青岛地区经皮冠状动脉介入术后患者二级预防现状的调查研究

Investigation on the status of secondary prevention in patients undergoing percutaneous coronary intervention (PCI) in Qingdao

目的了解冠心病二级预防药物的现状及危险因素控制情况,探讨冠心病二级预防规范化治疗的效果及不足。方法通过选择在2016年1月1日至2017年12月31日期间因冠心病在青岛市4家三级甲等医院住院接受经皮冠状动脉介入(PCI)治疗的患者528例,将青岛市省部级甲医院PCI术后218例患者分为A组、青岛市市级三甲医院乙、丙、丁PCI术后310例患者分为B组,采用回顾性研究方法,比较患者出院时、1月时、3月时、6月时及12月时冠心病二级预防药物应用情况及危险因素控制情况。结果他汀类、β受体阻滞剂、血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)类、服用3种药物及服用4种药物的服用率随着随访时间的延长,其下降趋势与住院比较下降明显,差异有统计学意义(P<0.05)。统计分析表明A组与B组中他汀类、β受体阻滞剂及ACEI/ARB类3种药物的服用率下降趋势明显,主要表现在出院6月及出院12月,且差异有统计学意义(P<0.05),在出院及出院1月A组与B组的各类药物的服用率,且差异无统计学意义;在出院12月比较A组与B组各类药物的服用率情况,抗血小板药物两组之间差异无统计学意义(P>0.05),而他汀类、β受体阻滞剂及ACEI/ARB类3种药物的服用率差异有统计学意义(P<0.05)。将患者出院12月资料进行统计学分析,戒烟、体质量达标、血压达标及血脂达标的可控危险因素的达标率较出院1月均有明显的提高,差异有统计学意义(P<0.05)。结论 PCI术后患者在住院期间二级预防药物用药很规范,但随着出院时间的延长,二级预防药物的服用率逐渐下降。

Objective To investigate the risk factors and secondary preventive drugs of patients with coronary heart disease after PCI in Qingdao so as to understand the status of secondary preventive drugs and control of risk factors and to explore the effect and deficiency of standardized treatment of secondary prevention of coronary heart disease.Methods 528 patients with coronary artery disease who were hospitalized in 4 tertiary first-class hospitals in Qingdao from January 1,2016 to December 31,2017 were selected.218 patients after PCI in Qingdao provincial and ministerial level A hospitals were divided into group A and 310 patients after PCI in three other tertiary A hospitals in Qingdao city were divided into group B.A retrospective study was conducted to compare the use of secondary preventive drugs and the control of risk factors at discharge,January,March,June and December.The body weight,smoking and smoking cessation,blood pressure,blood sugar,blood lipid,secondary drug use were measured by t-test and chi-square test.Results The rates of statins,beta blockers,ACEI/ARB,three drugs and four drugs decreased significantly with the prolongation of follow-up(P<0.05).The downward trend of statins,beta blockers and ACEI/ARB drugs in group A and group B was mainly manifested in 6 months after discharge and 12 months after discharge,with statistical difference(P<0.05).There was no significant difference in drug use rates between group A and group B in discharge and one month after discharge.There was no significant difference in the use rate of antiplatelet drugs between group A and group B in December after discharge(P>0.05).The rates of taking statins,beta-blockers and ACEI/ARB drugs were different,with statistical significance(P<0.05).The data of patients discharged from hospital in December were statistically analyzed.The rates of smoking cessation,weight,blood pressure and blood lipid were significantly higher than those of patients discharged from hospital in January(P<0.05).Conclusion The use of secondary preventive drugs in patients after PCI is very standardized during hospitalization,but with the prolongation of discharge time,the use rate of secondary preventive drugs gradually decreases.