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

摘要：

目的 探讨应用延续照护联合家庭医生模式干预急性心肌梗死行急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后患者居家康复的效果。方法 选取2015年10月—2017年1月在浙江省某医院收治的75例急性心肌梗死无严重合并症行急诊PCI的患者,按入院时间排序,用随机数字法分为实验组38例和对照组37例,实验组采取延续照护联合家庭医生模式进行延续护理,对照组采取单纯家庭医生模式进行延续护理,两组均随访至出院后1年。在出院前和PCI术后1年,采用超声心动图评估左心室射血分数,采用6 min步行试验评价患者活动耐力,通过动态心电图分析心率减速力,评估心脏性猝死高危患者,通过中国心血管疾病患者生活质量评定问卷调查两组生活质量,同时采用自制问卷评价两组的遵医行为。结果 PCI术后1年实验组左心室射血分数及6 min步行试验距离均高于对照组(P<0.001);心率减速力评估结果,实验组中—高危心脏性猝死风险比例明显低于对照组(P=0.024),实验组再发主要心血管不良事件显著低于对照组(P=0.020);两组1年内遵医行为比较,实验组优于对照组(P=0.008);实验组生活质量高于对照组(P=0.001)。结论 延续照护与家庭医生服务相结合模式,有益于PCI术后居家患者心功能的早期康复,对提高患者生活质量及降低心血管不良事件发生率有积极意义。

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