探討接受冠狀動脈支架置放術前後心絞痛症狀之變化及其相關影響因素

Investigate Symptom Changes of Angina and Related Factor before and after Coronary Artery Stent Implantation

徐珮倚(Pei-I Shu)

指導教授 ： 鄭綺

臺北醫學大學/護理學院/護理學研究所/碩士(2013年)

https://doi.org/10.6831/TMU.2013.00156

摘要

心臟病是目前國內十大死亡原因第二位，其中以冠狀動脈相關疾病佔最多數，主要治療方式為冠狀動脈介入術及支架置放術，期望改善冠狀動脈阻塞引起的心絞痛症狀。本研究目的探討患者接受冠狀動脈支架置放術前後心絞痛症狀變化及其影響之因素。
本研究設計採橫斷面相關性研究設計，經由立意取樣選取111位接受冠狀動脈支架置放術患者為研究對象，以結構式問卷測量，問卷包括人口學基本資料表、支架置放紀錄表、心絞痛症狀評估表、冠狀動脈阻塞嚴重度計分表進行手術前後心絞痛症狀變化之調查。資料分析採Spearman Correlation、stepwise regression及Logistic regression分析。
研究結果發現：(一) 疼痛性質描述術前主要以悶痛、刺痛及恐懼害怕最常見，術後4小時內主要也以悶痛、觸壓痛、刺痛常見。疼痛強度術前平均6.77分術後下降至1.30分。(二)影響支架置放術前「疼痛性質」之因素有性別、高血壓過去病史、高血脂過去病史、糖尿病過去病史、LAD冠狀動脈阻塞程度、支架置放術前冠狀動脈阻塞程度總分。支架置放術前「疼痛性質」預測因子有：性別及支架置放術前冠狀動脈阻塞程度總分，解釋術前心絞痛性質總變異量的12.6%。(三)影響支架置放術前「疼痛強度」之因素有高血壓過去病史、高血脂過去病史、年齡、LAD及LCX冠狀動脈阻塞程度、支架置放術前冠狀動脈阻塞程度總分。支架置放術前「疼痛強度」的預測因子有：支架置放術前冠狀動脈阻塞程度及LAD冠狀動脈阻塞程度，解釋術前心絞痛強度總變異量的33.0%。(四)影響支架置放術後4小時內疼痛性質及強度之共同因素為吸菸、高血壓過去病史、高血脂家族史、高血脂過去病史、教育程度、LAD及RCA冠狀動脈阻塞程度、支架置放術前冠狀動脈阻塞程度總分、支架置放術後RCA改變量、支架長度。支架置放術後4小時內疼痛性質及強度的預測因子皆相同，包括：高血脂過去病史、支架置放術前冠狀動脈阻塞程度總分、吸菸習慣。(五)影響支架置放術後4小時內及24小時是否出現心絞痛之共同因素為教育程度、有吸菸習慣、高血脂家族史、高血壓過去病史、高血脂過去病史、心電圖T波倒置、支架置放部位為LAD、支架長度、RCA及LAD冠狀動脈阻塞程度、支架置放術前冠狀動脈阻塞程度。支架置放術後4小時內及24小時是否出現心絞痛之預測因子皆為：吸菸者、高血脂過去病史、支架長度。

關鍵字

冠狀動脈支架置放術 ； 心絞痛症狀

並列摘要

Heart disease is the second leading causes of death in which coronary-related diseases accounted for the most. The main treatment for coronary artery diseases（CAD）are coronary intervention and stent implantation, aiming at improving the symptoms of angina caused by coronary artery occlusion.The purpose of this study is to investigate symptom changes of angina and related factor before and after coronary artery stent implantation.
Cross-sectional correlational design was used. 111 coronary stenting patients were recruited via purposive sampling. Data were collected, including demographic data, angina symptoms, records of stenting, and scoring system for the severity of coronary heart disease, before and after procedure. Data were analyzed by Spearman correlation, Stepwise regression and Logistic regression.
The results were a)The most common pain, dull pain, heaviness, stabbing and fear descriptions were in preprocedure; dull pain, heaviness, tenderness, stabbing were the most common in 4 hours after procedure. The average preprocedure pain intensity was 6.77 points while 1.30 points after procedure. b) The factors influencing quality of pain before stenting were gender, history of hypertension , hyperlipidemia and diabetes, LAD coronary occlusion score, preprocedure total coronary occlusion score（PTCOS）.The predictors of quality of pain before stenting were gender and PTCOS, explaining 12.6% of the variance of preprocedure angina quality. c) The related factors of pain intensity before stenting were history of hyperlipidemia and hypertension, age, LAD and LCX coronary occlusion scores, and PTCOS. Predictors of pain intensity before stenting including PTCOS and LAD coronary occlusion score explained 33.0% of the total variance of preprocedure angina intensity. d) The related factors in quality and intensity of pain in 4 hours after procedure were smoking, history of hypertension and hyperlipidemia, family history of hyperlipidemia, education level, LAD and RCA coronary occlusion score, PTCOS, amount of post procedure RCA change, and stent length. The predictors of quality and intensity of pain in 4 hours after procedure were the same including history of hyperlipidemia, PTCOS, and smoking. e) The related factors of whether angina appeared in 4 hours and 24 hours after procedure were education level, smoking, family history of hyperlipidemia, history of hyperlipidemia and hypertension, electrocardiographic T wave changes, stenting in LAD, stent length, RCA and LAD coronary occlusion score, and PTCOS. The predictors of whether angina appears in 4 hours and 24 hours after procedure were the same including smokers, history of hyperlipidemia, and stent length.

並列關鍵字

coronary artery stent implantation ； angina

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