経皮的冠動脈形成術後急性冠症候群患者の退院後の適応過程における精神的健康

Mental Health during Adaptation among Patients with Acute Coronary Syndrome who are Discharged after Percutaneous Coronary Intervention

要旨

目的：経皮的冠動脈形成術後急性冠症候群患者の適応過程である刺激，反応，退院後の精神的健康を記述すること．

方法：発症・術後1か月以上経過した患者10名を対象に半構造化面接を実施し内容分析を行った．ロイの適応モデルに基づき患者の意識が最も注がれる焦点刺激を発症，治療，退院と定義し，刺激がもたらす反応，精神的健康，関連・残存刺激を記述した．

結果：関連・残存刺激として【心臓疾患に対し恐怖心をもっていた】等9カテゴリー，反応として【退院後も胸部症状があった】【無理はできなくなったという認識になった】等22カテゴリー，精神的健康として【再発の心配がある】【胸部症状の出現がトラウマとなっている】等6カテゴリーが得られた．

結論：精神的健康が低下する患者の存在が示唆され，対応として退院後にかけてのリスクの高い者のスクリーニングや発症経験の振り返り，胸部症状出現時の対応方法の教授が有効な可能性が示唆された．

Objective: This study aimed to describe adaptation, including the stimuli, responses, and mental health, of patients with acute coronary syndrome who are discharged after percutaneous coronary intervention.

Methods: We conducted semi-structured interviews with ten patients after one month from the onset of the disease and intervention, and data were analyzed by content analysis. Onset, intervention, and discharge were predefined as focal stimuli based on the Roy Adaptation Model. Responses that were provoked by stimuli, mental health, and contextual and residual stimuli were described.

Results: Nine categories, including “having fear for cardiac diseases,” were identified as contextual and residual stimuli, and 22 categories, including “having cardiac symptoms after discharge” and “recognizing that it is better not to overtax myself,” were identified as responses. Six categories of mental health, including “having worry about recurrence” and “having trauma for appearance of cardiac symptoms,” were identified.

Conclusions: Our results indicate that patients experienced poor mental health. The identification of patients at a high risk of depression by observing both at hospitalization and ambulatory setting, review of experience at the onset, and instruction of response for cardiac event may be effective for patients' mental health.