本文選題：冠心病　切入點：PCI　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景經皮冠狀動脈介入術(percutaneous coronary intervention,PCI)是冠心病的主要治療方法。但PCI僅疏通了冠狀動脈,不能去除冠心病的死亡危險因素。我國冠心病的死亡率居高不下,原因之一是死亡危險因素沒有得到有效控制。吸煙是冠心病死亡的第一危險因素,可顯著增加PCI患者支架內再狹窄和死亡的風險。明確復吸的發(fā)生特點和相關因素,有利于采取相應的戒煙干預,但暫時未見有關PCI患者戒煙后復吸的發(fā)生率隨時間的變化特點及影響因素的報道。目的第一,調查介入術期間戒煙的冠心病患者1年內復吸的現狀;第二,分析和探討戒煙后復吸發(fā)生的特點和影響因素。方法本研究采取便利抽樣的方法,選取在介入術期間戒煙的冠心病患者進行調查和隨訪,調查了患者的人口學資料、疾病相關資料、吸煙相關資料和心理認知特點。使用的問卷包括:尼古丁依賴量表(FTND)、流調用抑郁自評量表(CES-D)、戒煙自我效能量表(SEQ-12)。在患者出院后3、6、9、12個月時,通過電話對患者和家屬進行隨訪,調查患者是否出現復吸,以及復吸開始的時間。結果共有221例在介入術期間戒煙的冠心病患者完成了全部研究。介入術1年內,51.1%(n=113)出現復吸,48.9%(n=108)戒煙成功。復吸者中,將近一半的患者(n=56)在介入術后3個月內復吸,而后復吸率隨術后時間的延長逐漸增長。就業(yè)狀態(tài)、尼古丁依賴水平、抑郁與復吸呈正相關。就業(yè)的患者復吸的可能性是非就業(yè)患者的3倍(OR:2.98,95%CI:1.15～7.73);尼古丁依賴程度較高的患者比較低者更容易復吸(OR:1.23,95%CI:1.03～1.46);抑郁患者比非抑郁患者復吸的可能性更高(OR:1.14,95%CI:1.05～1.24)。此外,戒煙自我效能與復吸呈負相關(OR:0.94,95%CI:0.91～0.97),即戒煙自我效能水平高的患者復吸的可能性低。結論介入術期間戒煙的冠心病患者1年內出現復吸的現象比較普遍。術后3個月內是復吸發(fā)生的高危時期和戒煙干預的重要時期。影響PCI患者戒煙后復吸的因素包括就業(yè)狀態(tài)、抑郁水平、尼古丁依賴程度和戒煙自我效能。戒煙干預時應評估復吸的風險,對復吸風險較高的患者應給予針對性的戒煙指導和幫助。
[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.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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