浦伟青 秦娜梅 王志农

[摘要] 目的 觀察冠状动脉旁路移植术后早发房颤患者疾病不确定感水平，并分析其影响因素。 方法 选取2013年6月～2014年12月期间因冠状动脉粥样硬化性心脏病于第二军医大学附属长征医院行冠状动脉旁路移植术后合并早发房颤的患者48例为研究对象。采用Mishel疾病不确定感量表评估患者的疾病不确定感水平，采用一般资料调查问卷、Connor-Davidson韧性量表、医学应对方式量表、自我效能评价量表及社会支持水平量表对研究对象进行调查，并分析与患者疾病不确定感的相关因素。 结果 48例患者疾病不确定感总分平均分为（102.3±11.8）分，处于中等水平。不同性别、年龄、文化程度、家庭月平均收入、病程、自我效能水平及患者是否有医保、是否合并症组组间患者疾病不确定感总分比较差异有统计学意义（P < 0.05）。Pearson相关分析显示，患者的疾病不确定感总分与坚韧（r = 0.395，P = 0.012）、自强（r = 0.372，P = 0.017）、乐观（r = 0.401，P = 0.004）、回避（r = 0.391，P = 0.008）、屈服（r = 0.562，P = 0.000）呈正相关，与社会支持总量（r = -0.463，P = 0.000）、支持利用度（r = -0.369，P = 0.019）及应对方式中的面对（r = -0.417，P = 0.000）呈负相关。多元线性逐步回归分析结果显示，年龄、文化程度、家庭月平均收入、医保、合并症、自我效能、自强、乐观、面对、回避、屈服及社会支持总量对疾病不确定感水平有显著影响。 结论 冠状动脉旁路移植术后早发房颤患者疾病不确定感水平处于中等，年龄、文化程度、家庭月平均收入、医保、合并症、自我效能、心理韧性、应对方式及社会支持水平是疾病不确定感水平的主要影响因素。

[关键词] 冠状动脉旁路移植术；房颤；疾病不确定感；相关因素

[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-7210（2016）02（b）-0067-04

Related factors of uncertainty in illness in coronary artery bypass graft surgery patients with early atrial fibrillation

PU Weiqing QIN Namei WANG Zhinong

Department of Cardiothoracic Surgey， Changzheng Hospital Affiliated to the Second Military Medical University， Shanghai 200003， China

[Abstract] Objective To investigate the current status of uncertainty in illness in coronary artery bypass graft surgery （CABG） patients with early atrial fibrillation and analyze its influential factor. Methods 48 coronary artery bypass graft surgery patients with early atrial fibrillation from June 2013 to December 2014 in Changzheng Hospital Affiliated to the Second Military Medical University were selected for the study. Uncertainty in Illness level was assessed by MishelUncertainty in Illness Scale （MUIS）. General information questionnaire， Connor-Davidson Resilience Scale， medical coping style scale， self-efficacy scale and social support rating scale were used in this study， and the relevant factors of uncertainty of illness were analysed. Results The average score of uncertainty in illness in 48 coronary artery bypass graft surgery patients with early atrial fibrillation was （102.3±11.8） score， which was in the middle level. The score of uncertainty in illness of patients in different gender， age， education level， average monthly household income， duration， level of self-efficacy and whether the patient has health insurance， whether with complication were statistically significant different （P < 0.05）. Pearson correlation analysis showed that score of uncertainty in illness was positively correlated with tenacity （r = 0.395， P = 0.012）， self-reliance （r = 0.372， P = 0.017）， optimism （r = 0.401， P = 0.004）， avoidance （r = 0.391， P = 0.008） yield （r = 0.562， P =0.000）， and was negativly correlated with the utilization of support （r = -0.463， P = 0.000）， total social support scores （r = -0.369， P = 0.019） and facing in medical coping style scale （r = -0.417， P = 0.000）. Multiple linear regression analysis showed that age， education level， average monthly household income， health care， complications， self-efficacy， self-reliance， optimism， facing， avoiding， yield and total social support levels were the risk factors of uncertainty in illness level. Conclusion The level of uncertainty in illness in coronary artery bypass graft surgery patients with early atrial fibrillation is moderate. Age， education level， average monthly household income， health care， complications， self-efficacy， resilience， coping style and social support level are factors influencing uncertainty in illness level of patients.

[Key words] Coronary artery bypass grafting； Atrial fibrillation； Uncertainty in illness； Related factors

冠状动脉旁路移植术（coronary artery bypass grafting，CABG）通过血管重建，能有效改善心肌缺血、治愈或缓解患者心绞痛的症状、预防心肌梗死的发生、改善患者生活质量以及延长壽命，是冠状动脉粥样硬化性心脏病的主要治疗手段之一[1-3]。术后心房颤动是CABG术后常见并发症，其发生率为17%～33%[4-5]。研究表明疾病不确定感可影响患者的心理调节能力和对疾病的应对能力，进而影响患者的治疗效果和生活质量[6-7]。本研究对CABG术后发生房颤患者的疾病不确定感进行调查，并采用多元线性逐步回归分析与疾病不确定感相关的因素，为制订科学干预策略提供理论依据。……