基于智能手机媒介的远程督导在冠心病经皮冠状动脉介入治疗术后居家康复治疗的效果观察

Effect of smart phone-based remote supervision in home rehabilitation therapy of coronary heart disease after percutaneous coronary intervention

目的观察基于智能手机媒介的远程督导在冠心病患者经皮冠状动脉介入术后(PCI)居家康复治疗的效果.方法选取2017年6月至2019年8月我院心内科收治的冠心病PCI术后患者120例为研究对象,采用投掷法随机分为观察组、对照组各60例;对照组予以常规健康教育及随访管理,观察组予以基于智能手机媒介的远程督导管理.比较两组干预前后心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]、西雅图心绞痛量表(SAQ)评估结果;比较两组干预前后血压血脂水平及疾病康复相关知识评分、二级预防能力评分、Morisky服药依从性问卷、情绪状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)、一般自我效能感量表(GSES)]、再住院率.结果观察组干预后LVEF、SAQ评分高于对照组[(67.12±6.89)%比(57.48±5.83)%、(68.22±6.93)分比(66.41±6.63)分],而LVEDD、LVESD低于对照组[(37.48±3.89)mm比(40.52±4.17)mm、(34.01±3.68)mm比(35.09±3.75)mam](P<0.05);观察组干预后SBP、DBP、TC、TG、LDL-C低于对照组[(124.71±12.57)mmHg比(130.54±13.59)mmHg、(78.74±7.89)mmHg比(81.38±8.37)mm Hg、(3.95±0.41)比(4.28±0.45)mmol/L、(1.42±0.16)mmol/L比(1.65±0.17)mmol/L、(2.07±0.23)mmol/L比(2.58±0.26)mmol/L],而HDL-C高于对照组[(1.37±0.14)mmol/L比(1.27±0.13)mmol/L](P<0.05);观察组干预后疾病康复相关知识、二级预防能力、服药依从性得分均高于对照组[(70.45±7.18)分比(64.25±6.57)分、(68.44±6.93)分比(57.42±5.86)分、(6.12±0.65)分比(5.91±0.63)分](P<0.05);观察组干预后SAS评分、SDS评分低于对照组[(30.16±3.24)分比(35.96±3.67)分、(26.75±2.86)分比(34.52±3.61)分],而GSES评分较对照组高[(31.54±3.27)分比(29.89±2.93)分](P<0.01);观察组1年内再住院率低于对照组(1.67%比7.50%,P<0.05).结论基于智能手机媒介的远程督导应用于冠心病PCI术后居家康复治疗中有较好效果,有利于改善患者心功能、生化指标、心绞痛症状,提高对疾病的认知及服药依从性,减少患者负性情绪,降低再住院率,值得在临床推广实践.

Objective To observe the ffet of remote supervision based on smart phone in homerehabilitation therapy for the patients with coronary heart disease after percutancous coronary intervenion( PCI).Methods 120 patients with coronary heart disease who had undergone PCI in the cardiology department of ourhospital between June 2017 and August 2019 were randomized into observation group and control group. 60 cases in each group. The control group was given routine health education and follow-up management and theobseration group was given remote supervision and management based on smart phone. The cardiac function[leftventricular ection fraction (LVEF),left vetricular end diastolic diameter (LVEDD),left ventricular endsystolic diameter (LVESD) ],evaluation results of Seattle Angina Questionnaire (SAQ),blood pressure andblood lipid levels, rehabilitation related knowledge scores, secondary prevention ability scores, Morishymedication compliance questionnaire, emotional stutes [ Self-rating Anxiety Scale (SAS)。Self-rating DepressionScale(SDS ), General Self-Efficacy Scale(GSES)] and readmission rate were compared between the two groups.Results Ater intervention, LVEF and SAQ scores of the observation group were higher than the control group[(67.12±6.89)% vs. (57.48±5.83 )% , (68.22±6.93) vs. (66.41±6.63)], while LVEDD and LVESD were smallerthan the control group[ (37.48+3.89)mm vs. (40.52±4.17)mm, (34.01±3.68) mm vs. (35.0913.75)mm](P<0.05). Afer intervention, SBP, DBP, TC, TG and LDL-C in the observation group were lower than the controlgroup[ (124.71±12.57) mm Hg vs. ( 130.5±13.59) mm Hg. (78.74±7.89)mm Hg vs. (81.38±8.37) mm Hg,(3.95±0.41) vs. (4.28±0.45 )mmol/L, (1.42±0.16)mmol/L vs. ( 1.65±0.17 )mmol/L, (2.07±0.23 )mmol/L vs.(2.58+0.26)mmol/L], while HDL-C was higher than the control group[( 1.37±0.14)mmol/L Vs. (1.27±0.13)mmol/L](P<0.05). After intervention, scores for rchabilitation related knowledge。secondary prevention abilityand medication compliance of observation group were higher than the control group[ (70.45±7.18) Vs. (64.25±6.57), (68.44±6.93) vs. (57.42±5.86), (6.12±0.65) vs. (5.91±0.63)](P<0.05). SAS score and SDS score werelower than the control group[ (30.16±3.24) vs. (35.96±3.67). (26.75±2.86) vs. (34.52±3.61)], while the GSESscore was higher than the control group[ (31.54±3.27) vs. (29.89±2.93)](P<0.01 ). The readmission rate in theobservation group within 1 year was lower than the control group(1.679% vs. 7.50% , P<0.05). ConclusionRemote supervision based on smart phone applied in home rehabilitation for the patients with coronary heartdisease after PCI is beneficial to improve the patients' cardiac fiunetion, biochemical indicators, anginasymptoms, awareness of disease and medication compliance and would reduce their negative emotions andreadmission rate.