2026 年第 8 期 第 21 卷

基于健康行为改变整合理论的康复方案对老年冠心病经皮冠状动脉介入术后患者自我管理能力及康复结局的影响

Effects of rehabilitation program based on integrated theory of health behavior change on self-management ability and rehabilitation outcomes in elderly patients with coronary atherosclerotic heart disease after percutaneous coronary intervention

作者：华夏夏王志坚李晰杨树鹏柴萌

英文作者：Hua Xiaxia Wang Zhijian Li Xi Yang Shupeng Chai Meng

单位：首都医科大学附属北京安贞医院老年心血管病中心病房北京市心肺血管疾病研究所，北京100029

英文单位：Ward of Geriatric Cardiovascular Disease Center Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；健康行为改变；经皮冠状动脉介入；康复结局

英文关键词：Coronaryatheroscleroticheartdisease;Healthbehaviorchange;Percutaneouscoronaryintervention;Rehabilitationoutcomes

• 摘要：

• 目的 观察基于健康行为改变整合理论（ITHBC）的康复方案对老年冠心病（冠状动脉粥样硬化性心脏病）经皮冠状动脉介入（PCI）术后患者自我管理能力及康复结局的影响。方法 选取2023年1月至2024年6月在首都医科大学附属北京安贞医院接受PCI治疗的老年冠心病患者400例，采用随机数字表法分为观察组与对照组，各200例。对照组实施院内常规康复及出院后电话随访；观察组在对照组基础上增加基于ITHBC的结构化康复干预。分别于干预前、干预后1个月和3个月采用一般自我效能感量表（GSES）、冠心病自我管理量表（CSMS）、西雅图心绞痛量表（SAQ）评估患者自我效能感、自我管理能力和生活质量，同时评价冠心病危险因素认知与治疗依从性表现，统计心血管不良事件发生情况。结果 观察组失访9例，对照组失访15例，最终观察组和对照组分别纳入191例和185例患者。干预前2组患者基线特征，GSES、CSMS、SAQ以及冠心病危险因素认知评分与治疗依从性评分等各项指标差异均无统计学意义（均P＞0.05），干预1个月、3个月后观察组GSES、CSMS、SAQ、冠心病危险因素认知评分及治疗依从性评分均高于对照组（均P＜0.001）。观察组心血管不良事件总发生率低于对照组［11.0%（21/191）比39.5%（73/185）］（χ2=40.610，P<0.001）。结论 基于ITHBC的康复干预能够有效提升老年冠心病PCI术后患者康复效果，降低心血管不良事件发生率。

• Objective To observe the effects of rehabilitation program based on Integrated Theory of Health Behavior Change (ITHBC) on self-management ability and rehabilitation outcomes in elderly patients with coronary atherosclerotic heart disease after percutaneous coronary intervention (PCI). Methods A total of 400 elderly patients with coronary atherosclerotic heart disease who received PCI treatment in Beijing Anzhen Hospital, Capital Medical University from January 2023 to June 2024 were selected and divided into observation group and control group by random number table method, with 200 cases in each group. The control group received routine in-hospital rehabilitation and telephone follow-up after discharge; on the basis of the control group, the observation group was given structured rehabilitation intervention based on ITHBC. General self-efficacy scale (GSES), coronary atherosclerotic heart disease self-management scale (CSMS) and Seattle angina questionnaire (SAQ) were used to evaluate patients′ self-efficacy, self-management ability and quality of life before intervention, 1 month and 3 months after intervention. Meanwhile, cognition of coronary atherosclerotic heart disease risk factors and treatment compliance were evaluated, and the incidence of adverse cardiovascular events was recorded. Results Nine patients were lost to follow-up in the observation group and 15 in the control group. Finally, 191 patients in the observation group and 185 patients in the control group were included. There were no statistically significant differences in baseline characteristics, GSES, CSMS, SAQ, cognition scores of coronary atherosclerotic heart disease risk factors and treatment compliance scores between the two groups before intervention (all P＞0.05). At 1 month and 3 months after intervention, the scores of GSES, CSMS, SAQ, cognition of coronary atherosclerotic heart disease risk factors and treatment compliance in the observation group were all higher than those in the control group (all P＜0.001). The total incidence of adverse cardiovascular events in the observation group was lower than that in the control group ［11.0%(21/191) vs 39.5%(73/185)］(χ2=40.610, P<0.001). Conclusion Rehabilitation intervention based on ITHBC can effectively improve the rehabilitation effect and reduce the incidence of adverse cardiovascular events in elderly patients with coronary atherosclerotic heart disease after PCI.