Abstract: Background　Good self-management is the best way to improve the clinical outcome and therapeutic effect of patients，and it is of great significance for secondary prevention of coronary heart disease（CHD）．The self- management level of CHD in community is not optimistic at present in China，and there are few studies on its current situation and influencing factors.Objective　To investigate the current status of self-management among CHD patients in community and explore its related influencing factors.Methods　From April to June 2016，248 patients with CHD were selected from the electronic health records by simple random sampling method and interviewed in Pengpu New Estate Community Health Service Center in Shanghai.Questionnaire included the General Situation Questionnaire，Health-promoting Lifestyle ProfileⅡ（HPLP Ⅱ），CHD Awareness and Knowledge Questionnaire，Self-efficacy for Managing Chronic Disease 6-item Scale（SECD6）．Self-management behaviors of patients were evaluated by the HPLP Ⅱ scores and multiple linear stepwise regression was used to analyze the influencing factors of HPLPⅡ scores.Results　A total of 248 questionnaires were distributed and 236 valid questionnaires were recovered with the effective recovery rate of 95.2%.The mean score of HPLP Ⅱ was（110.9±19.0）．There were 21（8.9%） cases with poor self-management behaviors，172（72.9%）cases with general behaviors，and 43（18.2%）cases with good behaviors.The mean scores of CHD Awareness and Knowledge Questionnaire and SECD6 were（14.0±3.2） and （6.0±1.3），respectively.Multiple linear stepwise regression analysis indicated that marital status，history of myocardial infarction（MI），number of coronary angiography（CAG），score of CHD Awareness and Knowledge Questionnaire，and score of SECD6 were the influencing factors of patients' HPLP Ⅱ scores（P<0.05）．Conclusion　The self-management status of CHD patients in community is at a low level.Patients who were married，with no history of MI，fewer numbers of CAG，and higher level of knowledge about CHD and higher self-efficacy have higher level of self-management.

Key words: Coronary disease, Health promotion, Health self-management, Community health services, Self-efficacy, Health knowledge, Root cause analysis

摘要： 背景　良好的自我管理是提高患者临床照护结局和治疗效果的最佳方式，对于冠心病的二级预防有重要意义。目前我国社区层面冠心病的自我管理水平不容乐观，且针对其现状及影响因素的调查研究较少。目的　了解社区冠心病患者的自我管理现状，并探讨其影响因素。方法　于2016年4—6月，采用单纯随机抽样法在上海市静安区彭浦新村街道社区卫生服务中心签约电子健康档案内抽取冠心病患者248例。对纳入患者进行问卷调查，内容包括一般情况问卷、健康促进生活方式评定量表（HPLPⅡ）、冠心病知识和认知问卷、慢性病自我效能量表。以HPLPⅡ得分评价患者的自我健康管理行为，采用多元线性逐步回归分析患者HPLPⅡ得分的影响因素。结果　共发放问卷248份，回收有效问卷236份，问卷有效回收率为95.2%。患者的平均HPLPⅡ得分为（110.9±19.0）分，被评价为自我健康管理行为差21例（8.9%）、一般172例（72.9%）、良好43例（18.2%）。患者的平均冠心病知识和认知问卷、慢性病自我效能量表得分分别为（14.0±3.2）、（6.0±1.3）分。多元线性逐步回归分析结果显示，婚姻状况、心肌梗死史、冠状动脉造影次数、冠心病知识和认知问卷得分、慢性病自我效能量表得分是患者HPLPⅡ得分的影响因素（P<0.05）。结论　社区冠心病患者的自我健康管理处于较低水平，已婚、无心肌梗死史、冠状动脉造影次数少、冠心病相关知识水平和自我效能高的患者自我健康管理水平较高。

关键词: 冠心病, 健康促进, 自我健康管理, 社区卫生服务, 自我效能, 健康知识, 影响因素分析