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Article(id=1241522922796405412, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202310134, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1696867200000, receivedDateStr=2023-10-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931731175, onlineDateStr=2026-03-19, pubDate=1710000000000, pubDateStr=2024-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931731175, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931731175, creator=13701087609, updateTime=1773931731175, updator=13701087609, issue=Issue{id=1241522919977841545, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931730503, creator=13701087609, updateTime=1773931880386, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523548695622547, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523548695622548, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=951, endPage=954, ext={EN=ArticleExt(id=1241522923190669990, articleId=1241522922796405412, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Disease fear after coronary artery bypass grafting in Xinxiang of Henan Province, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between disease fear, self-efficacy, and psychological resilience after coronary artery bypass grafting (CABG) in Xinxiang of Henan province.

Methods

A total of 137 patients who underwent coronary artery bypass grafting in Xinxiang Central Hospital were selected by convenient sampling method. Fear disease progression simplified scale (FoPQ-SF) was used to investigate the status of postoperative fear of disease before discharge, 6 weeks, and 3 months after operation, and self-efficacy scale (GSES) and psychological resilience scale (CDRISC) were used to evaluate their self-efficacy and psychological resilience. Pearson method was used to analyze the correlation between GSES score, CD-RISC score, and FoP-Q-SF score, and Logistic regression model was used to analyze the influencing factors of self-efficacy and psychological resilience on disease fear progression.

Results

The scores of FoP-Q-SF items, total score, GSES score, and CD-RISC score increased gradually before discharge, 6 weeks, and 3 months after operation, and the difference was statistically significant. Pearson correlation showed that GSES score and CD-RISC score were positively correlated with FoP-Q-SF score. Stepwise multivariate Logistic regression analysis showed that GSES score and CD-RISC score were the influencing factors of postoperative disease fear progression.

Conclusion

The disease fear status of patients after coronary artery bypass grafting in Xinxiang area of Henan Province is at a high level, and self-efficacy and psychological resilience are closely related to it, which are also the influencing factors of postoperative disease fear progression.

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目的

调查研究河南新乡地区冠状动脉（简称冠脉）搭桥手术后疾病恐惧现状与自我效能、心理韧性的关系。

方法

采用便利抽样法选取新乡市中心医院三甲医院接受冠脉搭桥手术治疗的137例患者作为研究对象，分别于出院前、术后6周及术后3个月采用恐惧疾病进展简化量表（FoP-Q-SF）调查患者术后对疾病恐惧现状，并采用自我效能量表（GSES）、心理韧性量表（CD-RISC）分别评估其自我效能与心理韧性。采用Pearson法分析GSES评分、CD-RISC评分与FoP-Q-SF评分的相关性，logistic回归模型分析自我效能、心理韧性对疾病恐惧进展的影响因素。

结果

患者出院前、术后6周、术后3个月的FoP-Q-SF各条目评分、总分、GSES评分、CD-RISC评分呈逐渐上升趋势，差异具有统计学意义（P<0.05）。Pearson相关性显示，GSES评分、CD-RISC评分与FoP-Q-SF评分呈正相关（P<0.05）。逐步多因素logistic回归分析，结果显示，GSES评分、CD-RISC评分是影响患者术后疾病恐惧进展的影响因素（P<0.05）。

结论

河南新乡地区冠脉搭桥手术后患者的疾病恐惧现状处于较高水平，自我效能与心理韧性与其密切相关，也是患者术后疾病恐惧进展的影响因素。

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张颖，E-mail:
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张颖（1972—），女，硕士，副主任护师，研究方向：外科护理

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张颖（1972—），女，硕士，副主任护师，研究方向：外科护理

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Postoperative FoP-Q-SF score of patients （）

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时间FoP-Q-SF评分
生理健康评分社会/家庭状况评分总分
出院前16.28±3.8614.07±2.6630.54±2.74
术后6周19.74±4.94*15.74±4.72*35.58±6.77*
术后3个月22.64±5.03*#19.22±4.86*#41.67±6.49*#
), ArticleFig(id=1241678308564324688, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522922796405412, language=CN, label=表1, caption=

