中青年心脏起搏器植入术后患者重返工作准备度现状及影响因素分析

康斯坦; 高敏; 温高芹; 仲伟楠; 孙国珍

doi:10.16766/j.cnki.issn.1674-4152.003907

中青年心脏起搏器植入术后患者重返工作准备度现状及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003907

康斯坦¹,
高敏^1, ,,
温高芹¹,
仲伟楠¹,
孙国珍^{1, 2}

1.
南京医科大学第一附属医院心血管内科，江苏南京 210029
2.
南京医科大学护理学院，江苏南京 211103

基金项目:

国家自然科学基金面上项目 72074124

江苏省人民医院临床能力提升工程护理项目 JSPH-NC-2022-6

详细信息

通讯作者:
高敏，E-mail：2257797828@qq.com

中图分类号: R541 R318.11
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出版历程
- 收稿日期: 2024-08-11
- 网络出版日期: 2025-05-14

Current status and influencing factors of return-to-work readiness in middle-aged and young patients after cardiac pacemaker implantation

1.
Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

摘要

摘要: 目的重返工作是中青年心脏起搏器植入术后患者疾病康复的重要标志之一，然而目前针对其重返工作准备度的相关研究较少。本研究调查中青年心脏起搏器植入术后患者重返工作准备度现状，并分析其影响因素。方法采用便利抽样法选取2021年1月—2023年10月南京医科大学第一附属医院成功实施心脏起搏器植入术的158例患者作为研究对象。使用一般资料调查表、重返工作准备度问卷、简易应对方式问卷、社会衰弱问卷进行调查。结果中青年心脏起搏器术后患者重返工作率为61.39%，已重返工作的患者共97例[不确定维持阶段占比12.37%(12例)，主动维持阶段占比87.63%(85例)]，未重返工作的患者共61例[前意向阶段占比57.38%(35例)，意向阶段占比32.79%(20例)，行动准备-自我评估阶段占比3.28%(2例)，行动准备-行为阶段占比6.56%(4例)]。年龄、性别、教育程度、术前射血分数、积极应对方式和社会衰弱为中青年心脏起搏器植入术后患者是否返岗的影响因素。结论中青年心脏起搏器植入术后患者重返工作现况有待改善。临床医护人员应制定并采取多维个性化干预策略，引导患者积极应对疾病及生活，同时帮助患者拓展其自身社会支持网络，避免社会衰弱的发生，进而早日回归正常家庭生活及工作，实现全面的社会康复。
- 心脏起搏器植入术 /
- 中青年 /
- 重返工作准备度 /
- 影响因素
Abstract: Objective Return-to-work is one of the important indicators of recovery for middle-aged and young patients after cardiac pacemaker implantation. However, research on their readiness to return to work remains limited. This study aims to investigate the current status of return-to-work readiness among middle-aged and young patients after cardiac pacemaker implantation and analyze its influencing factors. Methods Using a convenience sampling method, this study selected 158 patients who successfully underwent pacemaker implantation at the First Affiliated Hospital of Nanjing Medical University from January 2021 to October 2023. Data were collected using the general demographic questionnaire, the readiness for return-to-work scale, the simple coping style questionnaire, and the HALFT (help, participation, loneliness, financial, talk) scale. Results The return-to-work rate among middle-aged and young patients post-pacemaker implantation was 61.39%. Among the 97 patients who returned to work, 12.37% (12 cases) were in the indeterminate maintenance phase, while 87.63% (85 cases) were in the active maintenance phase. Among the 61 patients who had not yet returned to work, 57.38% (35 cases) were in the pre-contemplation stage, 32.79% (20 cases) were in the contemplation stage, 3.28% (2 cases) were in the action preparation-self-assessment stage, and 6.56% (4 cases) were in the action preparation-behavior stage. Age, gender, education level, preoperative ejection fraction, positive coping style, and social frailty were significant influencing factors of the return-to-work status for middle-aged and young patients after cardiac pacemaker implantation. Conclusion The current status of return-to-work among middle-aged and young patients following cardiac pacemaker implantation requires improvement. Healthcare professionals should implement multidimensional, personalized intervention strategies to help patients actively cope with their illness and life challenges. These strategies should also focus on expanding social support networks to prevent social frailty, thereby accelerating patients ' return to normal family life and work and promoting comprehensive social rehabilitation.
- Cardiac pacemaker implantation /
- Middle-aged and young /
- Return-to-work readiness /
- Influencing factors

