糖尿病合并冠心病患者术后运动恐惧变化轨迹及其影响因素 [中文引用][英文引用]

目的  探讨糖尿病合并冠心病患者冠状动脉旁路移植术（coronary artery bypass grafting，CABG）后运动恐惧轨迹及其影响因素并总结护理对策。方法  选取 2022 年 1 月至 2024 年 12 月在本院接受 CABG 的 360 例糖尿病患者为研究对象，应用一般资料调查问卷和中文版心脏病患者运动恐惧量表（Chinese version of the Tampa scale for Kinesiophobia Heart，TSKHeart-C）对其进行调查，分别在术前、术后 1 个月、术后 3 个月、术后 6 个月评估患者运动恐惧水平，应用潜类别增长模型分析运动恐惧的变化轨迹，并通过多元 Logistic 回归分析其影响因素。结果  糖尿病患者 CABG 术后运动恐惧轨迹可分为运动恐惧缓解型、稳定型和增长型 3 类，分别占 18.1%、57.8% 和 24.1%。微型营养评定简表（mini nutritional assessment，MNA）评分、社会支持量表（social support rating scale，SSRS）评分、慢性病自我效能量表（chronic disease self-efficacy scale，CDSES）评分、糖化血红蛋白（glycated hemoglobin，HbA1c）水平、视力障碍、日常生活能力分级、降糖药物使用情况及桥血管类型是运动恐惧轨迹类型的影响因素（均 P<0.05）。其中，与缓解型相比，SSRS 评分降低、CDSES 评分降低、HbA1c 水平升高、存在视力障碍、日常生活依赖程度增加、口服药联合胰岛素治疗以及采用大隐静脉桥的患者易归属于运动恐惧稳定型；与缓解型相比，MNA 评分降低、SSRS 评分降低、HbA1c 水平升高、存在视力障碍及日常生活能力依赖程度增加的患者易归属运动恐惧增长型。结论  糖尿病患者 CABG术后运动恐惧轨迹呈明显异质性，其中运动恐惧稳定型占多数。需针对以上影响因素通过营养优化、心理干预、功能康复、血糖控制及术后延续护理等护理措施减少患者进入不良运动恐惧轨迹。

Objective To investigate the trajectories of motion phobia and the factors that influenced the patients with diabetes complicated with coronary heart disease after coronary artery bypass grafting（CABG），and to propose nursing countermeasures. Methods A total of 360 patients who received CABG in Jiangsu Provincial Hospital from January 2022 to December 2024 were investigated using the general information questionnaire and the Chinese version of the Tampa scale for Kinesiophobia Heart（TSK HEART-C）. Motion phobia of the patients were assessed before surgery and at 1，3，and 6 months after surgery. The latent category growth model（LGCM） was used to identify distinct trajectories of motion phobia，and multinomial logistic regression was performed to identify the associated factors. Results LCGM identified three distinct trajectories of motion phobia：mitigation（18.1%），stabilisation（57.8%）and aggravation （24.1%）. Multinomial logistic regression analysis demonstrated that the scores of mini nutritional assessment（MNA），social support rating scale（SSRS）and Chinese diabetes self-efficacy scale（CDSES），HbA1c，visual impairment，activities of daily living（ADL），use of antidiabetic medications and type of graft vessel for CABG were the factors influencing the trajectories type of motion phobia（all P<0.05）. Specifically，in comparison with the mitigation trajectory，the patients with lower scores in SSRS and CDSES，higher HbA1c，visual impairment，increased ADL dependence，oral medication combined with insulin and saphenous vein grafts for CABG were more likely of a stabilisation trajectory. While the patients with lower scores in MNA and SSRS，higher HbA1c，visual impairment，and increased ADL dependence were more likely of an aggravation trajectory. Conclusion The trajectories of motion phobia after CABG in the patients with diabetes and coronary heart disease exhibit significant heterogeneity，with the majority of stabilisation trajectory. Targeted nursing measures should be in place to address the identified factors that influence the motion phobia. Optimising nutrition supply，psychosocial support，functional rehabilitation，glycemic control and continuous care after discharge，etc. are essential to prevent patients from entering unfavourable trajectories of motion phobia.