患者术后FoP-Q-SF评分（）

, figureFileSmall=null, figureFileBig=null, tableContent=
时间FoP-Q-SF评分
生理健康评分社会/家庭状况评分总分
出院前16.28±3.8614.07±2.6630.54±2.74
术后6周19.74±4.94*15.74±4.72*35.58±6.77*
术后3个月22.64±5.03*#19.22±4.86*#41.67±6.49*#
), ArticleFig(id=1241678310980243808, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522922796405412, language=EN, label=Table 2, caption=

Postoperative self-efficacy and psychological resilience scores of patients （）

, figureFileSmall=null, figureFileBig=null, tableContent=
时间GSES评分CD-RISC评分
出院前37.09±3.6959.46±2.03
术后6周42.85±5.4763.79±2.31
术后3个月50.27±5.3668.64±2.52
), ArticleFig(id=1241678311491948906, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522922796405412, language=CN, label=表2, caption=

患者术后自我效能与心理韧性评分（）

, figureFileSmall=null, figureFileBig=null, tableContent=
时间GSES评分CD-RISC评分
出院前37.09±3.6959.46±2.03
术后6周42.85±5.4763.79±2.31
术后3个月50.27±5.3668.64±2.52
), ArticleFig(id=1241678311873630586, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522922796405412, language=EN, label=Table 3, caption=

Correlation analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
FoP-Q-SF评分GSES评分CD-RISC评分
r值P值r值P值
生理健康评分0.526<0.0010.544<0.001
社会/家庭状况评分0.537<0.0010.501<0.001
), ArticleFig(id=1241678315858219399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522922796405412, language=CN, label=表3, caption=

相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
FoP-Q-SF评分GSES评分CD-RISC评分
r值P值r值P值
生理健康评分0.526<0.0010.544<0.001
社会/家庭状况评分0.537<0.0010.501<0.001
), ArticleFig(id=1241678316806132113, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522922796405412, language=EN, label=Table 4, caption=

Multivariate analysis of postoperative fear of disease progression in patients

, figureFileSmall=null, figureFileBig=null, tableContent=
因素偏回归系数（B）标准误标准化回归系数（β）t值P值偏回归系数95%CI
常量-13.1193.640-3.604<0.001-20.343～-5.895
GSES评分0.3130.0060.99952.187<0.0010.301～0.325
CD-RISC评分0.3790.0640.5195.951<0.0010.252～0.505
), ArticleFig(id=1241678319578567068, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522922796405412, language=CN, label=表4, caption=

患者术后恐惧疾病进展的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素偏回归系数（B）标准误标准化回归系数（β）t值P值偏回归系数95%CI
常量-13.1193.640-3.604<0.001-20.343～-5.895
GSES评分0.3130.0060.99952.187<0.0010.301～0.325
CD-RISC评分0.3790.0640.5195.951<0.0010.252～0.505
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河南新乡地区冠状动脉搭桥术后疾病恐惧现状
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张颖 , 朱海芳
现代预防医学 | 临床与预防 2024,51(5): 951-954
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现代预防医学 | 临床与预防 2024, 51(5): 951-954
河南新乡地区冠状动脉搭桥术后疾病恐惧现状
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张颖 , 朱海芳
作者信息
  • 新乡市中心医院心胸外科，河南 新乡 453000

    • 张颖（1972—），女，硕士，副主任护师，研究方向：外科护理

通讯作者:

张颖，E-mail:
Disease fear after coronary artery bypass grafting in Xinxiang of Henan Province
Ying ZHANG , Hai-fang ZHU
Affiliations
  • Cardiothoracic Surgery Department of Xinxiang Central Hospital, Xinxiang, Henan 453000, China
出版时间: 2024-03-10 doi: 10.20043/j.cnki.MPM.202310134
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摘要
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目的

调查研究河南新乡地区冠状动脉（简称冠脉）搭桥手术后疾病恐惧现状与自我效能、心理韧性的关系。

方法

采用便利抽样法选取新乡市中心医院三甲医院接受冠脉搭桥手术治疗的137例患者作为研究对象，分别于出院前、术后6周及术后3个月采用恐惧疾病进展简化量表（FoP-Q-SF）调查患者术后对疾病恐惧现状，并采用自我效能量表（GSES）、心理韧性量表（CD-RISC）分别评估其自我效能与心理韧性。采用Pearson法分析GSES评分、CD-RISC评分与FoP-Q-SF评分的相关性，logistic回归模型分析自我效能、心理韧性对疾病恐惧进展的影响因素。

