医联体制度下社区PCI术后患者冠心病二级预防随访分析

Follow-up analysis of secondary prevention of coronary heart disease of postoperative patients with PCI in a community under the medical conjoined system

目的:了解医联体制度下社区PCI术后冠心病患者二级预防药物治疗依从性及危险因素控制情况。方法:选取社区卫生服务中心服务范围内签约了"1+1+1"服务的108名PCI术后患者,年龄38~89岁,平均年龄(67.96±9.31)岁。其中男性76例,占70.37%,女性32例,占29.63%。评估患者冠心病二级预防相关情况。结果:医联体体制下PCI术后患者中药物依从性顺序为阿司匹林/西洛他唑96.30%,氯吡格雷82.40%,他汀类药物75.93%,β受体阻滞剂66.67%、ACEI/ARB 62.96%;患者血压比术前有所下降,差异有统计学意义(P<0.05);患者目前饮酒和吸烟的比例低于术前,差异均有统计学意义(P<0.05)。结论:在医联体框架及"1+1+1"签约服务模式下,社区PCI术后患者冠心病二级预防药物治疗依从性高,患者术后血压和生活方式改变方面有所改善。

Objective： To understand the compliance of secondary prevention drug treatment and the control of risk factors in patients with coronary heart disease after PCI under the medical conjoined system. Methods： A total of 108 postoperative PCI patients who had contracted for ＂1＋1＋1＂ service within the scope of the community health service center were selected, and the age was 38-89 years old, with an average age of（67.96±9.31） years. Of these, 76 were males, accounting for 70.37%, and 32 were females, accounting for 29.63%. The secondary prevention of coronary heart disease was evaluated. Results： The order of drug compliance in the postoperative patients with PCI under the medical conjoined system was 96.30% for aspirin/cilostazol, 82.40% for clopidogrel, 75.93% for statins, 66.67% for β-blockers and 62.97% for ACEI/ARB; the blood pressure of patients was lower than before surgery, and the difference was statistically significant（P0.05）; the proportion of alcohol drinking and smoking was lower than that before operation, and the difference was statistically significant（P0.05）. Conclusion： Under the medical conjoined framework and the ＂1＋1＋1＂ contracted service mode, postoperative patients with PCI in the community have a high level of adherence to secondary prevention medications for coronary heart disease and the patient＇s postoperative blood pressure and lifestyle changes have been improved.