Analysis of the Nursing Effect of Continuity of Care on Elderly Patients with Coronary Heart Disease Unstable Angina and its Impact on Quality of Life

Objective:To analyze the effect of using continuity of care for elderly patients with coronary heart disease(CHD)with unstable angina pectoris(UAP)and its impact on their quality of life.Methods:100 cases of elderly patients with CHD with UAP admitted to our hospital from March 2022 to March 2023 were selected and grouped into an observation group and a control group of 50 cases each according to the randomized number table method.The nursing effect and quality of life of the observation group(continuity nursing)and the control group(routine nursing)were compared.Results:The total effective rate of nursing care was 96.00%observation group and 80.00%for the control group,and the differences were significant(χ2=6.061,P<0.05).Patients in the observation group had fewer episodes(1.42±0.21)times/week and a shorter duration(5.46±0.39)min,which were better than the control group(t=3.465,2.973;P<0.05).The depression self-rating depression scale(SDS)score(42.16±6.64)and anxiety self-rating scale(SAS)score(32.26±7.35)in the observation group were lower and the quality of life was higher as compared to that of the control group(P<0.05).Conclusion:Continuous nursing care improved the nursing effect of elderly CHD with UAP patients,promoted the alleviation of UAP symptoms,improved patient mentality,and improved their quality of life.Hence,continuous nursing care possesses significant clinical application value.

Effectiveness of Atorvastatin Combined with Trimetazidine in the Treatment of Coronary Heart Disease in the Elderly and Their Effect on Cardiac Function

Objective:To analyze the effect of atorvastatin combined with trimetazidine in the treatment of elderly coronary artery disease and the effect on patients’cardiac function.Methods:60 cases of elderly coronary artery disease patients were divided into 2 groups by randomization method,and all of them received conventional symptomatic treatment,while atorvastatin was added to the control group and trimetazidine was combined with atorvastatin in the observation group,and the clinical indexes were compared.Results:After treatment,the angina attack,cardiac function indexes,and inflammatory factor levels of the observation group were better than those of the control group(P<0.05),and the differences in adverse reactions between the two groups were not significant(P>0.05).Conclusion:Combined treatment of coronary heart disease in the elderly with atorvastatin and trimetazidine can positively reduce angina symptoms,improve cardiac function,and reduce inflammatory reactions,and the effect is definite.

Analysis of the Effectiveness of Clopidogrel Combined with Aspirin in the Treatment of Coronary Heart Disease in Community-Dwelling Elderly

Objective:To analyze the combined therapeutic effect of clopidogrel(CLO)and aspirin(ASP)on coronary heart disease(CHD)in community-dwelling elderly.Methods:Thirty elderly patients with CHD who were admitted to the Xinxin Community Health Service Station,Pangzhuang Street,Quanshan District,Xuzhou City,from November 2020 to November 2022 were selected and randomly grouped into an observation group and a control group,with 15 cases in each group.The observation group was given the combination of CLO and ASP and the reference group was given only ASP.The total effective rate and other treatment indicators between the two groups were compared.Results:The total effective rate of the observation group(93.33%)was higher than that of the reference group(60.00%)(P<0.05).The adverse drug reaction rate(13.33%)and long-term cardiovascular adverse event rate(6.67%)of the observation group were lower than those of the reference group at 46.67%and 40.00%respectively,(P<0.05).Before treatment,the two groups had no difference in the quality-of-life scores(P>0.05).After treatment,the quality-of-life scores of the observation group were higher than those of the reference group(P<0.05).Conclusion:CLO combined with ASP improved the therapeutic effect of community-dwelling elderly patients with CHD,reduced adverse reactions during medication,prevented adverse cardiovascular events,and comprehensively improved the patient’s quality of life.

