急性心肌梗死患者分级管理对预后影响的临床研究  

Clinical study on the effect of hierarchical management on prognosis of patients with acute myocardial infarction

作　　者：冯会英[1] 甄秀丽 耿俊丽[1] 张军涛[1] 孙建美[1] 鲁连菊 初蕙君 李爽 冯国鹏 FENG Hui-ying;ZHEN Xiu-li;GENG Jun-li(Department of Cardiology,Wuqing District People's Hospital,Tianjin 301700,China.)

机构地区：[1]天津市武清区人民医院心内科,天津301700

出　　处：《中国处方药》2021年第10期15-19,共5页Journal of China Prescription Drug

基　　金：天津市武清区科委课题(WQKJ201845)。

摘　　要：目的通过尝试急性ST段抬高型心肌梗死介入术后分级管理的新模式,改善患者的预后。方法针对急性ST段抬高型心肌梗死患者的CK-MB、肌钙蛋白、BNP前体、冠脉血管造影情况、LVEF等结果进行评分,按照轻、中、重度进行分级,分为Ⅰ、Ⅱ、Ⅲ三级,每级随机分为试验组和对照组,对试验组进行针对性分级管理,开展心梗患者认知教育课程,给予对应心肌梗死分级卡片,加强患者自我管理,指定随访医师,提高β受体阻滞剂、ACEI/ARB类药物依从性及靶剂量达标率,开展定期门诊复查,进行心理辅导及增加运动处方等内容,从而形成系统的急性心梗分级管理方案,对照组进行既往常规的随访复查,观察1年后试验组及对照组在药物依从性、靶剂量达标率、血脂达标率、心脏超声指标,再住院率,发病时间,生活质量评分、死亡率等指标的统计,分析分级管理对预后的影响。结果通过实施急性心肌梗死患者的分级管理,Ⅰ级及Ⅱ级心肌梗死患者试验组较对照组在发病时间及再住院率上无差别,但药物依从性均明显增高,β受体阻滞剂靶剂量达标率及LDL-C达标率提高。对于Ⅲ级心肌梗死试验组患者较对照组,在发病时间及再住院率、药物依从性、LDL-C达标率、β受体阻滞剂靶剂量达标率、心脏异构、生存质量等方面均有统计学意义,死亡率未见明显统计学差异。结论提高急性ST段抬高型心肌梗死患者介入术后分级管理有利于患者生活质量的提高,改善重症患者的预后。Objective Improve the prognosis of patients by trying a new model of the hierarchical management after interventional surgery for acute ST-segment elevation myocardial infarction.Methods According to the results of CK-MB,troponin,BNP precursor,coronary angiography,LVEF,etc.of patients with acute ST-segment elevation myocardial infarction,the scores are graded according to mild,moderate and severe,and divided intoⅠ,Ⅱ,andⅢthree levels,each level is randomly divided into the test group and the control group,carry out targeted hierarchical management of the test group,carry out cognitive education courses for patients with myocardial infarction,give corresponding myocardial infarction grading cards,strengthen patient selfmanagement,designate follow-up physicians,and improve drugs adherence withβ-blockers and ACEI/ARB drugs and the rate of compliance with target doses,regular outpatient review,psychological counseling and exercise prescriptions,etc.,to form a systematic acute myocardial infarction hierarchical management plan,the control group had a regular follow-up re-examination.After 1 year,the test group and the control group were observed the target drug dose compliance rate,blood lipid compliance rate,cardiac ultrasound index,rehospitalization rate,onset time,quality of life score and other indicators,and analyzed the hierarchical management on the impact of prognosis.Results By implementing the hierarchical management of patients with acute myocardial infarction,the patients in the test management group of gradeⅠandⅡmyocardial infarction showed no difference in onset time and recurrence rate compared with the control group,but the drug compliance was significantly increased,β-blocker target dose compliance rate and LDL-C compliance rate increased.Compared with the control group,patients in the gradeⅢmyocardial infarction test group had significant statistical difference in terms of onset time and recurrence rate,drug compliance,LDL-C compliance rate,β-blocker target dose compliance rate,cardiac

关 键 词：急性ST段抬高型心肌梗死 分级管理 预后 

分 类 号：R542.22[医药卫生—心血管疾病]