结果

患者出院前、术后6周、术后3个月的FoP-Q-SF各条目评分、总分、GSES评分、CD-RISC评分呈逐渐上升趋势，差异具有统计学意义（P<0.05）。Pearson相关性显示，GSES评分、CD-RISC评分与FoP-Q-SF评分呈正相关（P<0.05）。逐步多因素logistic回归分析，结果显示，GSES评分、CD-RISC评分是影响患者术后疾病恐惧进展的影响因素（P<0.05）。

结论

河南新乡地区冠脉搭桥手术后患者的疾病恐惧现状处于较高水平，自我效能与心理韧性与其密切相关，也是患者术后疾病恐惧进展的影响因素。

冠状动脉搭桥手术  /  疾病恐惧现状  /  自我效能  /  心理韧性  /  相关性
Objective

To investigate the relationship between disease fear, self-efficacy, and psychological resilience after coronary artery bypass grafting (CABG) in Xinxiang of Henan province.

Methods

A total of 137 patients who underwent coronary artery bypass grafting in Xinxiang Central Hospital were selected by convenient sampling method. Fear disease progression simplified scale (FoPQ-SF) was used to investigate the status of postoperative fear of disease before discharge, 6 weeks, and 3 months after operation, and self-efficacy scale (GSES) and psychological resilience scale (CDRISC) were used to evaluate their self-efficacy and psychological resilience. Pearson method was used to analyze the correlation between GSES score, CD-RISC score, and FoP-Q-SF score, and Logistic regression model was used to analyze the influencing factors of self-efficacy and psychological resilience on disease fear progression.

Results

The scores of FoP-Q-SF items, total score, GSES score, and CD-RISC score increased gradually before discharge, 6 weeks, and 3 months after operation, and the difference was statistically significant. Pearson correlation showed that GSES score and CD-RISC score were positively correlated with FoP-Q-SF score. Stepwise multivariate Logistic regression analysis showed that GSES score and CD-RISC score were the influencing factors of postoperative disease fear progression.

Conclusion

The disease fear status of patients after coronary artery bypass grafting in Xinxiang area of Henan Province is at a high level, and self-efficacy and psychological resilience are closely related to it, which are also the influencing factors of postoperative disease fear progression.