Correlation between serum free fatty acids levels and Gensini score in elderly patients with coronary heart disease

Objectives To investigate the relationship between serum fxee fatty acids （FFAs） levels and the severity of coronary artery lesions in elderly patients with coronary heart disease （CAD）. Methods A total of 172 elderly patients who underwent coronary angiography were divided into CAD group （n = 128） and non-CAD group （n = 44） according to the results of coronary angiography. Serum FFAs and lipid levels were measured and the Gensini score were calculated. Results No matter the differences between age, gender and the usage of stat- ins or not, there was no statistical significance in FFAs levels （P 〉 0.05）. In terms of the Gensini score, it was higher in patients aged 70-79 years than in patients 60-69 years old [15.00 （5.00, 34.00） vs. 10.00 （2.00, 24.00）, P 〈 0.05], higher in men than women [14.00 （4.00, 34.00） vs. 7.00 （2.50, 19.75）, P 〈 0.05], and higher in patients on statins [13.50 （4.25, 33.50）vs. 6.50 （2.00, 18.00）, P 〈 0.05]. The serum FFAs lev- els [449.50 （299.00, 624.75） mEq/L vs. 388.00 （258.50, 495.25） mEq/L, P 〈 0.05J and Gensini score [17.50 （8.00, 41.75） vs. 1.00 （0, 5.00）, P 〈 0.05] were higher in the CAD group than in the non-CAD group. In the CAD group, there was no statistical significance in FFAs levels among patients with different numbers of diseased coronary vessels （P 〉 0.05）. Furthermore, the FFAs levels were positively correlated with the Gensini score （r = 0.394, P = 0.005）. Regression analysis showed that the FFAs levels were related to the Gensini score independently after adjusting for the other risk factors. Conclusions The serum FFAs levels were associated with the Gensini score in elderly patients with CAD. It might indicate FFAs as a biomarker predicting the severity of coronary artery lesions.

Validation of Veterans Specific Activity Questionnaire to assess exercise tolerance of Chinese elderly with coronary heart disease

Objective The Veterans Specific Activity Questionnaire （VSAQ） has been used to assess exercise tolerance. Nevertheless, there is no val- idated Chinese version. The aim of this study is to determine whether a questionnaire-based method using the Chinese version of VSAQ （the modified VSAQ） is a practical tool to assess exercise tolerance of Chinese elderly with coronary heart disease. Methods One hundred thirty consecutive elderly patients who were diagnosed with coronary heart disease （CHD） （mean age 68.9 -4- 6.0 years） referred for treadmill exercise testing （TET） for clinical reasons were included in the study. They were asked to complete a questionnaire for clinical characteristics information on age, sex, history, exercise habits, medications, the original VSAQ and the modified VSAQ. We investigated the relationship between exer- cise tolerance in metabolic equivalents （METs） estimated by VSAQ and that obtained by TET. Results The METs by the original VSAQ and the modified VSAQ did not difference significantly （P = 0.528）. The modified VSAQ scores were significantly correlated with the METs oh- mined by TET （r = 0.819, 95% CI： 0.7534）.873, P 〈 0.01）, and the scores of original VSAQ also correlated with the METs by TET （r = 0.804, 95% CI： 0.7454）.854, P 〈 0.01）. The Bland-Altman graph analysis showed few values outside the limits of agrcement, suggesting good precision between the METs estimated by questionnaire and the METs obtained by TET. Conclusions The Chinese version of the VSAQ confirmed its validity and equivalence to the original version, especially when evaluating individuals with coronary heart disease and older adults. The results showed that the VSAQ is a valuable tool to assess the exercise tolerance.

