運動活動對初次行經皮冠狀動脈介入術病人憂鬱及日常活動能力之影響：追蹤性研究

The Impact of Physical Activity on Depression and Activities of Daily Living Among Coronary Artery Disease Patients Undergoing Primary Percutaneous Coronary Interventions: A Follow-Up Study

蘇淑芬(Shu-Fen Su) ； 葉文婷(Wen-Ting Yeh) ； 麥育英(Yu-Ying Mai)

《澄清醫護管理雜誌》 18卷2期 (2022/04) Pp. 28-37

摘要

目的：探討運動活動對初次行經皮冠狀動脈介入術病人憂鬱程度及日常活動能力之影響。方法：採前瞻性追蹤性研究，立意取樣，自2018年2月至12月於中部某醫學中心進行，共收案129位病人，測量工具含基本屬性及醫療處置、醫院憂鬱量表及杜克活動狀況指數問卷，於住院手術前（T1）、出院第二週（T2）及出院第三個月（T3）進行測量。研究資料以描述性統計、T-test、Pearson Correlation及廣義估計函數式進行統計分析。結果：初次行經皮冠狀動脈介入術，43.4％病人有規律運動活動之習慣，48％病人感到憂鬱，13.2％覺得日常活動能力偏低。憂鬱與年齡（r=0.213）呈顯著正相關，與日常活動能力（r=-0.711）呈負相關。日常活動能力與年齡（r=-0.361）呈負相關。有運動活動的病人相較於無運動活動者，憂鬱程度較低和日常活動能力較高。從術前到出院後三個月，無論PCI手術前與術後，有／無運動活動習慣的二組，在憂鬱和日常活動能力的改變量，均無顯著差異。結論：初次行經皮冠狀動脈介入術病人年齡越大，憂鬱程度越高，但日常活動能力越低。無論手術前、後有無運動活動之習慣，術後3個月之憂鬱程度及日常活動能力的改變量並無顯著差異，可能與病人返家後並未改變原有的運動習慣和頻率，加上執行運動活動可能遭遇困境，故建議個管師須持續追蹤病人在家心臟復健運動之情形，確保病人獲得良好家庭支持，規劃和追蹤病人是否規律的身體運動活動，以預防冠心症再度發生。

關鍵字

運動活動 ； 冠心症 ； 經皮冠狀動脈介入術 ； 憂鬱 ； 日常活動能力

並列摘要

Purposes: This study was conducted to evaluate the impact of physical activity on depression and the ability to perform activities of daily living (ADLs) among coronary artery disease (CAD) patients who underwent primary percutaneous coronary interventions (PCIs). Methods: In this prospective follow-up study with purposive sampling, 129 patients from a medical center in central Taiwan were enrolled from February to December, 2018. The patients were evaluated based on demographic questionnaires, medical records, hospital depression scale, and the Duke activity status index. The evaluations were made pre-PCI, 2 weeks after discharge, and 3 months after discharge. Statistical analysis was conducted using descriptive statistics, t-tests, Pearson correlation, and generalized estimating equations (GEE). Results: The results showed that 43.4% patients exercised regularly, 48% felt depressed, and 13.2% perceived difficulty in performing ADLs. Depression correlated significantly and positively with age (r=0.213) and negatively correlated with the ability to perform ADLs (r=-0.711), whereas the ability to perform ADLs negatively correlated with age (r=-0.361). Compared with patients who did not indulge in regularly physical activity, patients who did were less depressed and performed ADLs better. The changes in depression levels and ability to perform ADLs were comparable between the two groups from pre-PCI to 3 months after discharge, regardless of patients' exercise habits. Conclusions: For CAD patients who underwent primary PCIs, an advanced age was associated with higher depression levels and reduced capacity to perform ADLs. The changes of depression levels and ability to perform ADLs 3 months after PCIs were comparable in patients, regardless of whether they exercised regularly before and after the PCIs. This may be attributed to the fact that patients continued their exercise habits and frequency after discharge, although they may have had difficulties in exercising at home. Therefore, we suggest that the case managers should track the cardiac rehabilitation exercise routine of CAD patients after they are discharged and ensure that patients receive adequate family support to prevent CAD recurrence.

並列關鍵字

Physical activity ； Coronary heart disease ； Percutaneous coronary intervention ； Depression ； Activities of daily living