外周动脉疾病血运重建术后患者居家运动水平现状及影响因素研究-现代医学

外周动脉疾病血运重建术后患者居家运动水平现状及影响因素研究

单位：1. 南京医科大学护理学院, 江苏南京 211166;
2. 南京医科大学第一附属医院血管外科, 江苏南京 210029

分类号：R654.4;R473.6

出版年·卷·期（页码）：2026·54·第三期（394-404）

摘要：

目的：调查外周动脉疾病(PAD)血运重建术后患者居家运动水平现状，基于健康行为过程模型(HAPA)分析其影响因素，为制定促进居家运动的干预方案提供依据。方法：采用便利抽样法，选取2023年10月至2024年9月在江苏省某三级甲等医院行下肢血运重建术后3个月的324例PAD患者为研究对象。采用一般资料调查表、运动行为阶段诊断量表、运动自我效能量表、结果期待量表、风险感知量表、运动意向量表、运动计划量表及体力活动等级量表(PARS-3)进行问卷调查。采用χ²检验、Mann-Whitney U检验进行单因素分析；对心理认知变量进行主成分分析提取因子；采用二元Logistic回归分析居家运动水平的影响因素。结果：患者居家运动量中位得分为8(4,16)分；小运动量者257例(79.3%)，中高运动量者67例(20.7%)。单因素分析显示，性别、年龄、文化程度、职业状态、疾病分期、吸烟史、运动行为阶段及8个心理认知变量(除风险感知外)与运动量分级显著相关(P<0.05)。主成分分析提取4个心理因子：运动计划与维持、积极应对信念、负向障碍感知、行动自我效能，累计方差贡献率83.49%。回归分析显示，年龄(OR=29.55，95%CI 5.34～163.45)、职业状态(OR=0.14，95%CI 0.03～0.59)和运动行为阶段(动机阶段OR=0.19，95%CI 0.06～0.58；准备阶段OR=0.25，95%CI 0.09～0.69)是居家运动水平的独立相关因素(P<0.05)，而心理因子未进入最终模型。结论：PAD血运重建术后患者居家运动水平普遍较低，受年龄、职业状态及运动行为阶段的影响。心理认知因素可能通过行为阶段间接发挥作用。干预应重点关注高龄、非在职患者，并促进行为阶段的转变。

Objective: To investigate the current status of home-based exercise levels in patients after lower-extremity revascularization for peripheral artery disease(PAD), and to analyze the influencing factors based on the health action process approach(HAPA), so as to provide evidence for developing interventions to promote home-based exercise behavior. Methods: A total of 324 patients with PAD at three months after lower-extremity revascularization were recruited from a tertiary hospital in Jiangsu Province from October 2023 to September 2024 using convenience sampling. Data were collected using the general information questionnaire, Stage of Exercise Behavior Change Scale, Exercise Self-Efficacy Scale, Outcome Expectation Scale, Risk Perception Scale, Exercise Intention Scale, Exercise Planning Scale and Physical Activity Rating Scale(PARS-3). Univariate analysis was performed using χ² test and Mann-Whitney U test. Principal component analysis was conducted to extract factors from psychological cognitive variables. Binary Logistic regression was used to identify influencing factors of home-based exercise level.Results: The median score of home-based exercise level was 8(4,16), with 257 patients(79.3%) in the low exercise group and 67 patients(20.7%) in the moderate-to-high exercise group. Univariate analysis showed that gender, age, education level, employment status, disease stage, smoking history, exercise behavior stage, and eight psychological cognitive variables(except risk perception) were significantly associated with exercise level(P<0.05). Principal component analysis extracted four psychological factors: exercise planning and maintenance, positive coping beliefs, negative barrier perception,action self-efficacy, accounting for 83.49% of the total variance. Logistic regression analysis revealed that age(OR=29.55, 95%CI 5.34-163.45), employment status(OR=0.14, 95%CI 0.03-0.59), and exercise behavior stage(motivation stage: OR=0.19, 95%CI 0.06-0.58; preparation stage: OR=0.25, 95%CI 0.09-0.69) were independently associated with home-based exercise level(P<0.05), while psychological factors did not enter the final model. Conclusion: The home-based exercise level of patients after revascularization for PAD is generally insufficient, and is influenced by age, employment status and exercise behavior stage. Psychological cognitive factors may play an indirect role through exercise behavior stage. Interventions should focus on elderly and non-employed patients, and promote the transition of exercise behavior stage.

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