Relationship between the Self-Efficacy and Mental Health of Elderly Patients with Coronary Heart Disease in Rural Hebei Province

Objective:To investigate the self-efficacy and mental health of elderly patients with coronary heart disease(CHD)in rural Hebei Province as well as to analyze the relationship between them.Methods:From June 2021 to December 2021,480 elderly patients with CHD from rural areas,who had been discharged by the Department of Cardiology from three tertiary hospitals in three cities with different economic levels in Hebei Province for more than a year,were selected as the research subjects.The general self-efficacy scale(GSES)and symptom self-rating scale(SCL-90)were used to investigate the self-efficacy and mental health of these patients.SPSS 25.0 was used for data analysis.Results:The total mean self-efficacy score of elderly patients with CHD in rural Hebei Province was 17.18±4.68,which is lower than the international norm(t=-32.067,P=0.000)and the national norm(t=-28.783,P=0.000);the total average SCL-90 score was 148.64±55.13,which is higher than the national norm for adults and the reference norm for ordinary elderly people;except for hostility and psychosis,the other dimensions were significantly higher than the national norm for adults(P<0.05);except for psychosis,the other dimensions were significantly higher than the reference norm for ordinary elderly people(P<0.05);the self-efficacy score was found to be negatively correlated with the total SCL-90 score and the score for each dimension(P<0.05).Conclusion:Elderly CHD patients with higher self-efficacy in rural Hebei Province have higher mental health level.It is suggested that the mental health of elderly patients with CHD in rural areas can be improved by improving their self-efficacy.

Effect of Psychological Education Combined with Progressive Muscle Relaxation Training on the Symptom Cluster and Rehospitalization Rate of Elderly Patients with Coronary Heart Disease

Objective:To investigate the effect of psychological education combined with progressive muscle relaxation training on the symptom cluster and rehospitalization of elderly patients with coronary heart disease.Methods:This study is a longitudinal randomized controlled study involving 140 elderly patients with coronary heart disease.The patients were divided into two groups:an intervention group and a control group,with 70 cases in each group,via random number table.The patients in the control group received routine nursing,whereas those in the intervention group received psychological education combined with progressive muscle relaxation training for 4 weeks on the basis of routine nursing.The effect of the intervention was evaluated before intervention,at the end of 1 month,3 months,and 6 months after intervention.Results:At the end of 1 month,3 months,and 6 months,the sleep,fatigue,anxiety,and functional status of the patients in the intervention group were significantly better than those of the control group,with statistical significance difference(P<0.05).The rehospitalization rate of the intervention group was lower than that of the control group,and the difference was statistically significant(X2=10.685,P=0.001).Conclusion:Psychological education combined with progressive muscle relaxation training is effective in alleviating the symptom cluster of elderly patients with coronary heart disease and reducing their rehospitalization rate;thus,it should be popularized.

A Readmission Risk Prediction Model for Elderly Patients with Coronary Heart Disease

Objective:To analyze the independent risk factors and establish a risk prediction model by investigating the readmission of elderly patients with coronary heart disease(CHD)within 1 year after discharge.Methods:A total of 480 CHD patients,who were hospitalized in the Affiliated Hospital of Hebei University from October 2019 to December 2020,were included in this study.A general data scale,mental health status scale,the Clinical Frailty Scale,Pittsburgh Sleep Quality Index,as well as the Family Adaptability and Cohesion Evaluation Scale were used to collect data.According to the number of readmissions due to CHD within 1 year after discharge,the patients were divided into two groups:the readmission group(n=212)and the no readmission group(n=268).General data,laboratory examination indicators,frailty,mental health status,sleep status,as well as family intimacy and adaptability were compared between the two groups.Logistic regression was used to analyze the independent risk factors for the readmission of these patients,and R software was used to construct a line diagram model for predicting readmission of elderly patients with CHD.Results:Five factors including body mass index(OR=1.045),low density lipoprotein(OR=1.123),frailty(OR=1.946),mental health(OR=1.099),as well as family intimacy and adaptability(OR=0.928)were included to construct the risk prediction model for the readmission of elderly patients with CHD within 1 year after discharge.The ROC curve showed that the area under the curve for predicting readmission of elderly patients with CHD was 0.816;Hosmer-Lemeshow goodness of fit test showed X2=1.456 and P=0.989;the maximum Youden index corresponding to the predicted value of risk was 0.526.The results showed that the model could accurately predict the risk of readmission in elderly patients with CHD within 1 year after discharge.Conclusion:This study constructed a line diagram model based on five independent risk factors of the readmission of elderly patients with CHD:body mass index,low density lipoprotein,frailty,mental health status,as well as family intimacy and adaptability.This model has good discrimination,accuracy,and predictive efficiency,providing reference for the early prevention and intervention of readmission in elderly patients with CHD recurrence.

