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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2018, Vol. 06 ›› Issue (04) : 339 -343. doi: 10.3877/cma.j.issn.2095-5782.2018.04.013

所属专题： 文献；

介入护理

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
刘永华1, 李铁2, 钟韶萍1, 谢雪花1, 马英东1,†()   
  1. 1. 519000　广东珠海，中山大学附属第五医院介入医学中心
    2. 519000　广东珠海，中山大学附属第五医院感染病防治中心
  • 收稿日期:2018-08-06 出版日期:2018-11-01
  • 通信作者: 马英东
  • 基金资助:
    广东省自然科学基金项目(2017A030310369)

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

Yonghua Liu1, Tie Li2, Shaoping Zhong1, Xuehua Xie1, Yingdong Ma1,†()   

  1. 1. Interventional Medical Center, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
    2. Infectious Disease Control Center, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
  • Received:2018-08-06 Published:2018-11-01
  • Corresponding author: Yingdong Ma
  • About author:
    Corresponding author: Ma Yingdong, Email:
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引用本文：

刘永华, 李铁, 钟韶萍, 谢雪花, 马英东. 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[J]. 中华介入放射学电子杂志, 2018, 06(04): 339-343.

Yonghua Liu, Tie Li, Shaoping Zhong, Xuehua Xie, Yingdong Ma. Effects of intensive nursing care intervention outside hospital in patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional therapy[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(04): 339-343.

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。

关键词: 急性心肌梗死, 护理干预, 随机对照试验
Objective:

To observe the efficacy of multifactor intensive nursing intervention (telephone consultation, setting up outpatient nurses for coronary heart disease, health education, psychological care and guiding cardiac rehabilitation) in patients with acute ST-segment elevation myocardial infarction (STEMI) .

Methods:

We conducted an open-label, randomized and controlled trial at the 5th Affiliated Hospital of Sun Yat-Sen University. A total of 1920 patients with STEMI undergoing emergency interventional therapy were recruited and randomly divided into control group receiving usual care or intervention group receiving intensive nursing care. The patients (1874 cases) completed the follow-up of 24 months and the self-management abilities and clinical outcomes were reviewed.

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 and self monitoring of blood sugar and blood pressure (P<0.001) . The use of secondary prevention drugs for CVD (statins, angiotensin-converting enzyme inhibitors, β-blockers and angiotensin II receptor antagonists) in intensive nursing group was higher than the usual-care group (P<0.001) , while the level of NT-pro-BNP, mortality and rehospitalization rates in intensive intervention group were lower than those of the usual-care group (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.

