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目的:评估护理协调预防计划降低急性冠脉综合征(ACS)患者心血管风险的效果,探讨其作为出院后常规随访计划的可行性。方法:将232例ACS患者随机分为干预组120例,出院前制定护理协调预防干预计划,出院后1个月及以后每2个月分别由专职护师进行电话随访;对照组112例,给予常规出院指导和门诊随访。收集两组出院后3、6、12个月于门诊复查的人体测量学指标和血液指标,比较预期目标达标率、弗雷明汉冠状风险(FCRS)评分、血管及其他不良事件发生率及12个月内的再入院率。结果:(1)3个月时,干预组舒张压(SBP)、饮酒量、体育锻炼达标患者比例与对照组比较,差异均有统计学意义(P<0.05)。6个月时,干预组腰围(WC)、SBP、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、空腹血糖(FPG)、戒烟、饮酒量、坚持体育锻炼及服药依从性仍达标患者的比例高于对照组,且在糖尿病患者中糖化血红蛋白(Hb A1c)<7%和FPG<8 mmol·L-1患者的比例亦高于对照组(P<0.05或P<0.01)。随访至第12个月,干预组各项指标的达标率有所降低,但WC、SBP、LDL-C、HDL-C、TG、FPG、服药依从性,及糖尿病患者Hb A1c<7%和FPG<8 mmol·L-1的达标比例仍高于对照组(P<0.05或P<0.01)。(2)从第3个月开始,两组低水平风险控制(0~3个风险因素被控制)比例持续降低,中等(4~6个风险因素被控制)和良好风险控制(7~9个风险因素被控制)比例持续升高,且各时间点干预组良好风险控制比例均高于对照组(χ~2值分别为5.275、8.436、4.342,P值分别为0.029、0.006、0.046)。(3)干预组总体不良事件发生率和因ACS再入院的比例均低于对照组(20.2%vs 44.4%,χ~2=13.465,P=0.000;9.6%vs 22.2%,χ~2=5.900,P=0.021)。结论:护理协调预防计划可提高ACS患者各项指标的达标率,减少再发心血管疾病的风险,并降低不良事件发生率,为ACS患者的长期随访提供了一种新的有效方式。
OBJECTIVES: To assess the effectiveness of a coordinated care prevention program in reducing cardiovascular risk in patients with acute coronary syndrome (ACS) and to explore its feasibility as a routine follow-up plan after discharge. Methods: A total of 232 patients with ACS were randomly divided into intervention group (n = 120). Before discharge, a nursing intervention plan was established. One month after discharge and every two months thereafter were followed up by full-time nurses. In the control group, 112 patients General discharge guidance and outpatient visits. The two groups were collected for anthropometric and blood parameters at outpatient visits at 3, 6, and 12 months after discharge. The expected target compliance rate, FCRS score, incidence of adverse vascular events and other adverse events were compared between the two groups The rate of readmission within a month. Results: (1) At 3 months, there were significant differences in the SBP, alcohol intake and physical activity between the intervention group and the control group (P <0.05). At 6 months, WC, SBP, LDL-C, TG, FPG, smoking cessation, alcohol intake, adherence to physical activity and medication adherence (P <0.05 or P <0.01). The proportion of Hb A1c <7% and FPG <8 mmol·L-1 in patients with diabetes mellitus was also higher than that of the control group (P <0.05 or P <0.01) . Follow-up to the 12th month, the compliance rate of each index in the intervention group decreased, but WC, SBP, LDL-C, HDL-C, TG, FPG, medication compliance and Hb A1c <7% and FPG <8 mmol·L-1 compliance rate is still higher than the control group (P <0.05 or P <0.01). (2) From the third month, the proportion of low-level risk control (0 to 3 risk factors being controlled) in both groups continued to decrease. Medium (4 to 6 risk factors were controlled) and good risk control (7 to 9 Risk factors were controlled), and the proportion of good risk control in the intervention group was higher than that of the control group at each time point (χ ~ 2 values were 5.275, 8.436 and 4.342 respectively, P values were 0.029,0.006 and 0.046 respectively). (3) The incidences of adverse events and re-admission due to ACS in intervention group were lower than those in control group (20.2% vs 44.4%, χ ~ 2 = 13.465, P = 0.000; 9.6% vs 22.2%, χ ~ 2 = 5.900 , P = 0.021). Conclusion: The nursing coordination and prevention plan can improve the compliance rate of each index of patients with ACS, reduce the risk of recurrent cardiovascular disease and reduce the incidence of adverse events, providing a new and effective way for long-term follow-up of ACS patients.