2025 年第 8 期 第 20 卷

影响急性A型主动脉夹层术后患者运动量的患者因素及作用路径分析

Analysis of the influencing factors and action path of postoperative exercise volume in patients with acute type A aortic dissection

作者：司茜茜韩畅陆晓方王鑫朱俊明

英文作者：Si Qianqian Han Chang Lu Xiaofang Wang Xin Zhu Junming

单位：首都医科大学附属北京安贞医院心外科，北京100029

英文单位：Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性A型主动脉夹层；运动量；患者因素；路径分析

英文关键词：AcutetypeAaorticdissection;Amountofexercise;Patientfactors;Pathanalysis

• 摘要：

• 目的 探讨影响急性A型主动脉夹层术后患者运动量的患者因素及作用路径，为制定针对性强的运动干预方案提供参考。方法 采用便利抽样法，于2022年12月至2024年6月，选取首都医科大学附属北京安贞医院268例急性A型主动脉夹层术后患者作为研究对象，采用一般资料调查表、心脏疾病运动恐惧量表、运动自我效能量表、简易疾病感知问卷及体育活动等级量表进行调查。采用单因素分析、Spearman相关分析，运用Mplus7.4软件检验各变量间的链式中介效应。结果  268例急性A型主动脉夹层术后患者运动量总分为（18.0±7.0）分，处于偏低水平；其中40例（14.9%）低锻炼量患者，228例（85.1%）中等/高锻炼量患者。患者心脏疾病运动恐惧量表得分（36.3±5.4）分，运动自我效能量表得分（62.1±15.8）分，简易疾病感知问卷得分（41.2±8.5）分。单因素分析结果显示，年龄、受教育程度、职业状态、高血压病史、心功能分级、体重指数是急性A型主动脉夹层术后患者运动量的影响因素（均P＜0.05）。疾病感知、运动自我效能、运动恐惧对急性A型主动脉夹层术后患者运动量的直接效应成立，效应值分别为-0.339、0.636、-0.241；运动自我效能通过疾病感知的中介作用间接影响患者运动量（中等/高锻炼量），效应值为0.097，占总效应的13.23%；运动恐惧通过运动自我效能的单独中介作用及运动自我效能-疾病感知的链式中介作用间接影响患者运动量（中等/高锻炼量），效应值为-0.701，占总效应的74.41%。结论  临床医护人员应重视疾病感知、运动自我效能、运动恐惧对急性A型主动脉夹层术后患者运动量的影响，开发科学、精准的干预方案，以提高急性A型主动脉夹层术后患者运动量。

• Objective To investigate the influencing factors and action path of postoperative exercise volume in patients with acute type A aortic dissection, so as to provide a reference for formulating targeted exercise intervention programs. Methods From December 2022 to June 2024, convenience sampling was used to select 268 patients with acute type A aortic dissection after operation in Beijing Anzhen Hospital, Capital Medical University as the research object. The general information questionnaire, fear of heart disease exercise scale, exercise self-efficacy scale, brief illness perception questionnaire and physical activity rating scale were used for investigation. Univariate analysis and Spearman correlation analysis were used to test the chain mediating effect between variables by Mplus7.4 software. Results Among 268 patients with acute type A aortic dissection after surgery, the total score of exercise volume was (18.0±7.0), which was at a low level. There were 40 patients (14.9%) with low exercise volume and 228 patients (85.1%) with moderate/high exercise volume. The patient′s score on the cardiac disease exercise fear scale was (36.3±5.4), the score on the exercise self-efficacy scale was (62.1±15.8), and the score on the simple disease perception questionnaire was (41.2±8.5). Univariate analysis showed that age, education level, occupational status, history of hypertension, cardiac function classification and body mass index were the influencing factors of exercise volume in patients with acute type A aortic dissection after surgery (all P＜0.05). The direct effects of illness perception, exercise self-efficacy and exercise fear on the amount of exercise in patients with acute type A aortic dissection after surgery were established, with effect values of -0.339, 0.636 and -0.241, respectively. Exercise self-efficacy indirectly affected the amount of exercise (moderate/high exercise) of patients through the mediating effect of illness perception, and the effect value was 0.097, accounting for 13.23% of the total effect. Exercise fear indirectly affected the amount of exercise (moderate/high exercise) through the single mediating effect of exercise self-efficacy and the chain mediating effect of exercise self-efficacy illness perception, and the effect value was -0.701, accounting for 74.41% of the total effect. Conclusion Clinical medical and nursing staff should pay attention to the influence of illness perception, exercise self-efficacy and exercise fear on the exercise volume of patients with acute type A aortic dissection after surgery, and develop scientific and accurate intervention programs to improve the exercise volume of patients with acute type A aortic dissection after surgery.