Coronary artery bypass surgery  /  Disease fear status  /  Self-efficacy  /  Psychological resilience  /  Correlation
张颖, 朱海芳. 河南新乡地区冠状动脉搭桥术后疾病恐惧现状. 现代预防医学, 2024 , 51 (5) : 951 -954 . DOI: 10.20043/j.cnki.MPM.202310134
Ying ZHANG, Hai-fang ZHU. Disease fear after coronary artery bypass grafting in Xinxiang of Henan Province[J]. Modern Preventive Medicine, 2024 , 51 (5) : 951 -954 . DOI: 10.20043/j.cnki.MPM.202310134
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冠心病在心血管疾病中具有较高的病死率，随着社会经济水平提高，人们生活方式变化，导致心血管这一疾病的人群数量逐年增加，成为危害人类生命健康方面的重大问题[1-2]。由冠心病不可逆且无法彻底治愈，使患者的劳动力受限，且需长期治疗，患者易产生拖累家人的负担心理感受。冠状动脉（简称冠脉）搭桥手术即为冠脉旁路移植术，是一种有效治疗冠心病的确切手段，具有良好近远期疗效[3]。该手术在临床中日益成熟，接受冠脉搭桥患者逐渐增多。由于心脏疾病给患者带来的心理应激与术后症状困扰等，患者术后多存在不同程度疾病恐惧心理，加重心理负担，且长期过度恐惧进一步加重负性情绪，影响生活质量而降低治疗依从性，形成恶习循环，不利于预后[4-5]。自我效能为人们对自身组织、实施行为并达到与其效果能力的主观判断，即对自身行为能力的信心，也是患者术后生活质量的重要影响因素[6]。自我效能水平越高表示行为采取的努力程度越高，有助于疾病康复。作为心理保护方面的一种资源，心理韧性能够一定程度上让病人对疾病的应对方面能力和治疗依从性提高，增强其自我护理方面的能力，可以较好的发挥情绪调节的作用[7]。冠脉搭桥手术由于手术费用高且术后需长期服药，患者可能伴有焦虑、自责等负性情绪，加重其自我负担，不利于康复[8]。目前有关冠脉搭桥患者术后疾病恐惧现状的研究较少有报道。为此，本研究通过调查研究河南新乡地区冠脉搭桥手术患者术后疾病恐惧现状与其自我效能和心理韧性方面的关系，旨在为病人术后日常生活的质量改善提供相应的理论依据。
1　资料与方法
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1.1　一般资料
采用便利抽样法选取2020年5月—2022年12月河南新乡地区新乡市中心医院（三甲医院）接受冠脉搭桥手术治疗的137例患者作为研究对象。纳入标准：（1）成功且第一次实施冠脉搭桥手术；（2）年龄>18岁；（3）术后预生存期超过半年；（4）配合量表填写调查；（5）对本调查研究知情同意。排除标准：（1）沟通交流方面存在障碍的病人；（2）存在其他方面的恶性肿瘤者；（3）肾脏功能方面存在比较严重障碍者；（4）病情状态无法行问卷调查患者。纳入患者中男性75例，女性62例；年龄为35～70岁，平均（43.19±8.38）岁；患病时间：<1年64例，1～5年48例，>5年25例；婚姻状况：已婚95例，丧偶42例；费用支付方式：自费32例，医疗保险84，公费21例；文化程度：小学及以下，中学及以上；居住地：农村58例，城市79例。本研究取得本地医院伦理委员会批准（伦理批号：2023_138）。
1.2　方法
1.2.1　调查量表
人口学资料方面的调查：问卷自行设计，内容主要有性别、职业、年龄、婚姻方面的情况、具体的文化程度、家庭具体的月收入、过去的病史情况等。
术后疾病恐惧现状调查：恐惧疾病进展简化量表（FoP-Q-SF）[9]评估患者疾病恐惧进展现状，量表包括生理健康、社会/家庭状况2个维度，每维度包含6个条目；每条目采用5级评分法分别计1～5分，总分12～60分，分数与患者疾病恐惧进展程度成反比。
自我效能方面的调查：利用一般自我效能感量表（GSES）[10]对病人的自我效能予以评估，量表共有条目10个，采用1～4分代表完全不正确、完全正确，其中1～10分代表自信心很低，甚至有点自卑；11～20分代表自信心偏低；21～30分代表自信心较高；31～40分代表自信心非常高；分数越高其自我效能越好。
心理韧性调查：心理韧性量表（CD-RISC）[11]评估患者心理韧性方面的情况，量表共有条目25个，分为力量、坚韧和乐观这3个维度，各项采用5级评分法，其中25分以下心理弹性极差，抗挫折能力极差；26～50分抗压能力心理弹性较差；51～75分代表抗压能力较好；总分在76～100分代表抗压能力很强；分数与心理韧性成正比。
1.2.2　调查方法
患者于术后在治疗医院接受相同常规护理与冠心病教育，待病情稳定后行问卷调查；调查时间为出院前、术后6周与术后3个月。为防止患者对调查产生误解，调查人员经全面统一培训，统一指导语向病人说明具体的填写方式，对存在疑问的问题给出解释，由病人自己填写；若其无法填写，让研究者向病人仔细朗读问卷的内容然后再记录其所选的答案。研究人员在病人问卷全部填写完毕后当场检查并收回问卷，出现遗漏的情况需要立马补充。本调查共发放142份，回收137份，有效率方面，该问卷达到了96.48%。
1.3　统计学方法
