疾病管理对冠心病患者二级预防的影响

Effects of Disease Management Programmes on Secondary Prevention in Patients with Coronary Heart Disease

目的探索冠心病疾病管理计划的可行性和对冠心病二级预防的影响。方法将397例冠心病患者随机分为两组,疾病管理组203例,对照组194例。疾病管理组干预包括6次健康教育、电话随访、专科门诊等。对照组无上述干预,自行去专科门诊治疗。观察12月后两组患者的结果。结果两组患者临床特征,差异无统计学意义(P>0.05)。随访12月,对照组吸烟率29.9%,体重指数(BMI)(23.7±1.34)kg/m2,有氧运动比例31.9%。疾病管理组吸烟率3.4%,BM(I22.7±1.19)kg/m2,有氧运动比例63.1%。两组比较差异有统计学意义(P<0.01)。对照组血压达标率77.8%,糖化血红蛋白(HbA1C)达标率66.5%,低密度脂蛋白(LDL)水平下降(-18.4±23.5)%。疾病管理组血压达标率88.2%),HbA1C达标率85.7%,和LDL水平下降(-24.1±20.4)%。两组比较差异有统计学意义(P<0.01)。除血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARBs)外,疾病管理组服药依从性显著优于对照组(P<0.05)。疾病管理组总心血管病事件率20.2%显著低于对照组40.7%,差异有统计学意义(P<0.01)。结论冠心病疾病管理计划可显著改善冠心病患者的生活方式、提高血压、HbA1C、LDL达标率,增加服药依从性,显著降低远期心血管病事件率。

Objective To investigate the feasibility and effects of disease management programmes on secondary prevention in patients with coronary heart disease（CHD）. Methods 397 patients with CHD were randomly divided into two groups, disease management group（n=203） and control group（n=194）. The intervention of disease management group included 6 times of healthy education, telephone follow-up, specialist out-patient and so on, while the control group had no the above intervention, they went to the specialist out-patient for treatment by themselves. The conditions of the two groups 12 months later were observed. Results The difference in clinical characteristics between the 2 groups was not statistically significant（P〉0.05）. The results of 12-month follow-up showed that, between the control group and the disease management group, there were statistically significant differences in smoking rate（29.9% vs. 3.4%, P〈0.01）, the body mass index（BMI）（23.7±1.34kg/m2 vs. 22.7±1.19kg/m2, P〈0.01） and aerobic exercise rate（31.9% vs. 63.1%, P〈0.01）. Between the control group and the disease management group, there were statistically significant differences in the standard-reaching rate of blood pressure（77.8% vs. 88.2%, P〈0.01）, standard-reaching rate of glycosylated hemoglobin（HbA1C）（66.5% vs. 85.7%, P〈0.01）, and the reduction of low density lipoprotein（LDL）（-18.4±23.5% vs.-24.1±20.4%, P〈0.01）. The medication compliance was higher in the disease management group than in the control group, except for ACEI/ARBs（P〈0.05）. The total cardiovascular event rate of the disease management group was 20.2%, obviously lower than 40.7%of the control group, the difference was statistically significant（P〈0.01）. Conclusion Disease management programmes can improve the lifestyle of patients with CHD, enhance the standard-reaching rate of blood pressure and HbA1 C and LDL, increase the medication compliance and reduce the long-term cardiovascular event rate significantly.