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表 1 中青年心脏起搏器植入术后患者不同准备阶段RRTW得分情况

Table 1. The RRTW scores of middle-aged and young patients after cardiac pacemaker implantation at different preparation stages

项目	准备阶段	例数(%)	得分(x±s, 分)
未重返	前意向	35(57.38)	3.924±0.701
	意向	20(32.79)	4.050±0.394
	行动准备-自我评估	2(3.28)	4.250±1.061
	行动准备-行为	4(6.56)	3.750±0.319
已重返	不确定维持	12(12.37)	3.667±0.695
	主动维持	85(87.63)	4.053±0.533

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表 2 中青年心脏起搏器植入术后患者重返工作的单因素分析

Table 2. Univariate analysis of return-to-work in middle-aged and young patients after cardiac pacemaker implantation

项目	未重返(n=61)	已重返(n=97)	统计量	P值	项目	未重返(n=61)	已重返(n=97)	统计量	P值
年龄[例(%)]			8.739^a	0.003	术前射血分数[例(%)]			4.864^a	0.027
＜45岁	6(9.84)	29(29.90)			＜50%	26(42.62)	25(25.77)
≥45岁	55(90.16)	68(70.10)			≥50%	35(57.38)	72(74.23)
性别[例(%)]			5.798^a	0.016	起搏器名称[例(%)]			7.968^a	0.093
女性	27(44.26)	25(25.77)			CRT	1(1.64)	5(5.15)
男性	34(55.74)	72(74.23)			CRTD	13(21.31)	8(8.25)
教育程度[例(%)]			32.427^b	＜0.001	DDD	30(49.18)	54(55.67)
小学及以下	12(19.67)	3(3.09)			ICD	13(21.31)	27(27.84)
初中	29(47.54)	24(24.74)			VVI	4(6.56)	3(3.09)
高中或中专	13(21.31)	23(23.71)			首次植入起搏器[例(%)]			0.003^a	0.956
大专	5(8.20)	22(22.68)			否	9(14.75)	14(14.43)
本科及以上	2(3.28)	25(25.77)			是	52(85.25)	83(85.57)
居住地[例(%)]			11.186^a	0.004	按时随访[例(%)]			-2.620^b	0.009
城市	19(31.15)	52(53.61)			从不	1(1.64)	0
乡镇	16(26.23)	26(26.80)			偶尔	10(16.39)	5(5.15)
农村	26(42.62)	19(19.59)			总是	50(81.97)	92(94.85)
婚姻状况[例(%)]			9.357^a	0.025	合并慢性病[例(%)]			5.547^a	0.476
已婚	53(86.89)	90(92.78)			无	31(50.82)	46(47.42)
未婚	0	4(4.12)			冠心病	7(11.48)	7(7.22)
离异	5(8.20)	3(3.09)			慢性阻塞性肺疾病	1(1.64)	1(1.03)
丧偶	3(4.92)	0			糖尿病	6(9.84)	9(9.28)
子女数[例(%)]			7.345^b	0.062	高脂血症	1(1.64)	2(2.06)
1个	37(60.66)	61(62.89)			高血压	8(13.11)	26(26.80)
2个	17(27.87)	28(28.87)			其他	7(11.48)	6(6.19)
3个及以上	7(11.48)	3(3.09)			自我感觉健康状况[例(%)]			-2.402^b	0.016
无	0	5(5.15)			很好	10(16.39)	28(28.87)
居住情况[例(%)]			4.899^a	0.298	较好	21(34.43)	42(43.30)
与子女居住	10(16.39)	6(6.19)			一般	23(37.70)	26(26.80)
与配偶及子女居住	28(45.90)	49(50.52)			较差	6(9.84)	1(1.03)
与配偶居住	18(29.51)	32(32.99)			差	1(1.64)	0
独居	4(6.56)	6(6.19)			术前从事的职业[例(%)]			30.676^a	＜0.001
其他	1(1.64)	4(4.12)			企/机关/事业单位人员	5(8.20)	32(32.99)
家庭人均月收入[例(%)]			15.936^b	0.001	工人	9(14.75)	21(21.65)
≤1 000元	11(18.03)	3(3.09)			农民	25(40.98)	8(8.25)
1 000~3 000元	22(36.07)	24(24.74)			自由职业者	18(29.51)	26(26.80)
3 000~5 000元	16(26.23)	33(34.02)			其他	4(6.56)	10(10.31)
>5 000元	12(19.67)	37(38.14)			术前职业性质[例(%)]			15.489^a	＜0.001
术前为家庭主要经济来源[例(%)]			2.578^a	0.108	以体力劳动为主	35(57.38)	26(26.80)
否	15(24.59)	14(14.43)			以脑力劳动为主	13(21.31)	43(44.33)
是	46(75.41)	83(85.57)			脑力+体力	13(21.31)	28(28.87)
宗教信仰[例(%)]			0.152^a	0.696	术前日均工作时长[例(%)]			2.794^a	0.095
无	57(93.44)	89(91.75)			＜8 h	36(59.02)	44(45.36)
有	4(6.56)	8(8.25)			≥8 h	25(40.98)	53(54.64)
医疗付费方式[例(%)]			0.334^a	0.563	社会衰弱[例(%)]			9.278^a	0.002
医保	58(95.08)	90(92.78)			无	37(60.66)	80(82.47)
自费	3(4.92)	7(7.22)			有	24(39.34)	17(17.53)
					积极应对(x±s, 分)	21.98±7.67	24.79±6.92	-2.383^c	0.018
注：^a为χ²值，^b为Z值，^c为t值。CRT为心脏再同步化治疗(cardiac resynchronization therapy)，CRTD为带除颤功能的心脏再同步化治疗(cardiac resynchronization therapy with defibrillator)，ICD为植入式心脏除颤器(implantable cardioverter defibrillator)，DDD为双腔起搏器(Dual-chamber)，VVI为心室起搏器(ventricular pacing, ventricular sensing, inhibited)。