Key words: Acute myocardial infarction, Nursing case intervention, Randomized controlled trial
表1 两组患者的一般临床资料比较（±s）或例（%）
指标 普通护理组(n=1 070) 强化护理组(n=804) 统计量 P值
发病至冠脉血流开通时间(h) 5.6±1.8 5.7±1.6 t=-1.378 0.168
梗死相关动脉 ? ? χ2=2.406 0.359
? 前降支 452(42.2) 326(40.6) ? ?
? 回旋支 218(20.4) 149(18.5) ? ?
? 右冠状动脉 400(37.4) 329(40.9) ? ?
男性 580(54.2) 454(56.5) χ2=0.950 0.330
年龄（岁） 65.0±12.7 64.3±10.2 t=1.238 0.216
吸烟 747(69.8) 569(70.8) χ2=0.202 0.654
合并高血压 644(60.2) 518(64.4) χ2=3.505 0.061
合并糖尿病 292(27.3) 247(30.7) χ2=2.638 0.104
TC(mmol/L) 5.27±1.34 5.28±1.21 t=-0.168 0.866
LDL-C(mmol/L) 3.28±1.32 3.35±1.14 t=-1.214 0.225
肌酐(mmol/L) 90.60±43.91 88.82±31.36 t=0.988 0.323
使用ACEI/ARB 1 050(98.1) 797(99.1) χ2=3.223 0.073
使用 β 受体阻滞剂 1 019(95.2) 773(96.2) χ2=0.910 0.340
使用他汀类药物 1 070(100.0) 804(100.0) χ2=0 1.000
左室舒张末内径(mm) 47.06±6.98 47.25±6.79 t=-0.596 0.551
左室射血分数(%) 56.14±4.75 56.54±5.37 t=-1.706 0.088
NT-pro-BNP(ng/L) 1 202.17±304.23 1 193.08±293.34 t=0.650 0.516
表2 两组患者随访24个月后的结果（±s）或例（%）
指标 普通护理组(n=1 070) 强化护理组(n=804) 统计量 P值
每周康复运动次数（次） 1.20±0.81 3.41±1.12 t=-49.358 <0.001
吸烟 712(66.5) 314(39.1) χ2=140.001 <0.001
血脂达标 501(46.8) 614(76.4) χ2=166.296 <0.001
自我监测血糖血压 728(68.0) 740(92.0) χ2=155.836 <0.001
使用ACEI/ARB 729(68.1) 797(99.1) χ2=291.714 <0.001
使用 β 受体阻滞剂 698(65.2) 781(97.2) χ2=280.918 <0.001
使用他汀类药物 861(80.5) 804(100.0) χ2=176.756 <0.001
左室舒张末内径(mm) 52.30±6.80 48.90±7.27 t=10.396 <0.001
左室射血分数(%) 47.03±4.01 59.00±5.78 t=-52.869 <0.001
NT-pro-BNP(ng/L) 1 608.31±380.44 803.47±298.19 t=54.055 <0.001
死亡 24(2.2) 6(0.7) χ2=6.528 0.011
再入院 98(9.2) 44(5.5) χ2=8.907 0.003
[1]
Wijeysundera HC,Machado M,Farahati F, et al. Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994-2005[J]. JAMA, 2010, 303(18):1841-1847.
[2]
Amsterdam EA,Wenger NK,Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2014, 64(24):e139-e228.
[3]
Li X,Murugiah K,Li J, et al. Urban-Rural Comparisons in Hospital Admission, Treatments, and Outcomes for ST-Segment-Elevation Myocardial Infarction in China From 2001 to 2011: A Retrospective Analysis From the China PEACE Study（Patient-Centered Evaluative Assessment of Cardiac Events）[J]. Circ Cardiovasc Qual Outcomes, 2017, 10(11): e003905.
[4]
Tra Jvander,Wulp I,Appelman Y, et al. Adherence to guidelines for the prescription of secondary prevention medication at hospital discharge after acute coronary syndrome: a multicentre study[J]. Neth Heart J, 2015, 23(4):214-221.
[5]
Yusuf S,Islam S,Chow CK, et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries（the PURE Study）: a prospective epidemiological survey[J]. Lancet, 2011, 378(9798):1231-1243.
[6]
Ibanez B,James S,Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation[J]. Rev Esp Cardiol（Engl Ed）, 2017, 70(12):1082.
[7]
Du X,Spatz ES,Dreyer RP, et al. Sex differences in clinical profiles and quality of care among patients with ST-segment elevation myocardial infarction from 2001 to 2011: insights from the China Patient-Centered Evaluative Assessment of Cardiac Events （PEACE）-retrospective study[J]. J Am Heart Assoc, 2016, 5（2）.
[8]
Raber L,Taniwaki M,Zaugg S, et al. Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries（IBIS-4）: a serial intravascular ultrasonography study[J]. Eur Heart J, 2015, 36(8):490-500.
[9]
Teo K,Lear S,Islam S, et al. Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology（PURE）study[J]. JAMA, 2013, 309(15):1613-1621.
[10]
Harbman P. The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: a prospective cohort study[J]. Int J Nurs Stud, 2014, 51(12):1542-1556.
[11]
Forsetlund L,Bjorndal A,Rashidian A, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes[J]. Cochrane Database Syst Rev, 2009, (2):CD003030.
[12]
Liem S,Sander HB,Oemrawsingh PV, et al. MISSION!: optimization of acute and chronic care for patients with acute myocardial infarction[J]. Am Heart J, 2007, 153(1):14 e11-11.
[13]
Aggarwal B,Shah GK,Randhawa M, et al. Utility of glycated hemoglobin for assessment of glucose metabolism in patients with ST-Segment elevation myocardial infarction[J]. Am J Cardiol, 2016, 117(5):749-753.
[14]
Lee WC,Fang HY,Chen HC, et al. Anemia: A significant cardiovascular mortality risk after ST-segment elevation myocardial infarction complicated by the comorbidities of hypertension and kidney disease[J]. PLoS One, 2017, 12(7):e0180165.
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