞痛复发、非致死性心肌梗死及再住院的情况。两组均值的比较采用独立样本的t检验;多组均值的比较采用单因素方差分析,组间比较采用LSD法;计数资料的比较采用卡方检验;采用多元线性回归方程分析ACS患者社会支持的相关影响因素。结果:本研究基线共收回有效问卷771例,其中男517例(67.1%),女254例(32.9%)。ACS患者基线、随访6月、12月的社会支持评分分别为17.08?3.61、17.72?3.04、17.76?3.05;与基线相比,6月(LSD-t=-2.69,P㩳0.01)和12个月(LSD-t=-2.86,P㩳0.01)的社会支持评分显著增高,差异有统计学意义。社会支持基线多元线性回归分析显示,工人和农民(t=2.82,P=0.01)、低家庭月收入(t=2.42,P=0.02)、焦虑(t=-3.66,P=0.00)、抑郁(t=-3.22,P=0.00)和低生活质量(t=4.38,P=0.00)是低社会支持的独立影响因素。总人群的一年死亡率和非致死性心肌梗死率很低,分别为0.4%和1.7%;且与社会支持水平无关;而低社会支持者的心绞痛复发风险(HR 1.66;95%CI1.06-2.62;P㩳0.05)和再住院风险均显著高于高社会支持者(HR2.16;95%CI1.16-4.05;P㩳0.05)。结论:在ACS患者中,工人和农民、低家庭月收入者、伴有焦虑或抑郁者的社会支持偏低。反过来,低社会支持又与患者的焦虑抑郁状态和低生活质量和不良心血管预后密切相关。提示因采取针对社会支持的相关措施,从整体上改善急性冠脉综合征患者的健康状况和心血管预后。
[Abstract]:Objective: to investigate the social support status and related influencing factors in patients with acute coronary syndrome (ACS), to investigate the changes of social support, the outcome of health status and the occurrence of cardiovascular events in patients with acute coronary syndrome (ACS). To analyze the influence of social support on cardiovascular prognosis and to provide evidence for the formulation of treatment strategies for social support. Methods: from January 2013 to June 2014, Beijing Chaoyang Hospital, Capital Medical University, Beijing Friendship Hospital, Dongzhimen Hospital, Beijing University of traditional Chinese Medicine, Beijing University of traditional Chinese Medicine, Beijing Medical University, Beijing Medical University, Beijing Hospital of Friendship, Beijing University of traditional Chinese Medicine, 778 ACS inpatients who met the criteria were selected and included in the Department of Cardiovascular Medicine of Beijing Tuiyangliu Hospital. The questionnaires were completed within 7 days of admission and in June and December, respectively. It includes the ENRICHD Social support rating scale (ENRICHD Social Support inventory), the generalized anxiety disorder scale (anxiety disorder scale), the patient health questionnaire (PHQ-9), the quality of Life scale (short form 12 health survey questionnaire) SF-12, the sleep questionnaire and the social-demographic informatics data. Follow up for one year to investigate death, recurrence of angina pectoris, non-fatal myocardial infarction and re-hospitalization. T test of independent samples was used to compare the mean values of two groups, single factor analysis of variance was used to compare multiple mean values, LSD method was used in comparison between groups, chi-square test was used to compare counting data. Multivariate linear regression equation was used to analyze the related factors of social support in patients with ACS. Results: a total of 771 effective questionnaires were collected from the baseline in this study, including 517 males (67.1%) and 254 females (32.9%), followed up for 6 months. The scores of social support for 12 months were 17.083.61and 17.723.04 and 17.763.05, respectively. Compared with the baseline, the scores of social support in June (LSD-t-2.69P0. 01) and 12 months (LSD-t- 2.86P0. 0. 0) were significantly higher than those in baseline. The difference is statistically significant. The multivariate linear regression analysis of social support baseline showed that workers and peasants were independent factors of low social support, such as 2.82% P0. 01, 2. 42% P0. 02 of low household income, 3. 66% P0. 00m of anxiety, 3. 22% P0. 00 of depression, and 4. 38 P0. 00. of low quality of life. The annual mortality rate and non-fatal myocardial infarction rate of the total population were very low (0.4% and 1.7%, respectively), and were not related to the level of social support, while the risk of angina pectoris recurrence in the low social supporters was 1.6695% (CI 1.06-2.62P0. 05) and the risk of rehospitalization was significantly higher than that of the high social supporters (HR2.1695CI1.16-4.05 P0.05G). Conclusion: in ACS patients, workers and farmers, low family monthly income, anxiety or depression with low social support. In turn, low social support is associated with anxiety and depression, low quality of life and poor cardiovascular outcomes. It is suggested that the health status and cardiovascular prognosis of patients with acute coronary syndrome can be improved by taking relevant measures aimed at social support.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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