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表 3 变量赋值情况

Table 3. Variable assignment

自变量	赋值方法
年龄	＜45岁=1，≥45岁=2
性别	女性=1，男性=2
教育程度	小学及以下=1，初中=2，高中/中专=3，大专=4，本科及以上=5
居住地	城市=(1，0)，乡镇=(0，1)，农村=(0，0)
婚姻状况	已婚=(1，0，0)，未婚=(0，1，0)，离异=(0，0，1)，丧偶=(0，0，0)
家庭人均月收入	≤1 000元=1，1 000~3 000元=2，3 000~5 000元=3，>5 000元=4
术前射血分数	＜50%=1，≥50%=2
按时随访	从不=1，偶尔=2，总是=3
自我感觉健康状况	差=1，较差=2，一般=3，较好=4，很好=5
术前从事的职业	企/ 机关/ 事业单位人员=(1，0，0，0)，工人=(0，1，0，0)，农民=(0，0，1，0)，自由职业者=(0，0，0，1)，其他=(0，0，0，0)
术前职业性质	以体力劳动为主=(1，0)，以脑力劳动为主=(0，1)，脑力+体力=(0，0)
积极应对	连续性变量，以实际值赋值
社会衰弱	无=1，有=2

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表 4 中青年心脏起搏器植入术后患者重返工作影响因素的二元logistic回归分析

Table 4. Binary logistic regression analysis of factors influencing return-to-work in middle-aged and young patients after cardiac pacemaker implantation

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄≥45岁	-1.494	0.53	7.929	0.005	0.225	0.079~0.635
男性	1.144	0.405	8.004	0.005	3.141	1.421~6.940
教育程度高	0.242	0.118	4.174	0.041	1.274	1.010~1.607
术前射血分数≥50%	0.875	0.410	4.551	0.033	2.398	1.074~5.356
积极应对	0.051	0.026	3.949	0.047	1.052	1.001~1.107
社会衰弱	-0.832	0.420	3.917	0.048	0.435	0.191~0.992
注：本表仅列出差异有统计学意义的变量。

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