急性冠状动脉综合征患者经皮冠状动脉介入治疗的护理管理

Nursing management for percutaneous coronary intervention in patients with acute coronary syndrome

目的探讨急性冠状动脉综合征患者经皮冠状动脉介入治疗(PCI)围术期护理风险管理的价值。方法回顾性分析152例急性冠状动脉综合征患者在PCI围术期开展护理风险管理的情况,再根据患者是否发生不良事件分为发生组38例(出现不良心血管事件)和未发生组114例(未出现不良心血管事件)。比较2组一般资料,运用二元Logistic回归分析探讨影响患者出现不良心血管事件的独立因素,再用受试者工作特征(ROC)曲线分析各项独立因素的预测价值。结果152例患者接受风险管理后,38例(25.00%)出现不良心血管事件。经二元Logistic回归分析,存在高血压病史、体质量指数(BMI)≥24 kg/m^(2)、存在吸烟史、高密度脂蛋白胆固醇(HDL-C)≤0.9 mmol/L、低密度脂蛋白胆固醇(LDL-C)>2.6 mmol/L、白细胞计数≥10×10^(9)/L是导致患者出现心脏不良事件的独立因素。经ROC曲线分析显示,白细胞计数、吸烟史、高血压病史、HDL-C、LDL-C、BMI早期预测患者出现心脏不良事件的AUC分别为0.702、0.732、0.667、0.724、0.754、0.706。结论急性冠状动脉综合征患者在PCI治疗围术期开展护理风险管理效果显著,但仍受到诸多因素影响,故需早期识别、控制危险因素。

Objective To explore the value of perioperative nursing risk management for percutaneous coronary intervention(PCI)in patients with acute coronary syndrome.Methods The nursing risk management conditions of 152 patients with acute coronary syndrome during PCI was analyzed retrospectively,and they were divided into occurrence group(38 cases with adverse cardiovascular events)and non-occurrence group(114 cases without adverse cardiovascular events)according to incidence of adverse cardiovascular events.The general data of the two groups were compared,the independent factors affecting adverse cardiovascular events were explored by binary Logistic regression analysis,and the predictive value of each independent factor was analyzed by receiver operating characteristic(ROC)curve.Results After implementation of risk management,there were 38 of 152 cases(25.00%)with adverse cardiovascular events.Binary Logistic regression analysis showed that history of hypertension,body mass index(BMI)≥24 kg/m^(2),smoking history,high density lipoprotein cholesterol(HDL-C)≤0.9 mmol/L,low density lipoprotein cholesterol(LDL-C)>2.6 mmol/L and leukocyte count≥10×10^(9)/L were the independent factors for adverse cardiac events.The ROC curve analysis showed that the AUCs of leukocyte count,smoking history,history of hypertension,HDL-C,LDL-C and BMI in the early prediction of adverse cardiac events were 0.702,0.732,0.667,0.724,0.754 and 0.706,respectively.Conclusion The effect of perioperative nursing risk management in patients with acute coronary syndrome during PCI treatment is remarkable,but it is still affected by many factors,so it is necessary to identify and control risk factors in early stage.