Clinical perspective on C-reactive protein in prognostication of major adverse cardiac events in the elderly with established coronary heart disease

The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……

Sex Hormones and Androgen Receptor:Risk Factors of Coronary Heart Disease in Elderly Men

Objective To investigate the variation of sex hormone and its receptor level in elderly male patients with coronary heart disease (CHD) and to evaluate the correlations between CHD and sex hormone as well as sex hormone receptor. Methods Altogether 139 male CHD patients (CHD group) aged 60-92 years and 400 healthy men (control group) aged 60-90 years were included in this cross sectional study. The plasma concentrations of dehydroepiandrosterone sulfate (DHEAS),total testosterone (TT),free testosterone (FT),estradiol (E2),sex hormone binding globulin (SHBG),luteinizing hormone (LH),and follicle-stimulating hormone (FSH) were measured. The androgen receptor (AR) was tested by flow cytometry. Correlations between CHD and levels of sex hormones and AR were analyzed. Results Compared with the control group,the levels of DHEAS,TT,FT,SHBG,and the fluorescence intensity of AR in the CHD group significantly reduced (P<0.05),while the levels of FSH and E2 significantly increased (P<0.01). Age was negatively correlated with TT (r=-0.28,P=0.00) and FT (r=-0.17,P=0.01),while it was positively correlated with SHBG (r=0.14,P=0.04) and E2 (r=0.33,P=0.00). AR fluorescence intensity was negatively correlated with systolic blood pressure (r=-0.12,P=0.01). Binary logistic regression analysis showed that TT,SHBG,and AR were all negatively correlated with CHD (P<0.05). Conclusions Elderly male patients with CHD are found to have low levels of DHEAS,TT,FT,SHBG,and AR,while high concentrations of E2 and FSH. Low levels of TT and SHBG may be the potential risk factors of CHD in elderly men.

Coronary heart disease incidence and competing risks： an important issue

The estimation of lifetime morbid events is not a rare presentation of relatively old and of more recent epidemi- ological investigations, accompanied by evaluating rates, risks and predictors （more in general determinants or risk factors）. However, when the follow-up period is very long and Kaplan-Meier survival curves are adopted, or Kaplan- Meier-based more complex models such as Cox＇s analysis are used, clinical （or epidemiological） reality may well be distorted since by these survival methods risks tend to be overestimated, whereas survival tends to be reduced.

Stable Ischemic Heart Disease in the Older Adult

Demographic trends worldwide show a progressively aging population and an increase in the overall medical complexity of elderly patients with cardiovascular disease.Elderly patients,especially those aged 75 or older,are relatively underrepresented in many of the clinical trials that helped create major society guidelines for evaluation and management of ischemic heart disease.Consequently,risk benefi t ratios of a guideline-based approach in these patients are not well defi ned,especially with regards to pharmacotherapies and percutaneous coronary interventions.In this article we offer a practical approach to defi ning the elderly population,and provide an evidenced based review of the diagnostic and therapeutic implications of advanced age in the evaluation and management of ischemic heart disease.

