中青年男性冠心病PCI术后患者及其配偶二元应对对生活质量的影响

目的　了解中青年男性冠心病经皮冠状动脉介入术（PCI）术后患者及其配偶的二元应对、生活质量现状，探讨患者及配偶二元应对方式对双方生活质量的影响，为临床制订夫妻共同应对冠心病的干预措施提供依据。方法　采用便利抽样法，选取2020年1月1日至2021年1月31日在南阳医学高等专科学校第一附属医院及南阳市第六人民医院门诊复查的中青年男性冠心病PCI术后患者及其配偶共220对为研究对象。入组患者年龄18～59岁，均符合已婚且与配偶共同生活等纳入条件。配偶纳入标准主要为患者的主要照顾者，近期6个月内未发生创伤性事件等。采用一般资料调查表、二元应对问卷、简明健康状况调查问卷进行调查。采用描述性统计、χ²检验、t检验、Pearson相关分析数据。建立主-客体互倚模型，通过Bootstrap法分析变量间的主客体效应。结果　患者二元应对总分为（104.06±8.34）分，配偶二元应对总分为（104.13±7.80）分，差异无统计学意义（P>0.05）。患者与配偶的生活质量总分比较，差异无统计学意义（P>0.05）。Pearson相关分析表明，患者与其配偶的二元应对总分呈正相关（r=0.326，P<0.001）；患者与其配偶的生活质量总分呈正相关（r=0.357，P<0.001）。患者二元应对总分与自身、配偶生活质量总分呈正相关（r=0.570、0.465，均P<0.05）；配偶二元应对总分与自身、患者生活质量总分呈正相关（r=0.601、0.348，均P<0.05）。主客体互倚模型结果表明，患者及配偶的二元应对均对其自身生活质量有正向预测作用（β=0.623、0.710，P<0.05）。患者的积极二元应对对配偶生活质量有正向影响（β=0.342，P<0.05），配偶的积极二元应对对患者生活质量有正向影响（β=0.431，P<0.05）。结论　中青年男性冠心病PCI术后患者及其配偶的二元应对和生活质量水平均有待提高。建议将配偶纳入到疾病管理中，围绕夫妻为中心制定针对性二元应对干预方案，从而有效提高患者、配偶以及整个家庭的健康和生活质量。     

Clinical Utility of Real-Time MR-Navigated Ultrasound with Supine Breast MRI for Suspicious Enhancing Lesions Not Identified on Second-Look Ultrasound

This study evaluated the usefulness of magnetic resonance (MR)-navigated ultrasound (US) for evaluation of magnetic resonance imaging (MRI)-detected lesions not visible on second-look US and analyzed differences in lesion-to-nipple distance between supine and prone positions. Of the 831 consecutive patients who were diagnosed with breast cancer and examined with breast MRI from June 2013 to September 2015, 40 lesions in 37 patients who underwent MR-navigated US for MRI-detected lesions that were not visible on second-look US were included. First, MRI was performed in a prone position using a 1.5-T imager, and second, MRI was performed in a supine position for MR-navigated US. Of 40 lesions, 31 (78%) were identified with MR-navigated US, whereas 5 (13%) lesions disappeared on supine MRI and 4 (10%) exhibited no correlation on MR-navigated US. Of 31 lesions with pathologic confirmation, 7 (23%) were malignant, 2 (6%) were high-risk lesions and 22 (71%) were benign lesions. Comparison of the US findings of benign and malignant lesions revealed that orientation of the lesion differed significantly (p = 0.045), whereas lesion shape, margin and echo pattern did not significantly differ between the two groups (p = 0.088, p = 0.094 and p = 0.412, respectively). Median difference in lesion-to-nipple distance on supine and prone MRI was 8 mm (0–34 mm) in the horizontal direction and 5 mm (0–39.5 mm) in the vertical direction. Thirteen lesions exhibited a >1-cm difference in both horizontal and vertical directions. In conclusion, MR-navigated US was useful for the evaluation of MRI-detected lesions that were not visible on second-look US in breast cancer patients.