冠心病血运重建术后患者二级预防现状调查

Compliance of secondary prevention in patients with coronary artery disease post coronary revascularization

目的了解冠心病患者血运重建术后二级预防的现状。方法2009年1月至2010年10月，收集北京市劲松垂杨柳地区行冠心病血运重建术后3个月以上患者的基本信息、术后用药、健康生活方式状况等相关资料，同时测量身高、体重，并检测患者血脂、血糖、糖化血红蛋白水平。结果共入选患者512例，其中单纯接受冠状动脉介入治疗术治疗472例，单纯行冠状动脉旁路移植手术25例，介入治疗术加旁路移植手术者15例。二级预防药物使用情况：服用阿司匹林者93．9％（481／512），介入治疗术患者规范使用氯吡格雷或噻氯吡啶的为94．9％（462／487），使用β受体阻滞剂者82．0％（420／512），他汀类药物为81．4％（417／512），血管紧张素转换酶抑制剂或血管紧张素受体拈抗剂为76．2％（390／512），注射流感疫苗者3．7％（19／512）。重要危险因素指标中只有舒张压、HDL—C和糖化血红蛋白控制达标率超过90％，其他指标达标率均不高，LDL—C的达标率只有44．5％（228／512）。健康生活方式情况：目前不吸烟者比例为81．4％（417／512），饮食节制为78．5％（402／512），体重达标者61．7％（316／512），规律运动者为58．2％（298／512）。结论本组血运重建术后冠心病患者规范使用抗血小板及长期应用他汀类药物者比例较高，但多项重要的危险因素控制仍不理想，生活方式改善情况有待进一步提高，二级预防现状存在巨大改善空间。

Objective To investigate the compliance status of secondary prevention in patients with coronary artery disease （CAD） following revascularization. Methods A total of 512 patients with CAD who received procedures for coronary revascularization were enrolled in the study from January 2009 to October 2010, including 472 cases of percutaneous coronary intervention stenting, 25 cases of coronary artery bypass grafting and 15 cases of stenting plus bypass. The demographic information, prophylactic drug therapies, lifestyle changes and modifiable risk factors were surveyed with questionnaires, anthroposomatological measurements and laboratory tests in patients 3 months after coronary revascularization. Results The proportion of patients on statins, aspirin, [3-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers （ ACEIs/ARBs ） and influenza vaccination were 81.4% （417/512）, 93.9% （ 481/512 ）, 82.0% （ 420/512 ）, 76. 2% （ 390/512 ） and 3.7% （ 19/512 ） respectively. Based on the criteria recommended by the American Heart Association/American College of Cardiology （AHA/ACC） Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease： 2006 Update, the percentages of achieving therapeutic targets of modifiable risk factor management were as follows： glycosylated hemoglobin （90. 2%, 462/512）, total cholesterol （ 68.6% , 351/512 ） , triglycerides （ 58.8% , 301/512 ） , high-density lipoprotein cholesterol （91.6% ,469/512 ）, low-density lipoprotein cholesterol （44. 5% , 228/512 ）, systolic pressure （75.2% , 385/512） and diastolic pressure （90.4% ,463/512） respectively. And the proportions of improved lifestyle were as follows： smoking cessation/non-smoking 81.4% （417/512） , diet control 78. 5% （402/512） , achieving weight targets 61.7% （316/512） and regular exercise 58.2% （298/512）. Conclusions There is a relatively high percentage of standardized antiplatelet therapy and continuous statins medication in patients with coronary artery disease following revascularization. However, many significant modifiable risk factors have not been controlled optimally and lifestyle of patients needs further improvement. There is still a considerable scope for further improvement of secondary prevention in this group of patients.