关键词: 延续照护, 家庭医生, 急性心肌梗死, 经皮冠状动脉介入, 康复, 社区保健护理

Abstract:

Objective To explore the effects of continuous care combined with family doctor on in-home rehabilitation of patients with acute myocardial infarction after emergency percutaneous coronary intervention(PCI).Methods From October 2015 to January 2017,75 patients diagnosed with acute myocardial infarction without severe complications who underwent emergency PCI in one hospital in Zhejiang Province,were enrolled and assigned to the experimental group(continuous care and family doctor model) or to the control group(simple family doctors model)based on the random number according to time of admission,and 38 patients were assigned to the experimental group while 37 in the control group. Both groups were followed up to 1 year after first PCI procedure. The left ventricular ejection fraction was assessed by echocardiography before discharge and at 1 year after PCI. The patient’s exercise tolerance was assessed by the 6-minute walking test(6MWT). Holter monitoring was used to analyze heart rate deceleration(DC). Cardiac autonomic function was evaluated to predict the risk of sudden cardiac death. Quality of life was assessed through Chinese Cardiovascular Patients Quality of Life Questionaire(CCQQ). A self-designed questionnaire was applied to evaluate patients’ compliance. Results Left ventricular ejection fraction and distance of 6MWT in the experimental group were higher than those in the control group(P<0.001). In the experimental group,proportion of DC with moderate to high risk was significantly lower than that in the control group(P=0.024). The experimental group had much lower incidence of adverse cardiovascular events comparing to the control group(P=0.020). Patients’ compliance within 1-year follow-up in the experimental group was better than that in the control group(P=0.008). The experimental group had higher scores in CCQQ questionnaire(P=0.001). Conclusion Combination of continuous care and family doctor services is beneficial to the early rehabilitation of cardiac function for acute myocardial infarction patients after emergency PCI,and has positive impact on improving quality of life and decreasing incidence of adverse cardiovascular events.

Key words: Continuing Care, Family Doctor, Acute Myocardial Infarction, Percutaneous Coronary Infarction, Rehabilitation, Community Health Nursing