發(fā)布時(shí)間：2018-05-18 12:17

  本文選題：PCI + 冠心病危險(xiǎn)因素�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2014年碩士論文

【摘要】：背景 目前PCI(經(jīng)皮冠狀動(dòng)脈介入治療)已成為治療冠心病的有效手段,因其創(chuàng)傷少、可快速緩解癥狀、縮短住院時(shí)間且遠(yuǎn)期療效顯著而被臨床廣泛接受和應(yīng)用。但PCI并未阻止動(dòng)脈粥樣硬化的過(guò)程,忽視潛在冠心病危險(xiǎn)因素的存在可導(dǎo)致不良心血管事件的發(fā)生。研究顯示,冠心病患者糖代謝異常發(fā)生率顯著高于一般人群。而高血糖是引起冠狀動(dòng)脈支架再狹窄的獨(dú)立危險(xiǎn)因素。PCI術(shù)的有效性使患者忽視改善生活方式的必要性。特別是部分患者因住院首發(fā)糖代謝異常、無(wú)癥狀而忽視健康生活方式,引起糖、脂代謝紊亂,就會(huì)顯著增加冠心病危險(xiǎn)因素,從而影響了患者病情恢復(fù)甚至造成了PCI術(shù)后不良心血管事件的發(fā)生。 目的 通過(guò)對(duì)首發(fā)糖代謝異常PCT患者護(hù)理干預(yù),探討護(hù)理干預(yù)能否有效地控制冠心病PCI患者的危險(xiǎn)因素,減少不良心血管事件的發(fā)生,促進(jìn)患者的康復(fù),改善患者的生活質(zhì)量。 方法 選取某院心內(nèi)科2012年1月-2012年12月期間,成功實(shí)施PCI術(shù)的首發(fā)糖代謝異�；颊吖�188例,且均首次行單支或多支冠狀動(dòng)脈內(nèi)支架置入術(shù)。獲得知情同意后,將病人隨機(jī)分為實(shí)驗(yàn)組(n=94)和對(duì)照組(n=94),實(shí)驗(yàn)組接受長(zhǎng)期、綜合護(hù)理干預(yù),即住院期間進(jìn)行PCI危險(xiǎn)因素、糖代謝異常等相關(guān)知識(shí)的培訓(xùn),并在藥物治療的同時(shí)給予以改善生活方式為主的護(hù)理干預(yù),包括飲食管理、運(yùn)動(dòng)指導(dǎo)、心理護(hù)理為干預(yù)重點(diǎn),控制冠心病危險(xiǎn)因素為基本手段,于出院后1、6、12個(gè)月以電話隨訪、門診復(fù)查等形式進(jìn)行持續(xù)護(hù)理干預(yù)、跟蹤隨訪。對(duì)照組只在住院期間給予常規(guī)護(hù)理措施,在出院后1、6、12個(gè)月電話或門診隨訪患者的藥物服用情況、了解冠心病危險(xiǎn)因素等。收集兩組患者的一般資料、藥物服用情況、冠心病危險(xiǎn)因素。采用ACC(美國(guó)心臟病學(xué)學(xué)會(huì))和AHA(美國(guó)心臟協(xié)會(huì))2011-2012年P(guān)CI治療指南和WHO推薦的PCI術(shù)后冠心病危險(xiǎn)因素(血糖、血脂、血壓、體重指數(shù)等)為護(hù)理干預(yù)的主要評(píng)價(jià)指標(biāo)。并對(duì)所收集資料進(jìn)行統(tǒng)計(jì)學(xué)處理,采用標(biāo)準(zhǔn)差、百分比、t檢驗(yàn)、卡方檢驗(yàn)分析出院后1、6、12個(gè)月兩組患者的冠心病危險(xiǎn)因素、藥物服用情況等進(jìn)行比較,分析護(hù)理干預(yù)對(duì)兩組PCI患者危險(xiǎn)因素控制達(dá)標(biāo)率。 結(jié)果 1.干預(yù)前兩組患者的一般資料、冠心病危險(xiǎn)因素、藥物治療情況經(jīng)統(tǒng)計(jì)學(xué)處理,無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。 2.實(shí)驗(yàn)組患者出院1個(gè)月,血壓(BP)、低密度脂蛋白(LDL-C)、空腹血糖(FPG)、運(yùn)動(dòng)達(dá)標(biāo)率高于對(duì)照組(P0.01),餐后血糖(2hPG)、體重指數(shù)(BMI)達(dá)標(biāo)率與對(duì)照組無(wú)差別(P0.05)。 3.干預(yù)6個(gè)月后,實(shí)驗(yàn)組患者FPG、2hPG、LDL-C、運(yùn)動(dòng)達(dá)標(biāo)率高于對(duì)照組(P0.01),血壓(BP)達(dá)標(biāo)率與對(duì)照組無(wú)差別(P0.05)。 4.干預(yù)12個(gè)月后,實(shí)驗(yàn)組血糖(FPG、2hPG)、LDL-C、BP、BMI、運(yùn)動(dòng)達(dá)標(biāo)率高于對(duì)照組(P0.01)。 結(jié)論 對(duì)PCI患者進(jìn)行長(zhǎng)期、綜合的護(hù)理干預(yù)優(yōu)于短期、常規(guī)護(hù)理,可以有效控制PCI患者冠心病危險(xiǎn)因素。
[Abstract]:Background At present, PCI (percutaneous coronary intervention) has become an effective method in the treatment of coronary heart disease. PCI has been widely accepted and applied in clinic because of its less trauma, rapid relief of symptoms, shorter hospital stay and better long-term effect. However, PCI does not prevent the process of atherosclerosis, ignoring the existence of potential risk factors of coronary heart disease can lead to adverse cardiovascular events. The incidence of abnormal glucose metabolism in patients with coronary heart disease was significantly higher than that in the general population. Hyperglycemia is an independent risk factor for coronary stent restenosis. In particular, some patients with abnormal glucose metabolism and asymptomatic neglect of healthy lifestyle, causing disorders of glucose and lipid metabolism, will significantly increase risk factors for coronary heart disease. This affected the recovery of patients and even resulted in adverse cardiovascular events after PCI. Purpose Through nursing intervention in patients with first-episode abnormal glucose metabolism (PCT), this paper discusses whether nursing intervention can effectively control the risk factors of PCI patients with coronary heart disease, reduce the occurrence of adverse cardiovascular events, promote the recovery of patients and improve the quality of life of patients. Method From January 2012 to December 2012, a total of 188 patients with first-episode abnormal glucose metabolism who successfully performed PCI were selected, and all patients were treated with single or multiple coronary stents for the first time. After obtaining informed consent, the patients were randomly divided into two groups: the experimental group and the control group. The experimental group received long-term, comprehensive nursing intervention, that is, training on risk factors of PCI and abnormal glucose metabolism during hospitalization. At the same time, the patients were given nursing intervention mainly to improve their lifestyle, including diet management, exercise guidance, psychological nursing as the key intervention and controlling risk factors of coronary heart disease as the basic means. The patients were followed up by telephone at 1 day after discharge and 12 months after discharge. Continuous nursing intervention was carried out in the form of outpatient reexamination and follow-up. The control group was only given routine nursing measures during the period of hospitalization. The patients were followed up by telephone for 6 months 12 months after discharge to understand the risk factors of coronary heart disease and so on. General data, drug use and risk factors of coronary heart disease were collected. The risk factors of coronary heart disease (such as blood glucose, blood lipid, blood pressure, body mass index, etc.) recommended by WHO and PCI treatment guidelines for 2011-2012 were used as the main evaluation indexes of nursing intervention. The data collected were analyzed by statistical analysis, standard deviation, percentage t test and chi-square test. The risk factors of coronary heart disease and drug use were compared between the two groups at 1: 6and 12 months after discharge. Nursing intervention was analyzed to control the risk factors of PCI patients in two groups. Result 1. The general data of the two groups before intervention, coronary heart disease risk factors, drug treatment after statistical treatment, there was no statistical significance (P 0.05). 2. One month after discharge, the blood pressure, low density lipoprotein (LDL-C), fasting blood glucose (FBG) and FPGG were higher in the experimental group than those in the control group (P 0.01), and there was no significant difference between the two groups in achieving the standard rate of postprandial blood glucose 2 h PGI and BMI. 3. After 6 months of intervention, the LDL-C of PGN in the experimental group was higher than that in the control group (P 0.01), and there was no difference between the control group and the control group (P 0.05). 4. After 12 months of intervention, the blood glucose levels in the experimental group were significantly higher than those in the control group (P 0.01). Conclusion The long-term and comprehensive nursing intervention of PCI patients is better than that of short-term nursing. Routine nursing can effectively control the risk factors of coronary heart disease in patients with PCI.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R473.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 任洪艷;劉麗萍;趙慶華;;冠心病患者自我管理行為及相關(guān)因素分析[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2009年14期

