基于三级防控的255例心肌梗死患者中医健康管理效果评价的单臂队列研究
Effectiveness of TCM Health Management for Myocardial Infarction based on Tertiary Management System:A Single-arm Cohort Study of 255 Patients
郭红鑫 1朱明军 2于瑞 2李兴渊 2彭广操 2王新陆 2王建茹 2李彬 2赵齐飞 2王永霞2
作者信息
- 1. 河南中医药大学第一附属医院,河南省郑州市人民路19号,450003;河南中医药大学
- 2. 河南中医药大学第一附属医院,河南省郑州市人民路19号,450003
- 折叠
摘要
目的 评价基于三级防控的中医健康管理对心肌梗死(MI)患者的管理效能.方法 采用前瞻性单臂队列研究方法,纳入MI非急性期患者277例,通过"以患者为核心、村医/社区医师为执行主体、三级中医院专科医师为主导"的三级防控体系,给予包括健康教育、生活方式、危险因素、用药和中医适宜技术管理在内的中医健康管理措施,周期为12个月.通过患者报告结合病历调查收集管理前及管理12个月后的各项指标,并进行管理前后的比较分析.主要疗效指标包括再入院率和复发加重率,次要疗效指标包括疾病认识情况相关指标、生活行为相关指标、心血管危险因素相关指标、加拿大心血管病学会(CCS)心功能分级.结果 255例患者完成研究并纳入结果分析.管理前12个月内有92例(36.08％)发生复发加重,130例(53.72％)发生再入院,管理12个月内有59例(23.14％)发生复发加重,49例(20.25％)发生再入院,管理后复发加重率与再入院率均显著低于管理前(P＜0.01).疾病认知情况方面,管理前后患者除糖尿病判定标准知晓率差异无统计学意义(P＞0.05)外,其他各项心脑血管病防治知识知晓率均较管理前显著提高(P＜0.01),心脑血管病防治知识总分亦高于管理前(P＜0.01).生活行为方面,患者饮食偏咸率、饮食偏甜率和饮食偏油腻率均较管理前显著下降,适量运动率较管理前显著升高(P＜0.05或P＜0.01),吸烟率和剧烈运动率管理前后差异无统计学意义(P＞0.05).心血管病危险因素方面,患者总胆固醇、低密度脂蛋白胆固醇、甘油三酯、空腹血糖、抑郁评估量表总分和焦虑评估量表总分均较管理前显著下降(P＜0.01),收缩压和体重指数均较管理前升高(P＜0.05或P＜0.01),舒张压管理前后差异无统计学意义(P＞0.05).心血管病危险因素达标率方面,低密度脂蛋白胆固醇＜1.8mmol/L率较管理前显著升高(P＜0.01),体重指数＜24 kg/m2率、收缩压＜140 mmHg率均较管理前显著下降(P＜0.05或P＜0.01),舒张压＜90 mmHg和空腹血糖＜7.0 mmol/L率管理前后差异无统计学意义(P＞0.05).管理后患者CCS心功能分级较管理前显著降低(P＜0.05).结论 基于三级防控的中医健康管理具有较好管理效能,可增强MI患者对疾病的认识、改善不良生活习惯、降低血脂和血糖水平等危险因素,改善焦虑及抑郁状态,减少其复发加重率和再入院率.
Abstract
Objective To evaluate the efficacy of TCM health management based on tertiary management system for patients with myocardial infarction(MI).Methods A total of 277 patients with non-acute MI were enrolled and given comprehensive TCM health management strategies including health education,lifestyle adjustment,risk factors control,medication and TCM appropriate techniques management through a tertiary management system with"the patient as the core,village/community physicians as the main executive body,and tertiary TCM hospital specialists as the leading body",for a period of 12 months by using a prospective single-arm cohort study.Through patient reporting and medical records surveys,various indicators before and after 12-month management were collected and compared.The primary efficacy indicators were readmission rate and recurrent exacerbation rate,and the secondary efficacy indi-cators included disease awareness-related indicators,lifestyle behavior-related indicators,cardiovascular risk factor-related indicators and Canadian cardiovascular society(CCS)cardiac function classification.Results A total of 255 patients completed the study and were included in the final analysis.The recurrent exacerbation and readmission rates of patients after management were 23.14％(59 cases)and 20.25％(49 cases),respectively,significantly low-er than 36.08％(92 cases)and 53.72％(130 cases)before management(P＜0.05).Except for knowledge on dia-betes diagnostic criteria with no significant difference before and after management(P＞0.05),awareness of other knowledge with regard to the prevention and treatment of cardiovascular and cerebrovascular diseases were improved after management(P＜0.01),as well as the total score(P＜0.01).In terms of daily life behaviors,the rates of salty diet,sweet diet and greasy diet were significantly lower than baseline,while the rate of moderate exercise was signifi-cantly higher(P＜0.05 or P＜0.01);the rates of ongoing smoking and vigorous exercise were not significantly changed(P＞0.05).For cardiovascular risk factors,patients'total cholesterol,low-density lipoprotein(LDL)cho-lesterol,triglycerides,fasting glucose,total depression assessment scale score,and total anxiety assessment scale score were significantly reduced after management(P＜0.01).Systolic blood pressure and body mass index(BMI)were both higher after management(P＜0.05 or P＜0.01),and there was no statistically significant difference in diastolic blood pressure(P＞0.05).In terms of the cardiovascular disease risk factors reaching the standard levels,the rate of LDL cholesterol＜1.8 mmol/L significantly increased(P＜0.01),while the rate of BMI＜24 kg/m2 and the rate of systolic blood pressure＜140 mmHg both decreased significantly(P＜0.05 or P＜0.01)from baseline;the diastolic blood pressure and rate of fasting glucose＜7.0 mmol/L were not significantly changed(P＞0.05).The patients'CCS cardiac function classification was significantly reduced(P＜0.05).Conclusion TCM health man-agement based on the tertiary management system can enhance MI patients'awareness of the disease,change poor life-style habits,reduce risk factors such as blood lipids and blood glucose,improve anxiety and depression,increase activity tolerance,and reduce their recurrence exacerbation and readmission rates,which is worthy of clinical promotion.
关键词
心肌梗死/中医健康管理/三级防控/单臂队列研究Key words
myocardial infarction/traditional Chinese medicine health management/tertiary management system/single-arm cohort study引用本文复制引用
基金项目
国家重点研发计划(2019YFC1710003)
国家重点研发计划(2019YFC1710000)
国家自然科学基金(82030120)
国家中医药局岐黄学者支持项目(2021)()
河南省中原千人计划-中原名医项目(CZ0210-01)
出版年
2024
国家科技期刊平台
NSTL
万方数据