摘要
目的探讨经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后患者心血管健康评分轨迹的特征。方法采用方便抽样法,选取2019年5月—10月于哈尔滨市某三级甲等医院心内科首次行PCI且术后规律随访的急性心肌梗死患者339例,依据其术后基线、6个月、12个月的心血管健康评分,使用群组发展模型识别异质性轨迹,采用Cox比例风险回归模型分析轨迹组别对主要心脏不良事件的影响。结果该研究识别出5条心血管健康评分轨迹,分别为低-升高组(19.8%)、中-先降后升组(24.8%)、中-快速升高组(14.4%)、中-稳定组(31.9%)和高-稳定组(9.1%)。Cox比例风险回归模型表明,在调整混杂因素(年龄、性别、高密度脂蛋白胆固醇和饮酒)后,中-先降后升组、中-快速升高组、中-稳定组和高-稳定组发生主要心脏不良事件的风险分别是低-升高组的0.498(P=0.033)、0.446(P=0.049)、0.403(P=0.006)和0.259(P=0.030)倍。结论急性心肌梗死患者PCI术后1年的心血管健康评分呈现不同的变化轨迹,提升及保持较高水平的心血管健康评分与主要心脏不良事件的风险呈负相关。医护人员可动态监测心血管健康评分变化特征,加强危险因素管理并早期采取干预手段以改善预后。
Objective To investigate the characteristics of cardiovascular health score trajectories in patients after percutaneous coronary intervention(PCI).Methods The convenience sampling method was used to recruit 339 acute myocardial infarction patients who underwent PCI for the first time in the cardiology department of a first-class tertiary hospital in Harbin from May to October 2019 with regular follow-up after PCI.We used the group-based trajectory model to identify the heterogeneous trajectory groups of cardiovascular health score based on the baseline,6 months and 12 months follow-up.The Cox proportional risk regression model was used to analyze the effect of trajectory groups and major adverse cardiac events(MACE).Results 5 cardiovascular health score trajectories were identified as low-increasing group(19.8%),medium-declining and then increasing group(24.8%),medium-rapid increasing group(14.4%),medium-stable group(31.9%),high-stable group(9.1%).Cox proportional risk regression model showed that,after adjustment for potential confounding factors(age,sex,high-density lipoprotein cholesterol and alcohol consumption),the risk of MACE in medium-declining first and then increasing group,medium-rapid increasing group,medium-stable group and high-stable group were 0.498(P=0.033),0.446(P=0.049),0.403(P=0.006)and 0.259(P=0.030)times of low-increasing group,respectively.Conclusion Acute myocardial infarction patients after PCI for a year showed various cardiovascular health score trajectories;the improvement and maintainance of a high level of cardiovascular health score were negatively correlated with the risk of MACE.Medical staff can monitor the characteristics of cardiovascular health score changes dynamically,strengthen risk factor management and adopt early intervention methods to improve prognosis.
作者
张睿
高学琴
林平
赵振娟
王旖旎
ZHANG Rui;GAO Xueqin;LIN Ping;ZHAO Zhenjuan;WANG Yini
出处
《中华护理杂志》
CSCD
北大核心
2022年第7期816-822,共7页
Chinese Journal of Nursing
关键词
经皮冠状动脉介入术
心血管健康评分
急性心肌梗死
护理
Percutaneous Coronary Intervention
Cardiovascular Health Score
Acute Myocardial Infarction
Nursing Care
