护理干预对PCI患者冠心病危险因素的影响

发布时间：2018-05-18 12:17

本文选题：PCI + 冠心病危险因素　；参考：《新乡医学院》2014年硕士论文

【摘要】：背景目前PCI(经皮冠状动脉介入治疗)已成为治疗冠心病的有效手段,因其创伤少、可快速缓解症状、缩短住院时间且远期疗效显著而被临床广泛接受和应用。但PCI并未阻止动脉粥样硬化的过程,忽视潜在冠心病危险因素的存在可导致不良心血管事件的发生。研究显示,冠心病患者糖代谢异常发生率显著高于一般人群。而高血糖是引起冠状动脉支架再狭窄的独立危险因素。PCI术的有效性使患者忽视改善生活方式的必要性。特别是部分患者因住院首发糖代谢异常、无症状而忽视健康生活方式,引起糖、脂代谢紊乱,就会显著增加冠心病危险因素,从而影响了患者病情恢复甚至造成了PCI术后不良心血管事件的发生。目的通过对首发糖代谢异常PCT患者护理干预,探讨护理干预能否有效地控制冠心病PCI患者的危险因素,减少不良心血管事件的发生,促进患者的康复,改善患者的生活质量。方法选取某院心内科2012年1月-2012年12月期间,成功实施PCI术的首发糖代谢异常患者共188例,且均首次行单支或多支冠状动脉内支架置入术。获得知情同意后,将病人随机分为实验组(n=94)和对照组(n=94),实验组接受长期、综合护理干预,即住院期间进行PCI危险因素、糖代谢异常等相关知识的培训,并在药物治疗的同时给予以改善生活方式为主的护理干预,包括饮食管理、运动指导、心理护理为干预重点,控制冠心病危险因素为基本手段,于出院后1、6、12个月以电话随访、门诊复查等形式进行持续护理干预、跟踪随访。对照组只在住院期间给予常规护理措施,在出院后1、6、12个月电话或门诊随访患者的药物服用情况、了解冠心病危险因素等。收集两组患者的一般资料、药物服用情况、冠心病危险因素。采用ACC(美国心脏病学学会)和AHA(美国心脏协会)2011-2012年PCI治疗指南和WHO推荐的PCI术后冠心病危险因素(血糖、血脂、血压、体重指数等)为护理干预的主要评价指标。并对所收集资料进行统计学处理,采用标准差、百分比、t检验、卡方检验分析出院后1、6、12个月两组患者的冠心病危险因素、药物服用情况等进行比较,分析护理干预对两组PCI患者危险因素控制达标率。结果 1.干预前两组患者的一般资料、冠心病危险因素、药物治疗情况经统计学处理,无统计学意义,P0.05。 2.实验组患者出院1个月,血压(BP)、低密度脂蛋白(LDL-C)、空腹血糖(FPG)、运动达标率高于对照组(P0.01),餐后血糖(2hPG)、体重指数(BMI)达标率与对照组无差别(P0.05)。 3.干预6个月后,实验组患者FPG、2hPG、LDL-C、运动达标率高于对照组(P0.01),血压(BP)达标率与对照组无差别(P0.05)。 4.干预12个月后,实验组血糖(FPG、2hPG)、LDL-C、BP、BMI、运动达标率高于对照组(P0.01)。结论对PCI患者进行长期、综合的护理干预优于短期、常规护理,可以有效控制PCI患者冠心病危险因素。
[Abstract]:Background At present, PCI (percutaneous coronary intervention) has become an effective method in the treatment of coronary heart disease. PCI has been widely accepted and applied in clinic because of its less trauma, rapid relief of symptoms, shorter hospital stay and better long-term effect. However, PCI does not prevent the process of atherosclerosis, ignoring the existence of potential risk factors of coronary heart disease can lead to adverse cardiovascular events. The incidence of abnormal glucose metabolism in patients with coronary heart disease was significantly higher than that in the general population. Hyperglycemia is an independent risk factor for coronary stent restenosis. In particular, some patients with abnormal glucose metabolism and asymptomatic neglect of healthy lifestyle, causing disorders of glucose and lipid metabolism, will significantly increase risk factors for coronary heart disease. This affected the recovery of patients and even resulted in adverse cardiovascular events after PCI. Purpose Through nursing intervention in patients with first-episode abnormal glucose metabolism (PCT), this paper discusses whether nursing intervention can effectively control the risk factors of PCI patients with coronary heart disease, reduce the occurrence of adverse cardiovascular events, promote the recovery of patients and improve the quality of life of patients. Method From January 2012 to December 2012, a total of 188 patients with first-episode abnormal glucose metabolism who successfully performed PCI were selected, and all patients were treated with single or multiple coronary stents for the first time. After obtaining informed consent, the patients were randomly divided into two groups: the experimental group and the control group. The experimental group received long-term, comprehensive nursing intervention, that is, training on risk factors of PCI and abnormal glucose metabolism during hospitalization. At the same time, the patients were given nursing intervention mainly to improve their lifestyle, including diet management, exercise guidance, psychological nursing as the key intervention and controlling risk factors of coronary heart disease as the basic means. The patients were followed up by telephone at 1 day after discharge and 12 months after discharge. Continuous nursing intervention was carried out in the form of outpatient reexamination and follow-up. The control group was only given routine nursing measures during the period of hospitalization. The patients were followed up by telephone for 6 months 12 months after discharge to understand the risk factors of coronary heart disease and so on. General data, drug use and risk factors of coronary heart disease were collected. The risk factors of coronary heart disease (such as blood glucose, blood lipid, blood pressure, body mass index, etc.) recommended by WHO and PCI treatment guidelines for 2011-2012 were used as the main evaluation indexes of nursing intervention. The data collected were analyzed by statistical analysis, standard deviation, percentage t test and chi-square test. The risk factors of coronary heart disease and drug use were compared between the two groups at 1: 6and 12 months after discharge. Nursing intervention was analyzed to control the risk factors of PCI patients in two groups. Result 1. The general data of the two groups before intervention, coronary heart disease risk factors, drug treatment after statistical treatment, there was no statistical significance (P 0.05). 2. One month after discharge, the blood pressure, low density lipoprotein (LDL-C), fasting blood glucose (FBG) and FPGG were higher in the experimental group than those in the control group (P 0.01), and there was no significant difference between the two groups in achieving the standard rate of postprandial blood glucose 2 h PGI and BMI. 3. After 6 months of intervention, the LDL-C of PGN in the experimental group was higher than that in the control group (P 0.01), and there was no difference between the control group and the control group (P 0.05). 4. After 12 months of intervention, the blood glucose levels in the experimental group were significantly higher than those in the control group (P 0.01). Conclusion The long-term and comprehensive nursing intervention of PCI patients is better than that of short-term nursing. Routine nursing can effectively control the risk factors of coronary heart disease in patients with PCI.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.5

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