| ObjectiveTo study the sexual activity of young and mid-life male patients with coronary artery disease(CAD) before and after coronary stent implantation,analyzing the influenced factors,and raising the effective nursing measurements to improve the quality of sexual life for the patients.MethodsSelect December 2004-2006 December in the top three hospitals in Guangdong Province a cardiovascular medical emergency or elective period PTCA stent implantation in patients with 114 cases(selected criteria:men aged 30 to 55 years old; married;exclusion prostate disease and other organs of organic disease) in September 2006 - 2007 July selected targets of the investigation.114 CAD patients post coronary stent implantation were interviewed by telephone by using the self-designed questionnaire which included age,education degree,vocation,income,family history, generic life conditions(taking exercise,whether resume the job,the symptom and the self-feel after operation) and the sexual life condition(sexual desire 6 months before and after operation,times of sexual activities,erection and worries about sexual life) after operation.In order to lighten the patients' mental defenses,and make sure the representation and the reliability of the results,we didn't setup the sexual activity index too sensitively,for example,the duration and the posture of the sexual activity. We invited one male cardiovascular doctor to do all the telephone investigations, which make the patients be willing to accept the interview and avoid the bias between the different interviewers at the same time.Before ask the sexual questions,we ensure to keep the data secret and put the sexual life questions after the commonly life questions to eliminate the patients' worries.Dealing with the question related to the subjective feel,we directed the patients to imagine a line,which divided into 5 sections,and each point correspond to not at all,slightly,moderately,quite a bit, extremely,then ask the patients to choose based on themselves' conditions.The data were analyzed by the SPSS 11.0,using 2 independent samples tests,2 related samples test,chi-square test,there was significant difference if P≤0.05,using multiple partial regression to analyze the factors influenced the sexual life.ResultsUsing self-made questionnaires to conduct telephone interviews with 114 patients,including 27 cases of missing numbers change or visit patients refused to answer the question of sexual life,accounting for 23.7 per cent,three cases of death, accounting for 2.6%,the actual effective questionnaire to be 84,accounted for 73.7 percent.Four cases of age 30-35 years old,accounting for 4.8%,36-40-year-old eight cases,accounting for 9.5%,41-45-year-old 15 cases,accounting for 17.8%,46-50-year -old 22 cases,accounting for 26.2%,51-55-35 cases,accounting for 41.7%,with an average age of 41.3±6.1 years old.Admission reasons:66 cases of acute myocardial infarction,or 78.6%,and 18 cases of unstable angina,accounting for 21.4 per cent.Puncture ways:by the right radial artery 59 cases,accounting for 70.2 percent,the right femoral artery in 22 cases,accounting for 26.1%,the right radial artery + right femoral artery three cases,accounting for 3.6 percent.To PTCA + stenting more than one time is 9 patients,accounting for 11.1%,1 to 75 cases, accounting for 88.9%.When answering the question "of whether or not sexual life is important to you", the findings of this study with normal domestic life of the population compared to the status quotation,select "more important" and "neither important nor unimportant," and "not very important "and" unimportant "basically the same situation,but approval" very important "increase in the proportion of,the difference was significant (P＜0.001).In this survey,84.5%patients know little about the safe sexual life knowledge, and 85.7%patients expressed want to know or extremely want to know the sexual knowledge,but none of them would turn to the staff for help.The patients' sexual desire 6 months before and after operation,times of sexual activities,erection, satisfaction with the sexual partner and worries about sexual life,all of these had significant difference(P＜0.001).48.9%of the patients expressed their sexual activities were influenced by different degree after the disease.17.9%patients didn't resume the sexual activity until the survey(at least 7 months after the operation). Compare the re-stenosis patients and the ones without re-stenosis who resumed the sexual activities within one month,it still unable to consider the difference were significance(P＞0.05).Using multiple partial regression to analyze the factors influenced the sexual life, based on the total sexual life scores,we chose age,vocation,income,resume the job, take exercise,smoking,drinking,vigorous activities,moderate activities,light activities,sexual desire before and after illness,times of sexual life,erection,worries about the sexual life as dependent variables.Among the factors influenced the quality of sexual life,the anxiety to the sexual life after operation,sexual passion,and gently physical activity enter the equation.The anxious about the resume of the sexual life, the changes of the physiological function and the reducing of the sexual desire influenced the whole sexual life quality.The rehabilitation of the physical strength helps to resume the sexual activity.The patients' sexual life conditions after implantation depending on the condition before the operation.ConclusionThe final target of the cardiac rehabilitation is to improve the life qualities of the patients,and the recovery of the patients' sexual activities was one of the important manifestations,especially for the mid and young people.The medical staff should