【作者】 孟海英；

【导师】 郜玉珍； 李茂莲；

【作者基本信息】 山西医科大学 ， 护理学， 2008， 硕士

【摘要】 研究目的探讨多学科合作、多形式共用、医院与社区相结合的长期综合健康教育干预能否有效控制PCI术后病人冠心病危险因素,为PCI术后的二级预防工作提供参考依据。研究方法采取同期随机对照试验,研究对象选取山西省三所三级甲等医院2006年11月1日~11月30日期间,成功实施PCI手术的太原市区病人。获得知情同意后,采用分层随机化,将病人随机分为干预组和对照组;干预组接受综合健康教育,对照组接受常规健康教育。统一调查和体检收集病人的一般资料、药物服用情况、冠心病危险因素水平资料;以ACC/AHA2005/2007年PCI治疗指南和WHO推荐的PCI术后冠心病危险因素应控制的目标水平为干预效果判断标准。用两样本t检验、秩和检验、卡方检验分析两组病人一般资料、冠心病危险因素基线水平、基线药物服用情况的组间均衡可比性。用单因素分析(卡方检验、分层卡方检验)和多因素分析(非条件logistic回归)进行统计学处理,排除6个月后/12个月后药物治疗的混杂因素后,干预对6个月后、12个月后冠心病危险因素控制达标率与对照组有无差别。结果两组病人的一般资料、冠心病危险因素基线水平、基线药物服用情况经统计学处理,无组间差异,均衡可比。干预6个月后,经卡方检验,干预组LDL-C、BMI、WC、运动达标率高于对照组,BP、FB、戒烟达标率与对照组无差别;单因素和多因素分析结果显示:排除6个月后药物治疗的混杂因素后,综合健康教育干预对LDL-C、BMI、WC、运动不足4个冠心病危险因素达标率有影响。干预12个月后,经卡方检验,干预组BP、LDL-C、FB、BMI、WC、戒烟、运动达标率均高于对照组,单因素和多因素分析结果显示:排除12个月后药物治疗的混杂作用后,综合健康教育干预对BP、LDL-C、BMI、WC、吸烟、运动不足6个冠心病危险因素达标率有影响,对FB控制与常规健康教育无差别。结论干预6个月后,综合健康教育对PCI术后LDL-C、BMI、WC、运动不足4个冠心病危险因素控制效果可以肯定;干预12个月后,综合健康教育对PCI术后BP、LDL-C、BMI、WC、运动不足、吸烟6个冠心病危险因素控制效果可以肯定;综合健康教育干预对FB控制效果与常规健康教育无差别。长期健康教育干预效果可能优于短期,其结论需进一步证明。更多还原

【Abstract】 Objective: The objective of the present study was to determine whether a long-term comprehensive health intervention programme with a dedicated medical director, along with an interdisciplinary team approach, including hospital and community could favourably influence coronary risk factors(CRF) in patients after percutaneous coronary intervention and improvement Secondary prevention interventions for patients after PCI.Methods: Concurrent randomized control trials were conducted in this study. A consecutive series of eligible patients was recruited from three hospitals in Tai yuan city, shan xi province, China after their first percutaneous coronary intervention between November 1 and November 30, 2006. After obtaining informed consent, a total of 127 patients after PCI were included and randomised to a comprehensive intervention programme(IP) or to usual care(UC). Both groups were given the same comprehensive medication. At baseline all participants were asked to offer their demographic, medication status and underwent risk factor assessment (physical and laboratory examination). After a period of 6 months and 12 months of intervention, all participants were invited to undertaken the same factor assessment as baseline successively. 2007 AHA/ACC PCI Secondary Prevention Guidelines and relative recommendations of WHO were selected as the criterion of evaluation. Independent sample t-tests, wilcoxon rank sum test, Chi-square test were used to evaluate differences in basic demographic, medical characteristics and coronary risk factors between the two study groups. univariate analyses, The [chi]2 statistic and Mantel-Haenszel were used to identify intervention, medical characteristics associated with effectiveness rates of CRF controlled of 6 months later and 12months later. Logistic regression was computed to evaluated the effectiveness of intervention in coronary risk reduction. Level of significance for all tests is P=0.05 (two-tailed).Results: There were no differences between the two groups in baseline sociodemographic, medical characteristics or risk factors, suggesting that there was no systematic bias attributable to differences in the intervals to the follow-up interviews. In the univariate analyses, IP and medication after 6 months were associated with effectiveness rates of controlling LDL-C, BMI, WC, physical activity. When all the relative variables were entered into a logistic regression analysis, IP emerged as significant in increasing the likelihood of managing LDL-C, BMI, WC, physical activity. IP after 12 months was associated with effectiveness rates of controlling all seven CRFs. When all the relative variables were entered into a logistic regression analysis, IP emerged as significant in increasing the likelihood of standard managing all seven CRFs except FB.Conclusion: compared with usual care, comprehensive health intervention seems a more effective way to improved CRFs modification after PCI. This programme provide a method of prevention to decrease the rate of restenosis and further cardiovascular events.更多还原