延续性自我管理教育在冠心病介入治疗患者心脏康复中的应用

摘要

目的 探讨延续性自我管理教育在冠心病介入治疗患者心脏康复过程中的作用.方法 选取接受经皮冠状动脉介入治疗(PCI)的冠心病患者124例,随机分为干预组和对照组.两组均接受常规健康教育,干预组在此基础上接受综合自我管理教育,包括4期心脏康复训练和冠心病危险因素控制.观察出院6个月、12个月及24个月时,两组冠心病康复知识知晓情况及二级预防行为、冠心病危险因素达标率及心脏事件发生情况.结果 冠心病康复知识及二级预防行为得分:干预组在6个月、12个月及24个月明显高于对照组(P＜0.01).冠心病危险因素达标率比较:6个月时干预组低密度脂蛋白(LDL-C)、运动达标率好于对照组(P＜0.05);12个月和24个月时冠心病危险因素达标率均好于对照组(P＜0.05)；与入院时比较,干预组6个月、12个月及24个月戒烟和运动达标率均显著增高(P＜0.05),而对照组仅6个月时戒烟达标率增加明显(P＜0.05).PCI治疗后2年,干预组急性心肌梗死、不稳定性心绞痛和符合介入治疗或搭桥手术指征的患者少于对照组(P＜0.05).结论 延续性自我管理教育有助于提高患者健康知识水平和疾病自我管理能力,从而防止和减少临床事件的发生,是PCI术后一种安全、有效、依从性高的心脏康复模式.%Objective To evaluate the effects of a continued self-management education program the heart rehabilitation of patients after percutaneous coronary intervention (PCI) therapy. Methods Totally 124 patients after PCI were randomly divided into the experimental group and the control group. All patients received routine health education. In addition,the patients in the experimental group received a continued self-management education program including four-stage heart rehabilitation and risk factors control of coronary heart diseases. The patients' knowledge about heart rehabilitation and behavior of secondary prevention,the qualified rate of risk factors control of coronary heart diseases and the incidence of heart accident events were compared at 6 months, 12 months and 24 months after discharge between the two groups. Results The knowledge about heart rehabilitation and behavior of secondary prevention at 6 months, 12 months and 24 months after discharge were significantly better in the experimental group than that of the control group(P<0.01). At six months after discharge,the, qualified rates of Low-density lipoprotein(LDL) and exercise were significantly higher in the experimental group than those of the control group(P<0.05). At 12 months and 24 months after discharge, the qualified rates in each index of risk factors of coronary heart diseases were significantly higher in the experimental group than in the control group(P<0.05). In the experimental group,thee qualified rates of smoking cessation and exercise were significantly improved at 6 months, 12 months and 24 months after discharge (P<0.05).While in the control group,the qualified rate of smoking cessation only increased at 6 months after discharge(P<6.05). Two years later,the incidence of acute myocardial infarction,unstable angina and indicators for intervention therapy was significantly lower in the experimental group than that of the control group (P<0.05). Conclusions The continued self-management education program can improve the health knowledge level and the disease self-management ability,and thereby to prevent and reduce the incidence of heart accident events. It is a safe,effective and feasible heart rehabilitation model for patients after PCI.