结局引导的双心服务在冠心病不稳定型心绞痛患者PCI围手术期中的应用

doi:10.3760/cma.j.issn.1007-1245.2024.04.026

摘要/Abstract

摘要：

目的　探讨结局引导的双心服务在冠心病不稳定型心绞痛（UAP）患者经皮冠状动脉介入术（PCI）围手术期中的应用效果。方法　本研究为随机对照试验。选取2020年10月至2022年2月无锡市第二人民医院收治的行PCI治疗的100例UAP患者作为研究对象，随机分为对照组和研究组，各50例。研究组年龄（53.68±7.22）岁；男性31例、女性19例；体质量指数（BMI）（24.28±3.12）kg/m²；病程（3.02±0.61）年；纽约心脏病协会（NYHA）分级：Ⅰ级21例、Ⅱ级15例、Ⅲ级14例；冠状动脉病变支数：单支17例、双支20例、三支及以上13例。对照组年龄（55.32±5.76）岁；男性28例、女性22例；BMI（23.89±3.18）kg/m²；病程（2.89±0.57）年；NYHA分级：Ⅰ级23例、Ⅱ级15例、Ⅲ级12例；冠状动脉病变支数：单支15例、双支23例、三支及以上12例。对照组在围手术期采取常规护理模式，研究组在对照组的基础上采取结局引导的双心服务模式，两组均干预至患者出院。比较两组患者的干预前后焦虑抑郁情绪、心功能指标［左心室射血分数（LVEF）、B型钠尿肽（BNP）］、并发症以及西雅图心绞痛调查量表（SAQ）评分。计量资料采用t检验，计数资料采用χ²检验或Fisher确切概率法，等级资料采用秩和检验。结果　干预后，研究组焦虑自评量表（SAS）评分（38.74±7.13）分、抑郁自评量表（SDS）评分（42.26±8.03）分，均低于对照组的（42.38±7.54）分、（47.78±8.12）分（t=2.480、3.418，P=0.015、0.001）。干预后，研究组LVEF为（69.33±6.89）%，高于对照组的（58.93±6.42）%（t=7.809，P<0.001）；干预后，研究组BNP为（116.82±14.25）ng/L，低于对照组的（138.75±12.46）ng/L（t=8.192，P<0.001）。研究组的并发症发生率低于对照组［6.00%（3/50）比22.00%（11/50）］（χ²=4.070，P=0.044）。干预后，研究组SAQ的躯体活动受限程度评分（79.63±8.76）分、心绞痛稳定状态评分（57.76±9.32）分、心绞痛发作情况评分（70.37±7.11）分、治疗满意程度评分（82.23±8.04）分、疾病认知程度评分（70.12±9.07）分，均高于对照组（67.12±8.07）分、（53.35±8.22）分、（63.18±8.02）分、（69.35±9.33）分、（54.62±8.74）分（t=7.427、2.509、4.744、7.395、8.701，均P<0.05）。结论　在UAP患者PCI围手术期实施结局引导的双心服务减轻了患者的焦虑抑郁情绪，改善了患者的心功能，减少了并发症的发生，缓解了临床症状，提高了生活质量，促进患者预后改善。

关键词:

冠心病, 不稳定型心绞痛, 经皮冠状动脉介入术, 焦虑, 抑郁, 心功能, 结局引导, 双心服务

Abstract:

Objective　To investigate the application effect of outcome guided bicardiac service in the perioperative period of percutaneous coronary intervention (PCI) for patients with unstable angina pectoris (UAP). Methods　It was a randomized controlled trial. A total of 100 patients with UAP undergoing PCI in Wuxi Second People's Hospital from October 2020 to February 2022 were randomly divided into a control group and a study group, with 50 cases in each group. The age of the study group was (53.68±7.22) years old; there were 31 males and 19 females; the body mass index (BMI) was (24.28±3.12) kg/m²; the course of disease was (3.02±0.61) years; the New York Heart Association (NYHA) classification was grade Ⅰ in 21 cases, grade Ⅱ in 15 cases, and grade Ⅲ in 14 cases; the number of coronary artery lesions was single vessel in 17 cases, double vessels in 20 cases, and three or more vessels in 13 cases. The control group was (55.32±5.76) years old; there were 28 males and 22 females; the BMI was (23.89±3.18) kg/m²; the course of disease was (2.89±0.57) years; the NYHA classification was grade Ⅰ in 23 cases, grade Ⅱ in 15 cases, and grade Ⅲ in 12 cases; the number of coronary artery lesions was single vessel in 15 cases, double vessels in 23 cases, and three or more vessels in 12 cases. The control group received the routine nursing mode during the perioperative period, and the study group received the outcome guided bicardiac service mode on the basis of the control group. Both groups were intervened till discharge. The anxiety and depression, cardiac function indexes [left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP)], complications, and Seattle Angina Questionnaire (SAQ) scores of the two groups were compared before and after intervention. t test was used for the measurement data, χ² test or Fisher exact probability method for the count data, and rank sum test for the rank data. Results　After intervention, the scores of Self-rating Anxiety Scale (SAS) [(38.74±7.13) points] and Self-rating Depression Scale (SDS) [(42.26±8.03) points] of the study group were lower than those of the control group [(42.38±7.54) and (47.78±8.12) points] (t=2.480 and 3.418, P=0.015 and 0.001). After intervention, the LVEF of the study group was (69.33±6.89) %, which was higher than that of the control group [(58.93±6.42) %] (t=7.809, P<0.001); the BNP in the study group was (116.82±14.25) ng/L, which was lower than that in the control group [(138.75±12.46) ng/L] (t=8.192, P<0.001). The incidence of complications in the study group was lower than that in the control group [6.00% (3/50) vs. 22.00% (11/50)] (χ²=4.070, P=0.044). After intervention, the scores of physical activity restriction [(79.63±8.76) points], angina stable state [(57.76±9.32) points], angina pectoris attack [(70.37±7.11) points], treatment satisfaction [(82.23±8.04) points], and disease cognition [(70.12±9.07) points] of the SAQ in the study group were higher than those in the control group [(67.12±8.07) points, (53.35±8.22) points, (63.18±8.02) points, (69.35±9.33) points, and (54.62±8.74) points] (t=7.427, 2.509, 4.744, 7.395, and 8.701; all P<0.05). Conclusion　The implementation of outcome guided bicardiac service in the perioperative period of PCI for UAP patients can reduce the patients' anxiety and depression, improve their cardiac function, reduce the occurrence of complications, alleviate the clinical symptoms, improve the quality of life, and promote the prognosis.