think highly of the sexual life quality for the patients,giving the patients and the spouse necessary sexual knowledge to improve their life quality.In this survey we know that the main reason which make the patients and their spouse feel anxious is that they are afraid of the recurrence of the disease or even sudden cardiac death if resume the sexual activities.So we can print the safe sexual life knowledge into booklet,and give the patients and their spouse to see.To lighten the patients metal stress,we can tell them the fatalness to cardiac death coursed by the sexual activities is very lack,the re-infarction dose not have the closed relationship with the sexual activities.Give the patients and their spouse the necessary direction, for example,at what time to resume the sexual activity,frequency,posture,matters need attention(avoiding sexual activity after meal,drink,unease environment,sex after nervous and sex outside marriage) and so on.Physiology and psychology are the two main reasons influenced the sexual desire. The nurse should make the patients and their spouse to know the safe sexual life knowledge,alleviate their worries coursed by resume of the sexual life.Tell them there are drugs administered in the CAD patients to cure erection,suggest the ED patients to seek medical advice at the specialized outpatient service.Inform the patients the drugs' side effect which influenced the sexual function,at the same time, the nurse should tell the patients that the symptom may dissolve if withdrawal. Recommend the patients to give up smoking and place restrictions on drinking.The nurse should give individual psychological direction to the patients depend on their age,vocation,family situation,and so on,suggest them to accept the standard psychological therapy if necessary.This study indicate that the unrestricting of the lighten activities after the implantation correspond to high sexual life scores,so we direct the patients taking exercises at family.The reasonable and moderate exercises can improve cardiac function,strengthen the body's resistance,which is also beneficial for the patients' sexual life.Because of the shackles of traditional values,many physicians,nurses and patients are reluctant to discuss the issue of sexual activity,particularly patients ashamed to tell.Most of the patients did not receive advice on sexual activity,or only vague,non-professional advice.On the other hand,medical personnel has failed to take the initiative on patients with myocardial infarction on the resumption of sexual life,because that they not only lack of both physiological point of view and the practical expertise on this issue and the relevant information,but also medical staff not familiar with the guidance of conventional sexual life.Of course,the lack of consultation in the technical aspects of the specialized training is one of the reasons. Therefore,strengthening the cardiovascular heart disease by the medical staff about human life skills training is necessary.In order to reduce the patients' psychological defense,patients can be communicated as far as possible with the medical staff in same gender.At the same time due to the spouses of patients with CAD fear of a recurrence of patients,they give the patients with excessive protection,encouraging the patients rely on the psychological and useless flu.The spouse' ignorance of knowledge often intentionally or unintentionally avoids sexual contact,impeding the normal sexual interest and reduces the patient's level of excitement.It should be as early as possible to let patients and their spouses to participate in the consultation to the sexual life.On the follow-up of patients discharged from hospital,in addition to the general understanding of the postoperative recovery,medication,daily life,work,patients should also be concerned with the recovery of the sexual life.The nurse may use telephone follow-up,that is,economic convenient and time-saving,labor-saving, practical and patients easily accepted,and it helps protect the privacy of patients,and can get feedback.This will not only improve the health of the effectiveness of education,it can also increase the confidence of nurses to patients,improve satisfaction.Although the World Health Organization proposed as early as in 1970 the citizens of sexual health is one of the basic right to health,but for a long time due to cultural, religious and traditional moral constraints related to the slow progress of research in China,which until recent years the situation will change.Domestic studies about the sexual activities for the patients with heart disease are very few,the papers on rehabilitation of cardiovascular patients' sexual life guiding almost all of the review of literature,are essentially based on overseas research data and conclusions.And the sexual life quality is an important component of the heart disease patients' overall quality of life,as health care workers,we should pay attention to the sexual life conditions of the patients,attaching importance of this basic research,understanding the actual situation of sexual life for patients with heart disease.The study provides a number of the original data on sexual activities for patients with CAD after stent implantation,and advances some nursing strategies on the basis of the analysis of the results.The limitations of this study are to survey only age≤ 55-year-old married male patients.Sex is one of the people's instincts,which is a natural and healthy demand,even though the elderly are still a considerable number of people of interest.Thus the human heart study should include adults of all ages, female patients of the sexual life conditions should also be considerable attention. |
PDF Full Text Request