“五位一体”随访管理模式在急性心肌梗死合并糖尿病患者二级预防中的效果研究

Effect of "Five-in-one" follow-up management modein secondary prevention of acute myocardial infarction and diabetes in patients

  • 摘要:
      目的  探讨“五位一体”随访管理模式在急性心肌梗死合并糖尿病患者二级预防中的效果。
      方法  选取2018年1—12月在陕西省人民医院行冠状动脉介入术(PCI)治疗的急性心肌梗死合并2型糖尿病患者200例,根据患者出院后的随访意愿分为观察组(“五位一体”随访管理)103例和对照组(单一门诊随访)97例。随访1年后,比较2组空腹血糖、糖化血红蛋白、尿蛋白、尿糖、血压达标率、血脂达标率、体质量指数(BMI)、戒烟率、体力活动达标率、服药依从性、累计失访率和主要心血管不良事件(MACE)等指标。
      结果  随访1年后,观察组失访5例,对照组失访24例。2组累计失访率、MACE发生率、体力活动达标率、戒烟率、血压达标率、尿蛋白阳性率、尿糖阳性率比较,差异均有统计学意义(P < 0.05)。观察组β-受体阻滞剂、他汀类药物、血管紧张素转换酶抑制剂与血管紧张素II受体拮抗剂(ACEI/ARB)类药物、双联抗血小板药物的服药率高于对照组患者,平均收缩压、舒张压、BMI、空腹血糖、糖化血红蛋白、尿酸水平均低于对照组,差异有统计学意义(P < 0.05)。
      结论  “五位一体”随访管理模式可有效控制急性心肌梗死合并糖尿病患者的危险因素,提高服药依从性,规范冠心病二级预防用药,降低心血管事件的发生率。

     

    Abstract:
      Objective  To investigate the effect of "Five-in-one" follow-up management mode in secondary prevention of acute myocardial infarction and diabetes in patients.
      Methods  From January to December 2018, a total of 200 acute myocardial infarction patients with type 2 diabetes mellitus by treatment of percutaneous coronary intervention (PCI) in Shaanxi Provincial People's Hospital were selected, and they were divided into observation group ("Five-in-one" follow-up management mode) with 103 cases and control group (traditional outpatient follow-up) with 97 cases according to willingness of follow up after hospital discharge. One year after follow-up, indexes such as fasting blood glucose, glycosylated hemoglobin, urinary protein, urinary sugar, standard rate of blood pressure, standard rate of blood lipid, body mass index (BMI), smoking cessation rate, standard rate of physical activity, medication compliance, cumulative loss rate of follow-up and major adverse cardiovascular events (MACE) were compared between the two groups.
      Results  After 1-year follow-up, there were 5 cases lost during follow-up in the observation group and 24 cases in the control group. There were significant differences in cumulative loss rate of follow-up, incidence of MACE, standard rate of physical activity, smoking cessation rate, standard rate of blood pressure, positive rate of urinary protein and positive rate of urinary sugar between the two groups (P < 0.05). In the observation group, the medication rates of β-receptor blockers, statins, angiotensin converting enzyme inhibitors and angiotensin Ⅱ receptor antagonists (ACEI/ARB), and dual antiplatelet drugs were significantly higher than those in the control group, while the mean systolic blood pressure, diastolic blood pressure, BMI, fasting blood glucose, glycosylated hemoglobin and uric acid levels were significantly lower than those in the control group (P < 0.05).
      Conclusion  "Five-in-one" follow-up management model can effectively control the risk factors of acute myocardial infarction patients with diabetes, improve medication compliance, standardize the drug use for secondary prevention of coronary heart disease, and reduce the incidence of cardiovascular events.

     

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