本文選題：冠心病 + PCI　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景及目的:隨著社會(huì)壓力增大及人口老齡化,冠心病發(fā)病人數(shù)持續(xù)增加,給家庭、社會(huì)帶來(lái)的軀體、精神及經(jīng)濟(jì)上的負(fù)擔(dān)日益嚴(yán)重�，F(xiàn)代醫(yī)學(xué)治療不僅關(guān)注于改善癥狀體征,降低死亡率,延長(zhǎng)壽命,更注重軀體、心理、情感及社會(huì)功能等方面生活質(zhì)量的提高,后者更被臨床醫(yī)生、患者及社會(huì)認(rèn)為是醫(yī)療技術(shù)、疾病控制的終點(diǎn)評(píng)估指標(biāo)之一。經(jīng)皮冠狀動(dòng)脈介入治療(percutaneous coronary intervention,PCI)是冠心病治療領(lǐng)域的里程碑,因其可重復(fù)性高、療效可靠、康復(fù)快備受青睞。本研究應(yīng)用健康調(diào)查簡(jiǎn)表(SF-36)對(duì)首次成功施行PCI術(shù)的冠心病患者進(jìn)行術(shù)前、術(shù)后1年生活質(zhì)量評(píng)價(jià),比較術(shù)前及術(shù)后的生活質(zhì)量變化,并分析PCI術(shù)后生活質(zhì)量變化的影響因素,如性別、年齡;高血壓、糖尿病、高脂血癥;病變血管數(shù)量、未處理病變血管數(shù)量、植入支架數(shù)量、冠心病類型;BNP、左室射血分?jǐn)?shù)(left ventricular ejection fraction,LVEF)、是否存在節(jié)段性運(yùn)動(dòng)異常;術(shù)后血糖、血壓、血脂控制情況;術(shù)后吸煙狀態(tài)。以此為醫(yī)生診療、患者自我健康管理提供一定的理論依據(jù)。方法:研究對(duì)象為2015年2月-2016年2月期間,在大連醫(yī)科大學(xué)附屬第一醫(yī)院首次成功實(shí)施冠狀動(dòng)脈造影及藥物洗脫支架置入術(shù)的患者152例,經(jīng)患者本人及家屬知情同意后,選用普適性SF-36量表,術(shù)前由患者本人填寫(因視力差、文盲的患者,由研究者讀,患者本人選擇),PCI術(shù)后1年通過(guò)電話隨訪或門診復(fù)查進(jìn)行相關(guān)資料采集,應(yīng)用t檢驗(yàn),比較術(shù)前及術(shù)后1年生活質(zhì)量,應(yīng)用單因素分析及逐步多元線性回歸對(duì)影響PCI術(shù)后1年生活質(zhì)量變化的因素進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.SF-36量表各維度生活質(zhì)量分?jǐn)?shù)分析:PCI術(shù)后1年較術(shù)前生活質(zhì)量提高,且差異有統(tǒng)計(jì)學(xué)意義(P0.05);2.單因素分析影響因素結(jié)果:性別、年齡、冠心病類型、術(shù)后吸煙情況對(duì)PCI術(shù)后1年生活質(zhì)量變化有影響,而是否患有高血壓、糖尿病、高脂血癥、病變血管數(shù)量、未處理病變血管數(shù)量、植入支架數(shù)量、BNP、左室射血分?jǐn)?shù)(LVEF)、是否存在節(jié)段性運(yùn)動(dòng)異常、術(shù)后血壓、血糖、血脂控制情況對(duì)PCI術(shù)后1年生活質(zhì)量變化無(wú)影響。3.多元線性逐步回歸影響因素結(jié)果:性別、冠心病類型、術(shù)后吸煙情況與PCI術(shù)后1年生活質(zhì)量變化存在復(fù)相關(guān),復(fù)相關(guān)系數(shù)為0.365:男性SF-36總評(píng)分提高優(yōu)于女性;無(wú)吸煙史患者SF-36總評(píng)分提高優(yōu)于有吸煙史患者,術(shù)后戒煙患者SF-36總評(píng)分提高優(yōu)于術(shù)后未戒煙患者;不穩(wěn)定型心絞痛患者SF-36總評(píng)分提高優(yōu)于急性心肌梗死患者。結(jié)論:1.PCI術(shù)后1年較術(shù)前生活質(zhì)量明顯提高,PCI術(shù)可顯著提高冠心病患者生活質(zhì)量;2.性別、冠心病類型、術(shù)后吸煙情況是影響冠心病患者PCI術(shù)后1年生活質(zhì)量變化的因素。
[Abstract]:Background and purpose: with the increase of social pressure and the aging of the population, the number of patients with coronary heart disease is increasing, and the physical, spiritual and economic burden of the family and society is increasingly serious. Modern medical treatment is not only concerned with improving symptoms and signs, reducing mortality and prolonging life, but also paying more attention to physical, psychological, emotional and social functions. The improvement of the quality of life, the latter is also considered by clinicians, patients and society as one of the end-point evaluation indicators of medical technology and disease control. Percutaneous coronary intervention (percutaneous coronary intervention, PCI) is a milestone in the treatment of coronary heart disease, because of its high repeatability, reliable curative effect and fast recovery. To evaluate the quality of life before and after 1 years, the quality of life of patients with coronary heart disease after the first successful PCI operation was evaluated by SF-36. The factors such as