Effect of St. John＇s wort extract on depressive disorder in elderly patients with unstable angina

The elderly patients with coronary heart disease （CHD） are often accompanied with depression. This study aimed to assess the effect of St. John＇s wort extract （SWE） on depressive disorder in elderly patients with unstable angina pectoris. Altogether 170 patients who met the set criteria were enrolled in this prospective study. They were randomly divided into SWE group （44 patients）, Deanxit group （44）, psychotherapy group （42）, and control group （40）. The effectiveness of SWE was evaluated by reduced percentage of Hamilton depression （HAMD） scale and reduced frequency of angina pectoris attack, which were measured before and at 12 weeks after the treatment with SWE. The reduced percentages of HAMD scale were 79.5%, 56.8% and 57.1% in the SWE, Deanxit and psychotherapy groups, respectively. Compared with the control, the three groups had significant differences in the percentages （P〈0.001）. The improvement after the treatment was more significant in the SWE group than in the Deanxit or psychotherapy group （P〈0,05）. The improvement of angina pectoris evaluated by the Canadian Cardiac Society Classification was significantly better in the treatment groups （88.7%, 65.9%, 57.1%） than in the control group, and it was marked in the SWE group （P〈0.001）. Angina pectoris attack, its frequencies, durations and electrocardiographic changes were significantly improved in the treatment groups than in the control group （F=6.05, 4.58, 5.12, P〈0.01）. They are markedly improved in the SWE group （P〈0.05）. SWE can improve depressive symptoms more significantly in elderly patients with unstable angina pectoris than Deanxit or psychotherapy, proving that SWE contributes to better treatment of angina attack as well.

甘油三酯葡萄糖指数评估不同性别中年人群发生冠心病的价值

目的探讨甘油三酯葡萄糖指数(TyGindex)评估不同性别中年人群发生冠心病的价值。方法选取2015年1月至2022年12月在柳州市人民医院行冠状动脉造影的中年人群433例为研究对象。收集其一般资料、实验室检查指标和冠状动脉造影结果。根据TyGindex中位数将不同性别人群分为低TyG index组(男性107例;女性106例)、高TyGindex组(男性111例;女性109例)。采用多因素logistic回归分析不同性别中年人群发生冠心病的影响因素。采用ROC曲线评估TyGindex对不同性别中年人群发生冠心病的预测价值。结果多因素logistic回归分析结果显示,年龄(OR=1.103,95%CI 1.043~1.166)、吸烟史(OR=2.173,95%CI 1.199~3.938)、HDL-C(OR=0.244,95%CI 0.062~0.961)是中年男性人群发生冠心病的独立影响因素(P<0.05);年龄(OR=1.121,95%CI 1.032~1.218)、TyGindex(OR=2.606,95%CI1.220~5.567)是中年女性人群发生冠心病的独立影响因素(P<0.05)。ROC曲线分析结果显示,TyGindex预测中年男性和女性人群发生冠心病的曲线下面积分别为0.603(95%CI 0.526~0.680,P=0.009)、0.756(95%CI 0.686~0.826,P<0.001)。结论TyGindex升高不是中年男性人群发生冠心病的独立危险因素,预测价值低;而TyGindex升高是中年女性人群发生冠心病的独立危险因素,具有中等预测价值。

Risk factors for perioperative major cardiac events in Chinese elderly patients with coronary heart disease undergoing noncardiac surgery

Background Few studies have investigated perioperative major adverse cardiac events （MACEs） in elderly Chinese patients with coronary heart disease （CHD） undergoing noncardiac surgery. This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery, and established a risk stratification system. Methods This retrospective observational clinical study included 482 patients aged -〉60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital. The primary outcome was MACE within 30 days after surgery. Risk factors were evaluated using multivariate Logistic regression analysis. Results Perioperative MACE occurred in 61（12.66%） of the study patients. Five independent risk factors for perioperative MACE were identified： history of heart failure, preoperative arrhythmia, preoperative diastolic blood pressure 〈75 mmHg, American Society of Anesthesiologists grade 3 or higher, and intraoperative blood transfusion. The area under the receiver operating characteristic curve for the risk-index score was 0.710＋0.037. Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk. Conclusions Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE. Five independent risk factors for perioperative MACE were identified. Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.

