冠心病患者PCI术后1年生活质量的变化及其影响因素的研究

发布时间：2018-06-21 06:41

  本文选题：冠心病 + PCI　； 参考：《大连医科大学》2017年硕士论文

【摘要】：研究背景及目的:随着社会压力增大及人口老龄化,冠心病发病人数持续增加,给家庭、社会带来的躯体、精神及经济上的负担日益严重。现代医学治疗不仅关注于改善症状体征,降低死亡率,延长寿命,更注重躯体、心理、情感及社会功能等方面生活质量的提高,后者更被临床医生、患者及社会认为是医疗技术、疾病控制的终点评估指标之一。经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)是冠心病治疗领域的里程碑,因其可重复性高、疗效可靠、康复快备受青睐。本研究应用健康调查简表(SF-36)对首次成功施行PCI术的冠心病患者进行术前、术后1年生活质量评价,比较术前及术后的生活质量变化,并分析PCI术后生活质量变化的影响因素,如性别、年龄;高血压、糖尿病、高脂血症;病变血管数量、未处理病变血管数量、植入支架数量、冠心病类型;BNP、左室射血分数(left ventricular ejection fraction,LVEF)、是否存在节段性运动异常;术后血糖、血压、血脂控制情况;术后吸烟状态。以此为医生诊疗、患者自我健康管理提供一定的理论依据。方法:研究对象为2015年2月-2016年2月期间,在大连医科大学附属第一医院首次成功实施冠状动脉造影及药物洗脱支架置入术的患者152例,经患者本人及家属知情同意后,选用普适性SF-36量表,术前由患者本人填写(因视力差、文盲的患者,由研究者读,患者本人选择),PCI术后1年通过电话随访或门诊复查进行相关资料采集,应用t检验,比较术前及术后1年生活质量,应用单因素分析及逐步多元线性回归对影响PCI术后1年生活质量变化的因素进行统计学分析。结果:1.SF-36量表各维度生活质量分数分析:PCI术后1年较术前生活质量提高,且差异有统计学意义(P0.05);2.单因素分析影响因素结果:性别、年龄、冠心病类型、术后吸烟情况对PCI术后1年生活质量变化有影响,而是否患有高血压、糖尿病、高脂血症、病变血管数量、未处理病变血管数量、植入支架数量、BNP、左室射血分数(LVEF)、是否存在节段性运动异常、术后血压、血糖、血脂控制情况对PCI术后1年生活质量变化无影响。3.多元线性逐步回归影响因素结果:性别、冠心病类型、术后吸烟情况与PCI术后1年生活质量变化存在复相关,复相关系数为0.365:男性SF-36总评分提高优于女性;无吸烟史患者SF-36总评分提高优于有吸烟史患者,术后戒烟患者SF-36总评分提高优于术后未戒烟患者;不稳定型心绞痛患者SF-36总评分提高优于急性心肌梗死患者。结论:1.PCI术后1年较术前生活质量明显提高,PCI术可显著提高冠心病患者生活质量;2.性别、冠心病类型、术后吸烟情况是影响冠心病患者PCI术后1年生活质量变化的因素。
[Abstract]:Background and purpose: with the increase of social pressure and the aging of the population, the number of patients with coronary heart disease is increasing, and the physical, spiritual and economic burden of the family and society is increasingly serious. Modern medical treatment is not only concerned with improving symptoms and signs, reducing mortality and prolonging life, but also paying more attention to physical, psychological, emotional and social functions. The improvement of the quality of life, the latter is also considered by clinicians, patients and society as one of the end-point evaluation indicators of medical technology and disease control. Percutaneous coronary intervention (percutaneous coronary intervention, PCI) is a milestone in the treatment of coronary heart disease, because of its high repeatability, reliable curative effect and fast recovery. To evaluate the quality of life before and after 1 years, the quality of life of patients with coronary heart disease after the first successful PCI operation was evaluated by SF-36. The factors such as sex, age, high blood pressure, diabetes, hyperlipidemia, and the number of diseased vessels were analyzed. The number of diseased vessels, the number of stent implantation, type of coronary heart disease, BNP, left ventricular ejection fraction (LVEF), the existence of segmental dyskinesia, postoperative blood glucose, blood pressure, blood lipid control, and postoperative smoking state. For the first time in the first hospital affiliated to Dalian Medical University, 152 cases of coronary artery angiography and drug eluting stent implantation were successfully implemented in the First Affiliated Hospital of Dalian Medical University in February 2015. After informed consent of the patients and their families, the universal SF-36 was selected and the patients were filled out by the patient before the operation (because of poor eyesight, illiterate patients, read by the researchers. " The patient chose), 1 years after PCI, the related data were collected by telephone follow-up or outpatient review, and t test was used to compare the quality of life before and after 1 years. The factors affecting the changes of quality of life after 1 years after PCI were statistically analyzed by single factor analysis and stepwise multiple linear regression. Results: the life of the 1.SF-36 scale was in all dimensions. Quality score analysis: the quality of life was improved in 1 years after PCI, and the difference was statistically significant (P0.05). 2. single factor analysis of influencing factors were that sex, age, type of coronary heart disease, and postoperative smoking had an influence on the quality of life in 1 years after PCI, and whether there was hypertension, diabetes, hyperlipidemia, and the number of diseased vessels. The number of diseased vessels, the number of stent implantation, BNP, left ventricular ejection fraction (LVEF), the existence of segmental dyskinesia, postoperative blood pressure, blood glucose, and blood lipid control had no effect on the 1 year.3. linear stepwise regression factors after PCI: sex, type of coronary heart disease, postoperative smoking and the quality of life of 1 years after PCI The total score of 0.365: was better than that of women; the total score of SF-36 in patients with no smoking history was better than that of patients with smoking history. The total score of SF-36 in patients with smoking cessation was better than that of non smoking patients after operation, and the overall SF-36 score of patients with unstable angina was better than that of patients with acute myocardial infarction. Conclusion: 1 years compared with the preoperative quality of life was significantly improved after 1.PCI operation, PCI operation can significantly improve the quality of life of patients with coronary heart disease; coronary heart disease type 2. gender, smoking status, postoperative quality of life influence factors PCI in patients with coronary heart disease after 1 years.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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本文编号：2047627