老年冠心病患者自我管理能力与PCI术后主要心血管不良事件的关系研究

Relationship between self-management ability and major adverse cardiovascular events after PCI in elderly patients with coronary heart disease

目的探索自我管理能力与老年冠心病患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)术后主要心血管不良事件(major adverse cardiovascular events,MACE)的关联,为降低冠心病患者PCI术后MACE提供参考依据。方法采用方便抽样法于2023年2~6月在黑龙江省哈尔滨市3所医院选取60岁以上老年360例冠心病行PCI术后患者,进行一般人口学信息、冠心病自我管理能力量表问卷调查。采用二元Logistic回归分析MACE的影响因素;限制性立方样条模型分析自我管理能力与MACE间的剂量-反应关系。结果360例老年冠心病患者PCI术后发生MACE人数146例,检出率40.56%。老年冠心病患者自我管理能力得分(72.31±9.31)分。多因素Logistic回归结果显示年龄、患病时长、饮酒、甘油三酯、自我管理能力是老年冠心病PCI术后患者发生MACE的独立影响因素(P<0.05)。限制性立方样条模型结果显示,在控制混杂因素后,自我管理能力与MACE关联强度呈现非线性剂量反应关系(非线性检验P<0.001)。结论老年冠心病PCI患者术后MACE发生率较高。MACE受年龄、患病时长、饮酒、甘油三酯、自我管理能力影响,临床医护人员应重点关注高危人群,加强患者宣教,提高患者冠心病自我管理能力,减少MACE的发生。

Objective To explore the correlation between self-management ability and major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease,and to provide reference for reducing MACE in patients with coronary heart disease after PCI.Methods From February to June 2023,360 elderly patients aged 60 and above who underwent PCI in three hospitals in Harbin,Heilongjiang Province were randomly selected for general demographic information and coronary heart disease self-management ability scale questionnaire survey.The influencing factors of MACE was analyze by using binary Logistic regression;The dose-response relationship between self-management ability and MACE was analyzed by the restrictive cubic spline model.Results The results showed that 146 elderly patients with coronary heart disease experienced MACE after PCI,with a detection rate of 40.56%.The self-management ability score of elderly patients with coronary heart disease was(72.31±9.31)scores.The multivariate Logistic regression results showed that age,duration of illness,alcohol consumption,triglycerides,and self-management ability were independent influencing factors for the occurrence of MACE in elderly patients with coronary heart disease after PCI(P<0.05).The results of the restricted cubic spline model showed that after controlling for confounding factors,the correlation between self-management ability and MACE showed a non-linear dose-response relationship(non-linear test P<0.001).Conclusion The incidence of MACE is higher in patients with coronary heart disease after PCI.MACE is influenced by age,duration of illness,alcohol consumption,triglycerides,and self-management ability.Clinical healthcare professionals should focus on high-risk groups,strengthen patient education,improve patients’self-management ability for coronary heart disease,in order to reduce the occurrence of MACE.