云南省市县三级医院冠心病出院后一年随访干预疗效的多中心随机临床对照研究  

Effect of First-year Follow-up Intervention for Post-discharge CHD Patients from Provincial-,Municipal-and County- level Hospitals in Yunnan,China: a Multicenter Randomized Controlled Clinical Study

作　　者：孙煌[1] 李锐洁[1] 陆亚南 郭涛[1] 舒占坤 和泽源 卢京[4] 柳永华[5] SUN Huang;LI Rui-jie;LU Ya-nan;GUO Tao;SHU Zhan-kun;HE Ze-yuan;LU Jing;LIU Yong-hua(Department of Cardiology,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Cardiology,Luoping County People's Hospital,Luoping 655800,China;Department of Cardiology,People's Hospital of Yulong County,Yulong 674100,China;Department of Cardiology,the People's Hospital of Wenshan Prefecture,Wenshan 663000,China;Department of Cardiology,Baoshan People's Hospital,Baoshan 678000,China)

机构地区：[1]昆明医科大学第一附属医院心脏内科,云南省昆明市650032 [2]云南省罗平县人民医院心脏内科,655800 [3]云南省玉龙县人民医院心脏内科,674100 [4]云南省文山州人民医院心脏内科,663000 [5]云南省保山市人民医院心脏内科,678000

出　　处：《中国全科医学》2018年第8期902-907,913,共7页Chinese General Practice

摘　　要：目的探讨由云南省、市、县三级医院参与的一项冠心病患者出院后1年的随访干预研究,能否提高患者二级预防依从性,减少主要不良心血管事件(MACE)的发生。方法选取2014-09-01至2015-08-31在昆明医科大学第一附属医院、保山市人民医院、文山州人民医院、玉龙县人民医院、罗平县人民医院出院的冠心病住院患者2 119例,按照入院日期顺序,分为对照组(n=1 204)和干预组(n=915)。对照组仅在出院1年时进行随访,干预组出院前进行面谈并进行为期1年的随访,包括13次电话随访和出院1个月、6个月和1年时的面访。随访内容包括:MACE、二级预防用药的依从性及生命体征、实验室检查等。结果对照组在出院1年时992例(82.4%)患者完成随访;干预组出院1年时780例(85.2%)完成随访。两组出院1年时死亡、非致死性心肌梗死、冠状动脉旁路移植术(CABG)、脑卒中、出血发生率比较,差异均无统计学意义(P>0.05);干预组经皮冠状动脉介入治疗(PCI)、非计划内住院、总MACE发生率低于对照组(P<0.05)。两组出院1年时体质指数(BMI)、收缩压、舒张压、运动频率比较,差异均无统计学意义(P>0.05);干预组静息心率、低密度脂蛋白胆固醇(LDL-C)低于对照组,左心室射血分数、平均运动时间、药物费用高于对照组(P<0.05)。两组出院1年时血管紧张素转化酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)、β-受体阻滞剂服用比例比较,差异均无统计学意义(P>0.05);干预组出院1年时阿司匹林、氯吡格雷、他汀类药物服用比例高于对照组(P<0.05)。多因素Logistic回归分析结果显示,吸烟[OR=2.43,95%CI(1.47,4.21)]、经常运动[OR=0.88,95%CI(0.83,0.93)]、夜间打鼾[OR=1.21,95%CI(1.08,1.41)]、糖尿病[OR=1.05,95%CI(1.01,1.09)]、服用阿司匹林[OR=0.66,95%CI(0.52,0.83)]是冠心病患者发生MACE的影响因素(P<0.05)。结论云南省、市、县三级医院冠心病患者1年的随�Objective To study whether the intervention therapy for post-discharge coronary heart disease(CHD)patients conducted in the first-year follow-up,a program participated by provincial-,municipal-and county-level hospitals in southwest China's Yunnan province,is an effective way to improve patient compliance with secondary prevention and to reduce the incidence of major adverse cardiovascular events(MACE).Methods Altogether 2 119 eligible CHD patients,who were discharged from First Affiliated Hospital of Kunming Medical University,Baoshan People's Hospital,the People's Hospital of Wenshan Prefecture,People's Hospital of Yulong County,Luoping County People's Hospital located in Yunnan from September 1,2014 to August 31,2015,were recruited by the program,with 915 patients randomly assigned to the intervention group and 1 204 to the control group based on the admission time.The control group only received the follow-up intervention at the end of the first year after discharge,but the intervention group received face-to-face interview before discharge and a one-year positive post-discharge follow-up,including 13 telephone visits and face-to-face interviews conducted at the end of the 1st,6th and 12th months after discharge with the contents of MACE,compliance with secondary preventive medication and vital signs,and lab results.Results In the end,780(85.2%)in the intervention group and 992(82.4%)in the control group completed the follow-up intervention.At one year after discharge,the differences between the two groups in death rate,incidence of nonfatal MI,CABG treatment,stroke and bleeding had no statistical significance(P>0.05).The intervention group had fewer patients with PCI treatment,unplanned inpatient treatment and MACE(P<0.05).The differences between the two groups in BMI,SBP,DBP and frequency of exercise had no statistical significance either(P>0.05).The intervention group had lower average value of HR and LDL-C but higher average value of LVEF,longer average time of exercise and higher average medication fee t

关 键 词：冠心病 随访研究 医院 县 医院 市区 医院 大学 

分 类 号：R541.4[医药卫生—心血管疾病]