Key words:

Coronary heart disease, Unstable angina pectoris, Percutaneous coronary intervention, Anxiety, Depression, Cardiac function, , Outcome guided, Bicardiac service

张展李杏莫琳勤苏严琳孙艳彬.

结局引导的双心服务在冠心病不稳定型心绞痛患者PCI围手术期中的应用 [J]. 国际医药卫生导报, 2024, 30(4): 641-646.

Zhang Zhan, Li Xing, Mo Linqin, Su Yanlin, Sun Yanbin.

Application of outcome guided bicardiac service in patients with unstable angina pectoris of coronary heart disease during the perioperative period of PCI [J]. International Medicine and Health Guidance News, 2024, 30(4): 641-646.

参考文献

[1] Guo J, Dai S, Ding Y, et al. A randomized controlled trial for gualou danshen granules in the treatment of unstable angina pectoris patients with phlegm-blood stasis syndrome[J]. Medicine (Baltimore), 2020, 99(33):e21593. DOI: 10.1097/MD.0000000000021593.
[2] 郭智华,鲁培,卢晓燕,等.三七总皂甙对老年不稳定型心绞痛患者Th1/Th2细胞功能失衡的影响[J].国际医药卫生导报,2022,28(4):532-536. DOI:10.3760/cma.j.issn.1007- 1245.2022.04.022.
[3] 徐晨婕,侯亚冰,曹新西,等.冠心病及脑卒中的发病率和死亡率与互联网搜索引擎数据的关联分析[J].中国慢性病预防与控制,2020,28(4):270-273,279,封4. DOI:10.16386/j.cjpccd.issn.1004-6194.2020.04.007.
[4] Hoole SP, Bambrough P. Recent advances in percutaneous coronary intervention[J]. Heart, 2020, 106(18):1380-1386. DOI: 10.1136/heartjnl-2019-315707.
[5] 冯舒爽,华俊,魏睿宏,等.改良早期心脏康复方案在经皮冠状动脉介入术后患者中的应用[J].中华护理杂志,2020,55(9):1330-1335. DOI:10.3761/j.issn.0254-1769.2020. 09.009.
[6] 王志兴,王国良.沙库巴曲缬沙坦对经皮冠状动脉介入术后血管内皮功能、心肌损伤和近期预后的影响[J].安徽医药,2021,25(4):821-825. DOI: 10.3969/j.issn.1009-6469. 2021.04.046.
[7] Wei J, Chen X, Wen C, et al. Analysis of the application of "psycho-cardiology" model in nursing care of acute stroke patients with depression[J]. Am J Transl Res, 2021, 13(7):8021-8030.
[8] 冯红云,刘璠,赵媛媛,等.双心医学延续性护理在慢性心力衰竭伴2型糖尿病患者中的应用价值[J].现代中西医结合杂志,2020,29(17):1901-1904. DOI:10.3969/j.issn.1008- 8849.2020.17.020.
[9] 马玉琴.以护理结局为导向的多学科合作模式护理对胃癌患者术后护理干预效果探究[J].山西医药杂志,2020,49(20):2839-2841. DOI:10.3969/j.issn.0253-9926.2020. 20.047.
[10] 王朵,张丹,桂萍.腰椎管狭窄症患者应用以结局为导向的强化护理干预临床观察[J].中国医药导报,2022,19(28):194-196,封3. DOI:10.20047/j.issn1673-7210.2022.28.45.
[11] 喻莲,应少香,黄小明,等.冠心病患者经皮冠状动脉介入治疗围术期心理状况及"双心"护理效果[J].实用心脑肺血管病杂志,2019,27(9):100-103,108. DOI: 10.3969/j.issn.1008-5971.2019.09.022.
[12] 庄晓赛,葛慧娟,王洪旗,等."双心"干预在青年冠心病患者经皮介入治疗术后的应用效果分析[J].中国循证心血管医学杂志,2019,11(9):1115-1117. DOI:10.3969/j.issn.1674- 4055.2019.09.22.
[13] 刘媛媛,段咏梅,卡丽毕努尔·力提甫,等."双心医学"模式在经皮冠状动脉介入治疗术后伴抑郁患者护理中的应用分析[J].新疆医科大学学报,2020,43(7):985-988,992. DOI:10.3969/j.issn.1009-5551.2020.07.031.
[14] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛诊断和治疗建议[J].中华心血管病杂志,2000,28(6):409-412. DOI:10.3760/j.issn.0253-3758. 2000.06.002.
[15] Fisher JD. New York Heart Association Classification[J]. Arch Intern Med, 1972, 129(5):836.
