中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
26期
3142-3147
,共6页
张敏%史云科%刘苓%杨燕飞%肖践明%郭涛
張敏%史雲科%劉苓%楊燕飛%肖踐明%郭濤
장민%사운과%류령%양연비%초천명%곽도
疲劳%急性冠状动脉综合征%强体力活动
疲勞%急性冠狀動脈綜閤徵%彊體力活動
피로%급성관상동맥종합정%강체력활동
Fatigue%Acute coronary syndrome%Physical exertion
背景倦怠是一种压力作用下的负性情感反应，目前关于倦怠与冠心病预后的研究较少。目的观察倦怠对急性冠脉综合征（ ACS）患者康复过程中体力恢复的影响，探索倦怠与ACS患者康复之间的关系，为改善患者预后提供理论依据。方法本研究是一项前瞻性队列研究。选择2012年3月—2014年3月因首次发生ACS而收住昆明医科大学第一附属医院心内科的患者，病情稳定后用哥本哈根倦怠量表的一般倦怠子量表评估其倦怠水平，按倦怠水平分为高倦怠组和低倦怠组。出院后1个月时随访，用简短体力测试方案（ SPPB）检测患者体力状况，并再次评估倦怠水平，按倦怠水平变化情况分为4个亚组：持续高倦怠亚组、倦怠降低亚组、持续低倦怠亚组、倦怠升高亚组，比较各亚组之间体力状态的差异，并构建多重线性回归模型进一步检验倦怠对体力恢复的影响。结果低倦怠组患者SPPB体力评分较高倦怠组患者高，差异有统计学意义（ t=-3.307，P<0.01）。持续低倦怠亚组、持续高倦怠亚组、倦怠降低亚组、倦怠升高亚组，对应的SPPB评分分别为（9.7±1.6）、（7.8±1.8）、（8.6±1.8）、（7.3±2.0）分，各亚组患者出院后1个月时的SPPB评分间差异有统计学意义（ F=8.933，P<0.001）。两两比较显示，持续低倦怠亚组SPPB评分高于其他亚组，差异有统计学意义（ P<0.05）。以SPPB体力评分为因变量构建多重线性回归模型，结果显示，在排除年龄、性别等混杂因素后，出院时的一般倦怠子量表评分每升高1分，1个月后SPPB评分下降0.052分；出院后1个月时一般倦怠子量表评分每较基线增加1分，SPPB评分下降0.054分。结论倦怠可导致ACS患者康复过程中的体力活动下降，是ACS患者体力康复不良的独立危险因素。
揹景倦怠是一種壓力作用下的負性情感反應，目前關于倦怠與冠心病預後的研究較少。目的觀察倦怠對急性冠脈綜閤徵（ ACS）患者康複過程中體力恢複的影響，探索倦怠與ACS患者康複之間的關繫，為改善患者預後提供理論依據。方法本研究是一項前瞻性隊列研究。選擇2012年3月—2014年3月因首次髮生ACS而收住昆明醫科大學第一附屬醫院心內科的患者，病情穩定後用哥本哈根倦怠量錶的一般倦怠子量錶評估其倦怠水平，按倦怠水平分為高倦怠組和低倦怠組。齣院後1箇月時隨訪，用簡短體力測試方案（ SPPB）檢測患者體力狀況，併再次評估倦怠水平，按倦怠水平變化情況分為4箇亞組：持續高倦怠亞組、倦怠降低亞組、持續低倦怠亞組、倦怠升高亞組，比較各亞組之間體力狀態的差異，併構建多重線性迴歸模型進一步檢驗倦怠對體力恢複的影響。結果低倦怠組患者SPPB體力評分較高倦怠組患者高，差異有統計學意義（ t=-3.307，P<0.01）。持續低倦怠亞組、持續高倦怠亞組、倦怠降低亞組、倦怠升高亞組，對應的SPPB評分分彆為（9.7±1.6）、（7.8±1.8）、（8.6±1.8）、（7.3±2.0）分，各亞組患者齣院後1箇月時的SPPB評分間差異有統計學意義（ F=8.933，P<0.001）。兩兩比較顯示，持續低倦怠亞組SPPB評分高于其他亞組，差異有統計學意義（ P<0.05）。以SPPB體力評分為因變量構建多重線性迴歸模型，結果顯示，在排除年齡、性彆等混雜因素後，齣院時的一般倦怠子量錶評分每升高1分，1箇月後SPPB評分下降0.052分；齣院後1箇月時一般倦怠子量錶評分每較基線增加1分，SPPB評分下降0.054分。結論倦怠可導緻ACS患者康複過程中的體力活動下降，是ACS患者體力康複不良的獨立危險因素。
배경권태시일충압력작용하적부성정감반응，목전관우권태여관심병예후적연구교소。목적관찰권태대급성관맥종합정（ ACS）환자강복과정중체력회복적영향，탐색권태여ACS환자강복지간적관계，위개선환자예후제공이론의거。방법본연구시일항전첨성대렬연구。선택2012년3월—2014년3월인수차발생ACS이수주곤명의과대학제일부속의원심내과적환자，병정은정후용가본합근권태량표적일반권태자량표평고기권태수평，안권태수평분위고권태조화저권태조。출원후1개월시수방，용간단체력측시방안（ SPPB）검측환자체력상황，병재차평고권태수평，안권태수평변화정황분위4개아조：지속고권태아조、권태강저아조、지속저권태아조、권태승고아조，비교각아조지간체력상태적차이，병구건다중선성회귀모형진일보검험권태대체력회복적영향。결과저권태조환자SPPB체력평분교고권태조환자고，차이유통계학의의（ t=-3.307，P<0.01）。지속저권태아조、지속고권태아조、권태강저아조、권태승고아조，대응적SPPB평분분별위（9.7±1.6）、（7.8±1.8）、（8.6±1.8）、（7.3±2.0）분，각아조환자출원후1개월시적SPPB평분간차이유통계학의의（ F=8.933，P<0.001）。량량비교현시，지속저권태아조SPPB평분고우기타아조，차이유통계학의의（ P<0.05）。이SPPB체력평분위인변량구건다중선성회귀모형，결과현시，재배제년령、성별등혼잡인소후，출원시적일반권태자량표평분매승고1분，1개월후SPPB평분하강0.052분；출원후1개월시일반권태자량표평분매교기선증가1분，SPPB평분하강0.054분。결론권태가도치ACS환자강복과정중적체력활동하강，시ACS환자체력강복불량적독립위험인소。