采用SPSS 20.0软件处理相关的数据，符合正态分布的FoP-Q-SF评分、GSES与CD-RISC评分以（）表示，两组间比较采用独立样本t检验，重复测量数据比较采用重复测量方差分析；采用Pearson相关分析FoP-Q-SF总分与GSES、CD-RISC评分的相关性，逐步多因素logistic回归模型分析自我效能与心理韧性对患者术后疾病恐惧现状的影响。检验水准α=0.05。
2　结果
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2.1　患者术后的疾病恐惧现状
患者出院前、术后6周、术后3个月的FoP-Q-SF生理健康评分、社会/家庭状况评分以及总分对比，差异具有统计学意义（P<0.05）。其中术后3个月高于出院前、术后6周；术后6周高于出院前，差异具有统计学意义（P<0.05）。见表1。
2.2　患者自我效能与心理韧性调查结果
患者出院前、术后6周、术后3个月的GSES评分、CD-RISC评分对比，差异具有统计学意义（P<0.05）。其中术后3个月高于出院前、术后6周；术后6周高于出院前，差异具有统计学意义（P<0.05）。见表2。
2.3　相关性分析
Pearson相关性显示，GSES评分、CD-RISC评分与FoP-Q-SF评分呈正相关（P<0.05）。见表3。
2.4　影响因素分析
将GSES评分、CD-RISC评分这两个连续数值的自变量根据评分标准进行赋值，其中GSES评分为≤20分=0、>20分=1，CD-RISC评分为≤50分=0、>50分=1；采用逐步多因素logistic回归分析，结果显示，GSES评分、CD-RISC评分是影响患者术后疾病恐惧进展的影响因素（P<0.05）。见表4。
3　讨论
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随着经济水平提高，人们生活方式变化，心血管疾病成为危害健康的重大公共卫生问题[12]。心血管疾病中死亡率较高的为冠心病，冠脉搭桥术是治疗该病的常用方式[13]，能有效缓解患者缺血缺氧情况，提高血液灌注并改善冠脉狭窄程度。疾病恐惧进展为患者对于疾病有关的恐惧心理，包括对手术与预后不确定感，为患者普遍存在的心理[14]。研究指出，对疾病适当的恐惧能促进患者自我管理能力提高，但长期过度恐惧则产生不良影响[15]。目前随着冠脉搭桥手术技术的日益成熟，接受手术治疗的心脏患者逐渐增多。对于心脏疾病带来的不良影响，患者术后恐惧疾病进展心理较为严重。故关注患者术后恐惧疾病进展现状并探究其影响因素，进而早期对患者实施针对性干预能有效提高术后疗效与预后。
研究结果显示，患者出院前FoP-Q-SF总分为（30.54±2.74）分，说明患者普遍有过度心理恐惧，探究术后患者恐惧疾病进展的影响因素较为重要。患者术后大多缺乏对疾病应对处理的能力、心理健康水平处于较差水平。该结果原因可能是病人在面对危及自身生命健康且突发的疾病时，其对于疾病的担心让日常的生活与工作等出现负面的情绪。术后病人的生活自理方面的能力下降，面对社会和心理适应方面的能力调整，家庭角色的改变，造成其心理韧性不断的下降[16-17]。社会支持利用度越高，患者术后自我效能水平越高，尤其是家庭支持度[18]。患者GSES评分在出院前、术后6周及3个月逐渐上升，说明患者经冠脉搭桥治疗后症状得到改善，身体各功能缓解后在生活中建立治疗信心。本研究中大部分患者为在职或退休人群，经济负担相对较少，长期治疗与自我管理中得到家人较好的照顾与支持，获得正性情感交流，提高患者治疗信心，使其自我控制疾病的态度坚定，自我效能感更高[19-20]。故关注患者术后社会、家庭支持能有效高患者治疗信心并提高其自我效能。患者出院前CD-RISC评分（59.46±2.03）分，表明大部分患者冠脉搭桥术后缺乏对疾病应对能力，其情绪不稳定，心理健康处于较低水平。该结果原因可能为患者面对突发且危及生命的疾病，对疾病的担心影响正常生活，与人际交往出现负面影响[21-22]。术后病人家庭角色出现了改变，术生活自理方面的能力下降，造成其社会和心理方面的适应需重新调整，让心理韧性逐渐降低。经Pearson相关性显示，自我效能、心理韧性与疾病恐惧进展评分呈负相关，logistic回归分析显示，冠脉搭桥术后GSES评分、CD-RISC评分是影响患者术后疾病恐惧进展的影响因素。该结果原因可能为患者术后具有一定负性情绪，心理负担加重而影响其对疾病恐惧心理的进展[23-24]。
综上所述，河南新乡地区冠脉搭桥术后患者疾病恐惧进展程度较高，与其自我效能、心理韧性密切相关，且是影响疾病恐惧进展的影响因素。对患者术后应建立高效心理管理模式，改善其术后不良情绪以减轻对疾病恐惧心理。
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doi: 10.20043/j.cnki.MPM.202310134
  • 接收时间：2023-10-10
  • 首发时间：2026-03-19
  • 出版时间：2024-03-10
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  • 收稿日期：2023-10-10
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    新乡市中心医院心胸外科，河南 新乡 453000

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species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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