[16] Dunstan DA, Scott N. Norms for Zung's Self-rating Anxiety Scale[J]. BMC Psychiatry, 2020, 20(1):90. DOI: 10.1186/s12888-019-2427-6.
[17] Jokelainen J, Timonen M, Keinänen-Kiukaanniemi S, et al. Validation of the Zung self-rating depression scale (SDS) in older adults[J]. Scand J Prim Health Care, 2019, 37(3):353-357. DOI: 10.1080/02813432.2019.1639923.
[18] Thomas M, Jones PG, Arnold SV, et al. Interpretation of the Seattle Angina Questionnaire as an outcome measure in clinical trials and clinical care: a review[J]. JAMA Cardiol, 2021, 6(5):593-599. DOI: 10.1001/jamacardio.2020. 7478.
[19] Tian PP, Wu QJ, Li J, et al. Efficacy and safety of Chinese herbal medicine Wen Xin granules for the treatment of unstable angina pectoris with Yang deficiency and blood stasis syndrome: study protocol for a randomized controlled trial[J]. Trials, 2021, 22(1):798. DOI: 10.1186/s13063-021-05771-y.
[20] 刘文武,薛宪骏,罗显元,等.冠心丹参滴丸对老年冠心病不稳定型心绞痛气虚血瘀证患者血小板活化的影响——双盲安慰剂对照试验[J].中医杂志,2020,61(15):1339-1343. DOI:10.13288/j.11-2166/r.2020.15.013.
[21] Wang W, Zhang X, Chen K, et al. Effects of nicorandil infusion on ECG parameters in patients with unstable angina pectoris and percutaneous coronary intervention[J]. Ann Noninvasive Electrocardiol, 2020, 25(4):e12736. DOI: 10.1111/anec.12736.
[22] 刘世杰,吴磊,郭亚荣,等.灯盏生脉胶囊对不稳定型心绞痛经皮冠状动脉介入术后血液流变学、心肌保护、血小板功能的影响[J].中华中医药学刊,2022,40(2):198-201. DOI:10.13193/j.issn.1673-7717.2022.02.046.
[23] 于长生,宫丽鸿,赵殿臣.稳斑汤联合体外反搏治疗冠心病PCI术后心绞痛临床疗效及对血清ET-1和NO影响[J].辽宁中医药大学学报,2020,22(2):150-153. DOI:10.13194/j.issn.1673-842x.2020.02.041.
[24] 孙毅,张权宇,刘威,等.经皮冠状动脉介入治疗术后冠心病患者合并焦虑和(或)抑郁对预后影响[J].临床军医杂志,2020(5):518-520,525. DOI:10.16680/j.1671-3826. 2020.05.11.
[25] Santiváñez-Acosta R, Tapia-López ELN, Santero M. Music therapy in pain and anxiety management during labor: a systematic review and meta-analysis[J]. Medicina (Kaunas), 2020, 56(10):526. DOI: 10.3390/medicina56100526.
[26] Moreira JBN, Wohlwend M, Wisløff U. Exercise and cardiac health: physiological and molecular insights[J]. Nat Metab, 2020, 2(9):829-839. DOI: 10.1038/s42255- 020-0262-1.
[27] 张宁,吕向妮,付文,等.基于鱼骨图分析法的双心干预模式对PCI患者ASD及不良事件的影响[J].重庆医学,2022,51(11):1807-1811,1817. DOI:10.3969/j.issn.1671-8348. 2022.11.002.
[28] 陈静,颜博.心脏康复训练在不稳定型心绞痛经皮冠脉介入术治疗患者护理中的应用[J].临床与病理杂志,2021,41(1):173-178. DOI:10.3978/j.issn.2095-6959.2021.01.027.
[29] Langford B, Hunt C, Lerman A, et al. The use of the Seattle Angina Questionnaire in patients who underwent spinal cord stimulation for refractory angina pectoris[J]. Pain Med, 2021, 22(4):1005-1009. DOI: 10.1093/pm/pnaa447.
[30] 于翠迪,肖艳杰,余天浩.冠心病患者介入治疗前后生活质量及心血管并发症的影响因素分析[J].西北国防医学杂志,2019,40(7):420-425. DOI:10.16021/j.cnki.1007-8622. 2019.07.005.