标题：心理复原模型框架下的动机性访谈对冠心病老年患者健康管理的影响

      作者：郭燕 1，蔡丹霞 1，赵毅 1，陈士芳 1，车慧文 2    河南科技大学第一附属医院心内科 1、心理科 2，河南 洛阳 471003

      卷次： 2024年35卷12期

      【摘要】 目的 探讨心理复原模型框架下的动机性访谈对冠心病老年患者健康管理的影响。方法 选取2023年1~4月于河南科技大学第一附属医院就诊的164例老年冠心病患者纳入研究，按随机数表法分为研究组和常规组各82例。常规组患者采用常规护理，研究组患者在常规组护理的基础上联合心理复原模型框架下的动机性访谈，两组均干预3个月。干预前后比较两组患者的心功能[左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、6 min步行试验结果、生活质量[西雅图心绞痛调查问卷(SAQ)]、自我管理行为[冠心病自我管理行为量表(CSMS)]、心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]，同时比较两组患者的不良事件发生率和干预后 3个月的复发率。结果 干预后，研究组患者的LVESD、LVEDD分别为(46.25±3.25) mm、(45.39±1.17) mm，明显低于常规组的(50.14±4.19) mm、(49.87±1.39) mm，LVEF和6 min步行试验结果分别为(44.25±2.59)%、(362.27±12.35) m，明显高(长)于常规组的(39.98±2.21)%、(258.54±7.86) m，差异均有统计学意义(P<0.05)；干预后，研究组患者的CSMS、SAQ评分分别为(68.50±1.20)分、(242.21±7.85)分，明显高于常规组的(54.68±2.38)分、(222.05±6.52)分，SAS、SDS评分分别为(38.52±2.14)分、(35.97±1.14)分，明显低于常规组的(44.14±3.58)分、(40.49±2.59)分，差异均有统计学意义(P<0.05)；研究组患者的不良事件总发生率为3.66%，明显低于常规组的12.20%，差异有统计学意义(P<0.05)；干预后3个月，研究组患者的复发率为5.00%，明显低于常规组的15.19%，差异有统计学意义(P<0.05)。结论 心理复原模型框架下的动机性访谈应用于老年冠心病健康管理中可缓解患者负性情绪，改善患者自我管理行为，提升患者心功能及生活质量，降低不良事件发生风险，预防疾病复发。
      【关键词】 心理复原模型；动机性访谈；冠心病；健康管理；心功能
      【中图分类号】 R473.5 【文献标识码】 A 【文章编号】 1003—6350（2024）12—1814—06

Impact of motivational interviewing under the framework of psychological resilience model on the healthmanagement of elderly patients with coronary heart disease.
GUO Yan 1, CAI Dan-xia 1, ZHAO Yi 1, CHEN Shi-fang 1,CHE Hui-wen 2. Department of Cardiology 1, Department of Psychology 2, the First Affiliated Hospital of Henan University ofScience and Technology, Luoyang 471003, Henan, CHINA
【Abstract】 Objective To explore the impact of motivational interviewing under the framework of psychologi-cal resilience model on the health management of elderly patients with coronary heart disease. Methods A total of 164elderly patients with coronary heart disease who were treated at the First Affiliated Hospital of Henan University of Sci-ence and Technology from January 2023 to April 2023 were selected and randomly divided into a study group and a con-ventional group, each with 82 cases. The patients in the conventional group received conventional care, while the pa-tients in the study group received motivational interviewing under the framework of psychological resilience model in ad-dition to conventional care, both for 3 months. Before and after intervention, the cardiac function [left ventricularend-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter(LVEDD)], 6-minute walk test results, quality of life [Seattle Angina Questionnaire (SAQ)], self-management behavior[Coronary Artery Disease Self-management Scale (CSMS)], psychological status [Self-rating Anxiety Scale (SAS),Self-rating Depression Scale (SDS)] of the two groups were compared. The incidence of adverse events and the recur-rence rate at 3 months after intervention were also compared between the two groups. Results After intervention, theLVESD and LVEDD in the study group were (46.25±3.25) mm and (45.39±1.17) mm, respectively, which were signifi-cantly lower than (50.14±4.19) mm and (49.87±1.39) mm in the conventional group, and the LVEF and 6-minute walktest results were (44.25 ± 2.59)% and (362.27 ± 12.35) m, respectively, which were significantly higher than (39.98 ±2.21)% and (258.54±7.86) m in the conventional group, with statistically significant differences (P<0.05). After interven-tion, the CSMS and SAQ scores in the study group were (68.50±1.20) points and (242.21±7.85) points, respectively,which were significantly higher than (54.68±2.38) points and (222.05±6.52) points in the conventional group; the SASand SDS scores were (38.52±2.14) points and (35.97±1.14) points, respectively, which were significantly lower than(44.14±3.58) points and (40.49±2.59) points in the conventional group; the differences were statistically significant (P<0.05). The total incidence of adverse events in the study group was 3.66% (3/82), which was significantly lower than2.20% (10/82) in the conventional group (P<0.05). After intervention, the recurrence rate in the study group was 5.00%(4/80), which was significantly lower than 15.19% (12/79) in the conventional group (P<0.05). Conclusion The appli-cation of motivational interviewing under the framework of psychological recovery model in the health managementof elderly patients with coronary heart disease can alleviate negative emotions, improve patients' self-management be-havior, improve patients' cardiac function and quality of life, reduce the risk of adverse events, and prevent disease re-currence.
      【Key words】 Psychological resilience model; Motivational interviewing; Coronary heart disease; Health manage-ment; Cardiac function