目的 分析ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者经皮冠状动脉介入术（percutaneous coronary intervention,PCI）后早期运动恐惧现状及其危险因素。方法 回顾性分析2022年1月—2025年1月于南京市第一医院行PCI治疗的150例STEMI患者临床资料,采用Tampa运动恐惧症量表（Tampa Scale for Kinesiophobia,TSK）评估患者早期运动恐惧现状,根据评分将患者分为恐动组（>37分,n=63）及非恐动组（≤37分,n=87）,比较两组患者年龄、文化程度、经济状况、是否合并慢性疾病、术前左心室射血分数（left ventricular ejection fraction,LVEF）水平、婚姻状态、吸烟史、体质量指数（body mass index,BMI）、冠状动脉病变复杂程度（SYNTAX评分）、靶血管类型差异,统计两组一般自我效能感量表（General Self-Efficacy Scale,GSES）、社会支持评定量表（Social Support Rating Scale,SSRS）、广泛性焦虑障碍量表（Generalized Anxiety Disorder Scale,GAD）-2及主动寻求康复指导、对疾病的认知情况,采用单因素及多因素Logistic回归分析,采用Pearson相关系数评价恐动症Tampa评分表评分与GSES、SSRS、GAD-2评分的相关性。结果 STEMI患者PCI后早期恐动症发生率为42.00%;恐动组患者的年龄≥60岁占比、合并糖尿病占比、术前LVEF水平<40%占比、SYNTAX评分≥33分、GSES评分≤20分占比、SSRS评分≤30分占比、GAD-2评分≥3分占比均高于非恐动组。校正性别、文化程度、合并高血压、合并高脂血症、婚姻状态、吸烟史、BMI、主动询问康复计划、主动倾诉心理活动这些因素后,多因素分析显示,年龄、合并糖尿病、LVEF水平低、SYNTAX评分高、GSES评分低、SSRS评分低、GAD-2评分高均是影响STEMI患者PCI后早期运动恐惧的独立危险因素;Pearson相关分析显示,TSK评分与GAD-2评分呈正相关,与GSES、SSRS评分呈负相关。结论 STEMI术后早期运动恐惧的发生与患者年龄、合并糖尿病、术前LVEF水平、SYNTAX评分以及焦虑、自我效能感、社会支持密切相关。应重视对高危患者的识别和干预,通过提升患者的自我效能感和社会支持水平,降低其焦虑情绪,从而改善术后康复效果。
Abstract
Objective To analyze the status quo and risk factors of early kinesiophobia in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods The clinical data of 150 patients with STEMI who received PCI in Nanjing First Hospital from January 2022 to January 2025 were retrospectively analyzed. Tampa Scale for Kinesiophobia (TSK) was used to evaluate the status quo of early kinesiophobia. According to the score, the patients were divided into kinesiophobia group (>37 points, n=63) and non-kinesiophobia group (≤37 points, n=87). The differences in age, education level, presence or absence of chronic disease, preoperative left ventricular ejection fraction level, marital status, smoking history, body mass index (BMI), complexity of coronary artery disease (SYNTAX score) and target vessel type were compared between the two groups. The General Self-Efficacy Scale (GSES), Social Support Rating Scale (SSRS) and Generalized Anxiety Disorder Scale (GAD)-2, and actively seeking rehabilitation guidance, disease awareness were counted in both groups, and univariate and multivariate logistic regression analyses were adopted. Pearson correlation coefficient was used to assess the correlation between Tampa score and GSES, SSRS and GAD-2 scores. Results The incidence rate of early kinesiophobia in STEMI patients after PCI was 42.00%. The proportions of patients with age≥60 years old, concurrent diabetes mellitus, preoperative LVEF level<40%, SYNTAX score≥33 points, GSES score≤20 points, SSRS score ≤30 points and GAD-2 score≥3 points in kinesiophobia group were higher than those in non-kinesiophobia group. After adjusting for gender, education level, concurrent hypertension, concurrent hyperlipidemia, marital status, smoking history, BMI, active inquiry about rehabilitation plan, and active confiding of psychological activities, multivariate analysis showed that age, concurrent diabetes mellitus, low LVEF level, high SYNTAX score, low GSES score, low SSRS score and high GAD-2 score were independent risk factors of early kinesiophobia in STEMI patients after PCI. Pearson correlation analysis showed that TSK score was positively correlated with GAD-2 score, and negatively correlated with GSES score and SSRS score. Conclusion The occurrence of early kinesiophobia after STEMI is closely related to the age, concurrent diabetes mellitus, preoperative LVEF level, SYNTAX score, anxiety, self-efficacy and social support. It is necessary to pay attention to the identification and intervention of high-risk patients, and relieve the anxiety of patients by enhancing the self-efficacy and social support level, so as to improve the postoperative rehabilitation effect.
关键词
ST段抬高型心肌梗死 /
经皮冠状动脉介入术 /
早期 /
运动恐惧 /
自我效能感 /
社会支持 /
焦虑
Key words
ST segment elevation myocardial infarction /
percutaneous coronary intervention /
kinesiophobia /
self-efficacy /
social support /
anxiety
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基金
江苏省医学会介入医学第三期科研专项资金项目“滤器直径与滤器源性下腔静脉内膜增生相关性实验研究”[SYH-3201140-0088（2023035）]
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