Background Burnout is a kind of negative affective response under pressure, and there is a lack of researches about burnout and the prognosis of coronary heart disease at present. Objective To observe the influence of burnout on the physical strength recovery in the process of rehabilitation of patients with acute coronary syndrome( ACS)and examine the relationship between burnout and the rehabilitation of ACS patients,in order to provide theoretical references for the improvement of prognosis of ACS patients. Methods In this prospective cohort study,we enrolled patients having first ACS onset in the Department of Cardiology, the First Affiliated Hospital of Kunming medical University from march 2012 to march 2014 as subjects,and evaluated the subjects′burnout level by using the general burnout subscale of Copenhagen Burnout Inventory after their condition got stable. According to burnout level,the subjects were assigned into high burnout group and low burnout group. During the follow-up visits to the subjects one month after discharge,physical strength of the subjects was tested by using Short Physical Performance Battery( SPPB)and burnout level was evaluated again. According to the changes of burnout level,the subjects were divided into four subgroups:continuing high burnout subgroup, continuing low burnout subgroup, decreasing burnout subgroup and increasing burnout subgroup. Then physical strength status was compared among the four subgroups,and multiple linear regression model was built to further examine the influence of burnout on the recovery of physical strength. Results Low burnout group was significantly higher(t= -3. 307,P<0. 01)than high burnout group in SPPB score. The scores of continuing low burnout subgroup, continuing high burnout subgroup, decreasing burnout subgroup and increasing burnout subgroup were(9. 7 ± 1. 6),(7. 8 ± 1. 8),(8. 6 ± 1. 8)and(7. 3 ± 2. 0) respectively. The four subgroups were significantly different(F=8. 933,P<0. 001)in the SPPB score one month after discharge. The continuing low burnout subgroup was higher (P<0. 05)than the other three subgroups in SPPB score. The multiple linear regression model with SPPB score as dependent variable showed the following results:after the exclusion of the confounding factors like age and gender,one score increase in the general burnout subscale finished at discharge was associated with 0. 052 score decrease in the SPPB evaluation one month later;one score higher than baseline in the general burnout subscale finished one month after discharge was associated with 0. 054 score decrease in the SPPB evaluation. Conclusion Burnout could lead to the decrease of physical strength in the process of rehabilitation of ACS patients and is an independent risk factor for the poor rehabilitation of ACS patients.
