对行急诊介入治疗的急性心肌梗死患者进行院外多因素强化护理干预的研究  

Effects of intensive nursing care intervention outside hospital in patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional therapy

作　　者：刘永华[1] 李铁[2] 钟韶萍 谢雪花[1] 马英东[1] Liu Yonghua;Li Tie;Zhong Shaoping;Xie Xuehua;Ma Yingdong(Interventional Medical Center,：Infectious Disease Control Center,the Fifth Affiliated Hospital,Sun Yat-Sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院介入医学中心,广东珠海519000 [2]中山大学附属第五医院感染病防治中心,广东珠海519000

出　　处：《中华介入放射学电子杂志》2018年第4期339-343,共5页Chinese Journal of Interventional Radiology：electronic edition

基　　金：广东省自然科学基金项目(2017A030310369)

摘　　要：目的:对行急诊介入治疗的急性心肌梗死患者进行电话咨询、设立冠心病门诊护士、健康宣教、心理护理、指导心脏康复治疗等强化干预,观察其对患者自我管理能力及相关临床指标的影响。方法:通过前瞻性随机对照研究,将1 920名行急诊直接经皮冠脉介入治疗术出院的急性ST段抬高型心肌梗死患者随机分为普通护理组和强化护理组,普通护理组仅进行常规的门诊随访,强化护理组患者接受电话咨询、专门的冠心病门诊随诊及定期健康宣教、心理护理、指导心脏康复治疗。比较两组的自我管理能力、冠心病二级预防药物使用率及心功能改善情况。结果:通过24个月的随访观察,最终完成随访的患者共计1 874例。和普通护理组相比,强化护理组的自我管理能力(每周康复运动次数、戒烟率、血脂达标比例、血糖血压自我监测)显著增强(P均<0.01);冠心病二级预防药物(他汀类药物、血管紧张素转换酶抑制剂、β受体阻滞剂、血管紧张素Ⅱ受体拮抗剂)使用率更高(P均<0.01);心功能改善更明显(P均<0.001);氨基端B型利钠肽原、死亡率和再住院率显著降低(P均<0.05)。结论:对行急诊介入治疗的急性心肌梗死患者进行院外强化护理干预,可以提高患者的自我管理能力、改善心功能、降低死亡率和再住院率。Objective To observe the efficacy of multifactor intensive nursing intervention in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods We conducted an open-label, randomized, controlled trial at 5th Affiliated Hospital of Sun Yat-Sen University. A total of 1920 patients with STEMI undergoing emergency interventional therapy were recruited and randomly allocated to control group receiving usual care or intervention group receiving intensive nursing care. 1874 patients completed the 24 months of follow-up and reviewed self-management abilities and clinical outcomes. Results Compared with usual-care group, intensive intervention group had better heart function and self-management abilities, including regular rehabilitation exercise/smoking cessation ratio/lipid success rate （all, P〈0.001）. The use of secondary prevention drugs for CVD in intensive nursing group was higher than the usual-care group （all, P〈0.001）, while the level of NT-pro-BNP, mortality and rehospitalization rates in intensive intervention group were lower than the usual-care group （all, P〈0.05）. Conclusions Multifactor intensive nursing care intervention is a good nursing care measure. It can help improve the self-management abilities and clinical outcomes for STEMI patients undergoing emergency interventional therapy.

关 键 词：急性心肌梗死 护理干预 随机对照试验 

分 类 号：R473.5[医药卫生—护理学]