疾病管理对冠心病患者二级预防的影响  

Effects of management programm on secondary prevention for patients with coronary heart disease

作　　者：朱旖[1] 徐慧莲[1] 周卫华[1] 

机构地区：[1]江苏省老年医学研究所急诊中心,江苏省南京市210024

出　　处：《实用老年医学》2015年第4期294-296,299,共4页Practical Geriatrics

摘　　要：目的探索冠心病疾病管理计划的可行性和对冠心病二级预防的影响。方法将397例冠心病患者随机分为2组,干预组203例,对照组194例。干预组干预包括6次健康教育、电话随访、专科门诊等,观察12月后2组患者的临床指标以及药物使用等变化情况。结果随访12月,干预组吸烟率(3.4%比29.9%),体质量指数(22.7±1.19比23.7±1.34)和有氧运动比例(63.1%比31.9%)与对照组比较,均有显著差异(P均<0.01)。干预组血压达标率(88.2%比77.8%),糖化血红蛋白(Hb A1c)达标率(85.7%比66.5%),和LDL水平变化[(-24.1±20.4)%比(-18.4±23.5)%]与对照组比较,差异均有统计学意义(P<0.05或P<0.01)。除血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARBs)外,干预组服药依从性显著优于对照组(P<0.05)。干预组总心血管病事件发生率(20.2%)显著低于对照组(40.7%),差异有统计学意义(P<0.01)。结论冠心病疾病管理计划可显著改善冠心病患者的生活方式,提高血压、Hb A1c、LDL达标率,增加服药依从性,显著降低远期心血管病事件发生率。Objective To investigate the feasibility and effects of disease management programm for secondary prevention in patients with coronary heart disease（ CHD）. Methods From May 2012 to May 2013,397 patients diagnosed as CHD were randomly allocated to intervention group（ n = 203） and control group（ n = 194）. Patients in the intervention group received health education,telephone follow-up and cardiovascular department. Patients were followed for 12 months.Results After 12 months follow-up,there were significant differences between the intervention group and control group in smoking rate（ 3. 4% vs. 29. 9%）,BMI（ 22. 7 ± 1. 19 vs. 23. 7 ± 1. 34） and the proportion of exercise regularly（ 63. 1% vs. 31. 9%）,patients with blood pressure less than 140 /90 mm Hg（ 88. 2% vs. 77. 8%）,glycosylated hemoglobin less than 7%（ 85. 7% vs. 66. 5%）,and the reduction of low density lipoprotein（ LDL） [（- 24. 1 ± 20. 4） % vs.（-18. 4 ± 23. 5） %]. The reported intake of medications was higher in intervention group than in control group,except for ACEI / ARBs. Cardiovascular event rate of intervention group and control group was 20. 2% and 40. 7% respectively（ P〈0. 01）. Conclusions Disease management programm for CHD can improve life styles,improve compliance to CHD treatment and reduce the accurance rate of cardiovascular event.

关 键 词：冠心病 疾病管理计划 二级预防 生活方式 

分 类 号：R541.4[医药卫生—心血管疾病]