早期多维度心脏康复护理模式对经皮冠状动脉介入治疗术后患者干预效果分析

Analysis of the effect of early multi-dimensional cardiac rehabilitation nursing mode on patients after PCI

目的探讨早期多维度心脏康复护理模式对经皮冠状动脉介入治疗(PCI)术后患者的干预效果。方法选取2017年8月至2018年7月,中山大学附属第三医院心血管内科收治的100例冠状动脉粥样硬化性心脏病(CHD)行PCI术后患者作为研究对象,根据随机数字表,将患者分为对照组和观察组,每组各50例。对照组给予常规心脏康复护理干预,观察组给予早期多维度心脏康复护理模式进行干预。所有患者随访6个月,观察随访第1个月和第6个月时主要心血管不良事件(MACE)发生率;于PCI术后第2天和随访第1个月时利用躯体化症状自评量表(SSS)评价患者躯体化症状;于随访第1个月和随访第6个月时,利用服药依从性量表(MMAS-8)评价患者服药依从性。结果研究期间,2组各脱落3例,最终完成研究的2组患者均为47例。对照组患者随访1个月时和随访6个月时的MACE发生率分别为8.51%(4/47)和4.26%(2/47),观察组MACE发生率分别为10.64%(5/47)和4.26%(2/47),2组MACE发生率比较,差异均无统计学意义(χ^2值为0.123、0.000,P均>0.05)。随访第1个月时,对照组患者SSS评分(34.32±6.59)分,观察组患者SSS评分(31.04±7.04)分,均低于术后第2天的(37.21±6.19)、(37.43±7.29)分,差异有统计学意义(t值为4.633、2.660,P均<0.05),且观察组患者SSS评分低于对照组,差异有统计学意义(t值为2.330,P<0.05)。随访第1个月时,2组患者MMAS-8评分比较,差异无统计学意义(P>0.05),随访第6个月时,对照组患者MMAS-8评分(5.72±0.62)分,低于随访第1个月时的(6.93±0.54)分,差异有统计学意义(t值为10.028,P<0.05),且低于观察组的(6.89±0.58)分,差异有统计学意义(t值为9.490,P<0.05)。观察组患者随访第1个月时和随访第6个月时的MMAS-8评分比较,差异无统计学意义(P>0.05)。结论早期多维度心脏康复护理模式改善PCI术后患者MACE发生率作用有限,但可有效降低患者躯体化症状,维持良好的服药依从性。

Objective To investigate the effect of early multi-dimensional cardiac rehabilitation(CR)nursing mode on patients after percutaneous coronary intervention(PCI).Methods From August 2017 to July 2018,100 patients with coronary heart disease(CHD)underwent PCI in the Department of Cardiology,the Third Affiliated Hospital of Sun Yat-sen University were selected as subjects.According to the random number table,the patients were divided into control group and observation group,50 in each group.The control group received routine CR nursing intervention,and the observation group was given early multi-dimensional CR nursing mode for intervention.All patients were followed up for 6 months.The incidence of major cardiovascular adverse events(MACE)was observed 1 month and 6 months of follow-up.Patients with somatization were evaluated on the 2nd day after PCI and in the first month of follow-up using the Somatic Self-rating Scale(SSS).In the first month and the 6th month of follow-up,patient compliance was assessed using the 8-item Morisky Medication Adherence Scale(MMAS-8).Results During the study period,3 patients were detached from each group,and there were 47 patients in both groups who completed the study.The incidence of MACE in the control group in 1 month and 6 months was 8.51%(4/47)and 4.26%(2/47),respectively.The incidence of MACE in the observation group was 10.64%(5/47)and 4.26%,(2/47)respectively.There was no significant difference in the incidence of MACE between the two groups(χ^2 value was 0.123,0.000,P>0.05).In the first month of follow-up,the SSS scores of the control group(34.32±6.59)and the observation group(31.04±7.04)were lower than those of the second day after surgery(37.21±6.19,37.43±7.29),and the difference was statistically significant(t value was 4.633,2.660,P<0.05).The SSS scores of the observation group were lower than those of the control group,and the difference was statistically significant(t value was 2.330,P<0.05).In the first month of follow-up,there was no significant difference in MMAS-8 score between the two groups(P>0.05).In the 6th month of follow-up,the MMAS-8 score(5.72±0.62)in the control group was lower than the first month of follow-up(6.93±0.54),and the difference was statistically significant(t value was 10.028,P<0.05).The MMAS-8 score of the control group was lower than that of the observation group(6.89±0.58),and the difference was statistically significant(t value was 9.490,P<0.05).There was no significant difference in MMAS-8 score between the observation group in the first month of follow-up and the sixth month of follow-up(P>0.05).Conclusion Early multi-dimensional CR nursing mode has a limited effect on improving the incidence of MACE in patients after PCI,but it can effectively reduce the somatization symptoms of patients and maintain good medication compliance.