2 張文全;金惠根;劉宗軍;郜俊清;王明瑜;徐佑龍;汪蔚青;楊偉;汪志華;王大英;李英梅;劉鳴;;冠心病患者經(jīng)皮冠狀動(dòng)脈介入術(shù)后社區(qū)強(qiáng)化隨訪研究[J];國(guó)際心血管病雜志;2013年04期

3 朱霓虹;;糖尿病合并冠心病血脂異常的臨床分析與護(hù)理干預(yù)[J];海南醫(yī)學(xué)院學(xué)報(bào);2012年04期

4 蘇林,劉學(xué)波,葛均波;糖尿病與冠脈支架再狹窄的關(guān)系分析[J];中國(guó)臨床醫(yī)學(xué);2005年04期

5 楊勝軍;;冠心病危險(xiǎn)因素研究進(jìn)展[J];吉林醫(yī)學(xué);2013年20期

6 曹教育;;冠心病危險(xiǎn)因素的研究進(jìn)展與護(hù)理干預(yù)[J];齊齊哈爾醫(yī)學(xué)院學(xué)報(bào);2008年17期

7 尚躍豐;王佩顯;;冠狀動(dòng)脈支架術(shù)后再狹窄的危險(xiǎn)因子[J];心血管病學(xué)進(jìn)展;2007年05期

8 胡新磊;毛節(jié)明;;心臟運(yùn)動(dòng)康復(fù)新進(jìn)展[J];心血管病學(xué)進(jìn)展;2008年05期

9 沈玄霖;盛曉東;張劍平;金驍騎;;有氧運(yùn)動(dòng)對(duì)冠心病患者內(nèi)皮功能的影響[J];心血管康復(fù)醫(yī)學(xué)雜志;2011年04期

10 王宏宇,胡大一;冠心病的二級(jí)預(yù)防策略[J];中國(guó)醫(yī)刊;2003年07期

，

本文編號(hào)：1905804