Serum procalcitonin elevation in elderly patients with coronary heart disease at the onset of septic shock caused by either Gram negative or Gram positive bacteremia

Background Septic shock caused by bacteremia is a life-threatening infection whose prognosis is highly de- pendent on early recognition and appropriate treatment. Procalcitonin （PCT） has been shown to accurately and quickly distinguish bacteremia from noninfectious inflammatory states in critically severe patients. However, the extent of PCT magnitude elevation according to the Gram stain result in elderly patients with coronary heart disease （CHD） at the onset of septic shock caused by bacteremia varies, and has not been clearly elucidated. Methods The medical records of advanced age （non-neutropenic） patient with CHD and septic shock between Mar 2013 and Jun 2015 who had bacteremia caused by either Gram-positive （GP） bacteria or Gram-negative （GN） bacteria were reviewed, and the levels of PCT, C- reactive （CRP） protein and white blood cells count （WBC） in both groups were analyzed. Results 75 episodes of either GN bacteremia （n = 40） or GP bacteremia （n = 35） were enrolled. PCT levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia [（8.93± 17.58） vs. （64.42± 58.56） ng/L （P 〈 0.001）], whereas there was no significant differ- ence in CRP and WBC （P 〉 0.05）. Moreover, a high PCT level was found to be independently associated with GN bacteremia in this study population. A PCT level of 19.69 ng/mL yielded a 72.5% sensitivity, a 91.4% specificity, an 8.43 positive likelihood ratio and a 0.30 negative likelihood ratio for GN-related bacteremia in the study cohort [AUROCC = 0.870 （0.041）, 95% CI （0.790-0.949）]. Conclusion In an elderly patient （non-neutropenic） with CHD and septic shock, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia （PCT 〉 19.69 ng/mL）.

郭伟星教授论治中青年冠状动脉粥样硬化性心脏病气郁血滞证的经验

冠状动脉粥样硬化性心脏病(简称冠心病)是心血管科常发生的疾病之一,发作时胸闷如窒,呼吸欠畅,疼痛不已,持续不解。该病属于中医学“胸痹心痛病”的范畴。随着社会环境的变化,中青年冠心病越发常见,常出现无任何前兆的心前区疼痛感,胸闷气短,憋喘乏力,其症状让患者难以提前干预。如何做到预防冠心病的发生、保护心血管和改善临床的亚健康状态,是当前亟需通关的课题。郭伟星教授根据多年所学和临床经验,对中青年冠心病的病因病机以及治疗有自己独特的见解和心得。他指出,中青年冠心病的发作与老年冠心病略有区别,由于生活压力增大,中青年一方面容易脾气暴躁,另一方面倦怠乏力。郭教授认为这是因为中青年气血不和,诸病生焉,气与血在中青年冠心病的发生发展中起着至关重要的作用,并认为气血失和是诱发中青年冠心病的重要因素,气郁血滞是其基本病机,故采用行气活血通络法治疗该病,效如桴鼓,立起沉疴。笔者从跟诊实践出发,对郭教授治疗中青年冠心病之气郁血瘀证经验进行总结,希望能够帮助医者拓宽临床诊治思路,提高临床治疗效果,防止疾病进一步恶化、稳定斑块,营养心肌与血脉,缓解中青年冠心病患者的痛苦,提高他们的生活幸福度。

