随访模式对冠心病支架置入术后抗血小板治疗依从性及1年再入院率的影响

Effect of Follow-up Modes on Compliance of Antiplatelet Therapy and one Year Readmission rate After Stent Implantation of Coronary Heart Disease

目的观察不同随访模式对冠心病支架置入术后抗血小板治疗依从性及1年再入院率的影响。方法选取2011年5月至2014年5月连续3年在我院心内科成功接收PCI手术并置于支架的256例老年冠心病患者为研究对象,随机分为对照组和观察组,对照组患者接受定期门诊随访调查,观察组在对照组基础上同时进行定时电话随访调查,随访时间为1年。两组患者随访结束后,对两组患者采用调查问卷对随访效果进行评估,比较两组患者PCI术后1年内抗血小板药物服用依从性。比较两组患者PCI后不良心血管事件(MACE)发生情况,比较两组患者并发症发生情况、生活质量评分和1年内再入院率。结果 PCI术后1年内随访调查发现,观察组中患者医嘱依从性明显高于对照组(P<0.05)。观察组患者的抗血小板知识、及时就诊、按时复诊及自我管理评分均明显高于对照组(P<0.05)。术后1年内随访观察组靶血管重建、累积MACE发生率和再次入院发生率明显低于对照组,(P<0.05)。经术后1年随访观察组患者生活质量评分高于对照组(P<0.05)。结论定期门诊随访联合电话随访能够提高患者冠心病支架置入术后抗血小板药物服用的依从性和降低1年再入院率,对患者术后生活质量起到积极作用。

Objective To observe the effect of different follow-up modes on the compliance of antiplatetet therapy and 1-year readmission rate after stent implantation of coronary heart disease. Methods 256 cases of elderly patients with coronary heart disease who underwent successful PCI and stent implantation in the department of cardiology of our hospital between May 2011 and May 2014 for 3 consecutive years were selected as study subjects and were randomized into control group and observation group. Patients in the control group received regular outpatient follow-up survey. On the basis, patients in the observation group received 1-year regular telephone follow-up. At the end of follow-up, the follow-up effects in the two groups were evaluated by questionnaires. The compliance of antiplatelet therapy within 1 year after PCI was compared between the two groups. The incidence of major adverse cardiovascular events （ MACE ） , the incidence of complications, quality of life score and readmission rate within 1 year were also compared between the two groups. Results Follow-up within 1 year after PCI found that the compliance with doctor＇ s advice in the observation group was significantly higher than that in the control group （P 〈 0. 05 ）. The scores of antiplatelet knowledge, timely treatment, timely subsequent visit and self-management in the observation group were significantly higher than those in the control group （P 〈 0.05 ）. The incidence rates of target vessel reconstruction, cumulative MACE and readmission in the observation group were significantly lower than those of the control group （P 〈 0. 05 ） while the quality of life score was higher than that in the control group （ P 〈 0.05 ）. Conclusion Regular outpatient follow-up combined with telephone follow-up can improve compliance of taking antiplatelet agents in patients with coronary heart disease after stent implantation and reduce the 1- year readmission rate. It plays a positive role in improving postoperative quality of life.