三级医院与县级医院心绞痛一体化管理对高原稳定型心绞痛患者生活质量及心血管不良事件的影响

Influence of integrated management of tertiary hospitals and county hospitals for angina pectoris in quality of life and cardiac adverse events in plateau patients with stable angina pectoris

目的评价三级医院与县级医院心绞痛一体化管理对高原稳定型心绞痛(SAP)患者生活质量及主要心血管不良事件的影响。方法连续选取2019年1—12月于拉萨市辖区4所县级医院就诊的SAP患者200例,根据随机数字表法分为观察组(100例)和对照组(100例)。对照组给予常规心绞痛管理(常规门诊复诊),观察组在常规心绞痛管理基础上增加三级医院与县级医院心绞痛一体化管理,均治疗12个月。记录管理期间患者全因死亡、心源性死亡、非致死性心肌梗死、因心绞痛复发入院事件发生情况。比较2组管理前后治疗心绞痛药物使用率及西雅图心绞痛量表(SAQ)评分。结果管理期间,观察组因心绞痛复发入院比例低于对照组,差异有统计学意义(P<0.05)。管理后,观察组抗血小板药物、他汀类药物、β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、钙通道阻滞剂、硝酸酯类药物使用率均高于对照组,差异均有统计学意义(均P<0.05)。管理后,观察组躯体活动受限程度、心绞痛稳定状态、心绞痛发作频率、疾病认知程度、治疗满意度评分均高于对照组[73(70,77)分比69(67,72)分、61(58,65)分比54(51,56)分、69(67,71)分比63(60,66)分、63(59,66)分比53(50,55)分、77(74,80)分比71(68,74)分],差异均有统计学意义(均P<0.05)。结论三级医院与县级医院心绞痛一体化管理能够提高高原SAP患者的药物使用率,提高患者生活质量。

Objective To evaluated the influence of integrated management of tertiary hospitals and county hospitals for angina pectoris in quality of life and cardiac adverse events in plateau patients with stable angina pectoris(SAP).Methods From January to December 2019,200 patients admitted to 4 county hospitals in Lhasa were enrolled continuously.The patients were divided into observation group(100 cases)and control group(100 cases)according to random number table method.The control group was given routine angina management(routine outpatient follow⁃up)and the observation group was given integrated management of tertiary hospitals and county hospitals for angina pectoris based on routine angina management,all for 12 mounths.The all⁃cause death,cardiogenic death,nonfatal myocardial infarction,and myocardial reinfarction and admission of patients were recorded during the management.The drug use rate for angina pectoris and Seattle angina questionnaire(SAQ)score before and after management were compared.Results In management period,the rate of myocardial reinfarction and admission in observation group was lower than that in control group(P<0.05).After treatment,rates of anti⁃platelets,statins,β⁃blockers,angiotensin⁃converting enzyme inhibitors/angiotensin receptor blockers,calcium channel blockers and nitrates in observation group were higher than those in control group(all P<0.05).After treatment,the scores of limited physical activity degree,stable state of angina,frequency of angina,disease cognition and treatment satisfaction in observation group were higher than those in control group[73(70,77)vs 69(67,72),61(58,65)vs 54(51,56),69(67,71)vs 63(60,66),63(59,66)vs 53(50,55),77(74,80)vs 71(68,74)](all P<0.05).Conclusion Integrated management of tertiary hospitals and county hospitals for angina pectoris can enhance the drug use rate and improve the quality of life in plateau patients with SAP.