sex, age, high blood pressure, diabetes, hyperlipidemia, and the number of diseased vessels were analyzed. The number of diseased vessels, the number of stent implantation, type of coronary heart disease, BNP, left ventricular ejection fraction (LVEF), the existence of segmental dyskinesia, postoperative blood glucose, blood pressure, blood lipid control, and postoperative smoking state. For the first time in the first hospital affiliated to Dalian Medical University, 152 cases of coronary artery angiography and drug eluting stent implantation were successfully implemented in the First Affiliated Hospital of Dalian Medical University in February 2015. After informed consent of the patients and their families, the universal SF-36 was selected and the patients were filled out by the patient before the operation (because of poor eyesight, illiterate patients, read by the researchers. " The patient chose), 1 years after PCI, the related data were collected by telephone follow-up or outpatient review, and t test was used to compare the quality of life before and after 1 years. The factors affecting the changes of quality of life after 1 years after PCI were statistically analyzed by single factor analysis and stepwise multiple linear regression. Results: the life of the 1.SF-36 scale was in all dimensions. Quality score analysis: the quality of life was improved in 1 years after PCI, and the difference was statistically significant (P0.05). 2. single factor analysis of influencing factors were that sex, age, type of coronary heart disease, and postoperative smoking had an influence on the quality of life in 1 years after PCI, and whether there was hypertension, diabetes, hyperlipidemia, and the number of diseased vessels. The number of diseased vessels, the number of stent implantation, BNP, left ventricular ejection fraction (LVEF), the existence of segmental dyskinesia, postoperative blood pressure, blood glucose, and blood lipid control had no effect on the 1 year.3. linear stepwise regression factors after PCI: sex, type of coronary heart disease, postoperative smoking and the quality of life of 1 years after PCI The total score of 0.365: was better than that of women; the total score of SF-36 in patients with no smoking history was better than that of patients with smoking history. The total score of SF-36 in patients with smoking cessation was better than that of non smoking patients after operation, and the overall SF-36 score of patients with unstable angina was better than that of patients with acute myocardial infarction. Conclusion: 1 years compared with the preoperative quality of life was significantly improved after 1.PCI operation, PCI operation can significantly improve the quality of life of patients with coronary heart disease; coronary heart disease type 2. gender, smoking status, postoperative quality of life influence factors PCI in patients with coronary heart disease after 1 years.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
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本文編號(hào)：2047627