医院与社区联合干预模式对冠心病患者血运重建术后预后的影响  

Effects of combined intervention model of hospital and community health service center on the prognosis of patients with coronary heart disease after coronary artery revascularization

作　　者：刘敏[1] 张苏川[1] 闫杰[1] 徐亚宁[1] 刘波[1] 邹勇[1] 余信强[1] 

机构地区：[1]江汉大学附属武汉市第六医院心内科,武汉430015

出　　处：《临床心血管病杂志》2013年第10期745-749,共5页Journal of Clinical Cardiology

基　　金：武汉市科技计划项目(No:200951999575)

摘　　要：目的:探讨医院与社区联合干预模式对冠心病患者血运重建术(包括经皮冠状动脉介入治疗和冠状动脉旁路移植术)后预后的影响。方法:纳入行血运重建术后1个月内的冠心病患者150例,按随机区组设计分成联合干预组和对照组,每组各75例,随访12个月。由我院专科医生为所有入选患者制定治疗方案,并根据其病情变化及时调整;所有患者至少每个月到我院专科门诊就诊1次。此外,联合干预组患者由所在社区医生每周1次到其家中进行随访,开展卫生宣教、心理和行为干预等措施。每3个月对所有患者检测1次血脂、空腹血糖、BMI和肝肾功能,伴发2型糖尿病的患者还需检测糖化血红蛋白(HbA1c);记录再住院次数、平均住院天数、主要心脏不良事件(MACE)和药物不良反应。结果:①联合干预组干预治疗后的TC、TG、LDL-C和BMI均较干预治疗前显著下降(均P<0.05);对照组干预治疗后仅TC和LDL-C较治疗前下降(均P<0.05);联合干预组患者干预治疗后的TG和BMI均显著低于对照组(均P<0.05)。②两组中高血压病患者干预治疗后的血压达标率均较干预治疗前显著升高(均P<0.05);联合干预组高血压病患者干预治疗后血压达标率显著高于对照组(P<0.05)。③两组中2型糖尿病患者干预治疗后的空腹血糖、HbA1c和BMI达标率均较干预治疗前显著升高(均P<0.05);联合干预组2型糖尿病患者干预治疗后空腹血糖、HbA1c和BMI达标率均显著高于对照组(均P<0.05)。④联合干预组患者MACE发生率显著低于对照组(P<0.05)。⑤联合干预组患者1年再住院率和平均再住院天数均显著低于对照组(均P<0.05)。结论:医院与社区联合干预模式可以进一步改善冠心病患者血运重建术后的预后。Objective： To investigate the effects of combined intervention model of hospital and community health service center on the prognosis of patients with coronary atherosclerotie heart disease （hereinafter called coronary heart disease） after coronary artery revaseularization treatment （including the treatments of percutaneous coronary intervention and coronary artery bypass grafting）. Methods： We enrolled 150 patients who received coro- nary artery revaseularization treatment within 1 month. All patients were divided into two groups by randomized block design： combined intervention group and control group. All the patients were followed up for 12 months. Specialist of our hospital developed a treatment plan for all enrolled patients and adjusted it timely according to the change of patient＇s condition. All the patients visit the specialist of our hospital at least once a month. In addition, the community doctors followed up the patients of combined intervention group in their home once a week and car- ried out health education, psychological and behavioral interventions. We detected the patient＇s blood lipids, fast- ing glucose （FGLU）, body mass index （BMI）, liver function and kidney function every three months, and patients with type 2 diabetes also needed to detect glycosylated hemoglobin A1C. In addition, we recorded the number of readmission, average duration of hospitalization, major adverse cardiovascular events （MACE） and adverse reactions of drugs. Result：（1）After the intervention, the levels of TC, TG, LDL-C and BMI in combined intervention group were significantly reduced compared with baseline date （all P〈0.05）. Only the level of TC andLDL - C decreased in control group compared with baseline date （ all P 〈 0. 0 5 ） . After the intervention , the level of TG and BMI in combined intervention group were significantly lower than those in control group （all P〈0.05）. （2）After the intervention, control rates of the blood pressure in hypertensive patient

关 键 词：冠心病 血运重建术 再住院次数 平均住院日 主要心脏不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]