精准医疗框架下的护理模式干预对老年冠心病患者负性情绪及心绞痛控制的影响

目的回顾性分析精准医疗框架下的护理模式干预在老年冠心病患者中的应用效果。方法选取114例老年冠心病患者,按不同的护理方法分为精准医疗组(n=57)和常规组(n=57)。对常规组进行常规护理,精准医疗组在常规护理基础上行精准医疗框架下的护理模式干预。比较两组的心功能[每搏输出量(stroke volume,SV)、左心室射血分数(LVEF)]、心绞痛控制情况[西雅图心绞痛问卷(SAQ)]、负性情绪[症状自评量表(SCL-90)]、生活质量[明尼苏达心力衰竭生活质量量表(LHFQ)]和护理满意度。结果干预后精准医疗组SV、LVEF指标高于常规组(P<0.05),心绞痛稳定状态、心绞痛发作情况、躯体活动受限程度、疾病认知程度、对治疗的满意度等SAQ评分低于常规组(P<0.05)。干预后两组SCL-90评分和LHFQ评分均较干预前降低(P<0.05),且精准医疗组上述评分均明显低于常规组(P<0.05)。精准医疗组护理满意度高于常规组(98.25%vs.85.96%,P<0.05)。结论对老年冠心病患者实施精准医疗框架下的护理模式干预,能改善心功能、心绞痛控制情况、负性情绪,提高患者生活质量和护理满意度。

老年冠心病人群脂溶性维生素水平分布及与病情程度的相关性

目的:探讨老年冠心病人群脂溶性维生素水平分布及与病情程度的相关性。方法:选取2022年1月—2024年2月在我院治疗的老年冠心病患者82例作为观察组,同时选取同期因胸部不适行CAG检查排除冠心病的患者30例作为对照组,观察两组血清维生素D、E、A、K1水平,同时比较观察组不同病变程度、疾病类型患者间差异。结果:观察组维生素D为(22.41±6.40)nmol/L,明显低于对照组(P<0.05),而维生素E、维生素K1和维生素A分别为(14.25±2.22)μg/mL、(1.44±0.35)ng/mL、(72.25±13.35)ng/mL,明显高于对照组(P<0.05)。观察组重度病变患者维生素D为(15.84±6.11)nmol/L,明显低于轻度和中度病变患者(P<0.05),而维生素E、维生素K1和维生素A分别为(17.47±2.00)μg/mL、(1.80±0.24)ng/m L、(79.80±11.87)ng/mL,明显高于轻度和中度病变患者(P<0.05)。观察组急性心肌梗死患者维生素D为(20.07±5.06)nmol/L,明显低于不稳定性心绞痛患者(P<0.05),而维生素E、维生素K1、维生素A分别为(17.47±2.00)μg/mL、(1.80±0.24)ng/mL、(79.80±11.87)ng/mL,明显高于不稳定性心绞痛患者(P<0.05)。维生素D与病情严重程度呈负相关(r=-0.362,P<0.05),维生素E、维生素K1、维生素A与病情严重程度呈正相关(r=0.800、0.786、0.236,P<0.05)。结论:老年冠心病人群维生素D水平降低,而维生素E、K1、A水平升高,其中维生素D与病情严重程度存在负相关,而维生素E、K1、A病情严重程度存在正相关关系。

以整合照护理念为基础的综合干预体系对稳定性冠心病患者衰弱的影响

目的探讨以整合照护理念为基础的综合干预体系对稳定性冠心病患者衰弱的影响。方法选择2021年8月—2022年6月在驻马店市中医院诊治的老年稳定性冠心病患者78例,根据1∶1随机数字表法分为两组,每组各39例。常规组给予常规护理,整合组在常规组护理的基础上给予以整合照护理念为基础的综合干预体系,记录两组患者的预后情况。结果两组患者在护理3个月后的平衡测试评分、座椅站立测试评分均低于护理前,整合组护理3个月后的平衡测试评分、座椅站立测试评分与常规组相比也降低(P<0.05)。整合组护理3个月后的躯体、心理、社会、精神等维度的生活质量评分均高于常规组(P<0.05)。整合组随访1年的靶血管重建、心肌梗死、心源性死亡、冠状动脉再狭窄等主要心血管事件不良事件发生率为5.13%,常规组为25.64%,整合组低于常规组(P<0.05)。结论以整合照护理念为基础的综合干预体系能缓解老年稳定性冠心病患者的衰弱状况,改善患者的生活质量,降低主要心血管事件不良事件发生率。