[[alternative]]A Following up Study of Posttraumatic Stress Symptoms, Functional Status, and Depression among Acute Myocardial Infarction Patients

[[abstract]]國立台北護理學院護理研究所碩士論文摘要 研究所別：護理研究所 論文名稱：急性心肌梗塞患者之創傷後壓力症狀、功能狀態和憂鬱之追蹤探討 指導教授：蔡秀鸞博士 研究生：盧瑞華 本研究之目的旨在探討急性心肌梗塞患者在住院期和恢復期之創傷後壓力症狀、功能狀態及憂鬱之變化。採重複測量設計，以方便取樣法在北部五家地區教學以上之醫院進行，85位第一次發生心肌梗塞、意識清楚和過去無精神疾病者為研究樣本， 68位（80％）完成整個研究。研究資料共收集兩次，患者第一次心肌梗塞後5-7天，由研究者親自訪談，二個月後以郵寄自填式問卷或電話訪談方式收集資料，測量其創傷後壓力症狀、功能狀態和憂鬱。工具包括創傷後壓力症狀表、心臟患者功能狀態量表及貝氏憂鬱量表短表。資料分析包括描述性統計、成對t檢定、皮爾森積差相關分析及逐步迴歸分析。研究結果顯示，梗塞後早期，68位個案中，沒有一位符合創傷後壓力症候群之診斷標準，總分平均2.36分，其中以增加喚醒症狀程度較高，再經歷症狀次之，逃避症狀第三；恢復期68位個案中，有6位（9％）符合創傷後壓力症候群診斷，其中 34位個案（50％）有輕度的反應，6位個案（9％）有中度創傷後壓力症狀，兩階段的改變，有顯著性差異（t= -14.28, p.05；t=.53, p>.05）。 憂鬱狀態方面，早期僅4人(6%)有輕度憂鬱，平均2.68分；恢復期有憂鬱者為29人（42％），其中輕度憂鬱26人（38％），中度憂鬱3人（4％），並無重度憂鬱患者。且恢復期總分平均增加1.5分，改變達顯著之差異(t= -4.98, p.05；t=.53, p>.05). Only 4 persons (6%) had mild depression in 5-7days after first time AMI and the mean score of BDI short form was 2.68. Two months later, 29 (42%) showed depression in which mild depression was 26 (38%), 3 (4%) were found at moderate depression level, and no severe depression was found at this moment. Total depression score of the recovery phase increased 1.5 points and reached significant change (t= -4.98, p<.001) compared to the early days. Stepwise regression for the physical limitations, angina frequency, and depression at the early phase could explain why the PTSD at 2 months later was up to 32% total. In fact, the physical limitation contributed for the 19% posttraumatic stress symptoms variance (R2=.19, β= -.38, P<.001) and angina frequency was for additional 9%, while depression elevated another 4% (β= .21). The outcomes of this study suggest that the following assessment and more attention to those whom had lower physical limitation and angina frequency score as well as higher depression are necessary. The early detection and treatment would decrease the prevalence of PTSD at recovery stage of AMI. Key words: Acute myocardial infarction, posttraumatic stress symptoms, functional status, depressio