微信管理在冠心病PCI术后出院患者心脏康复护理中的应用

陈笑茜; 朱秀若; 张平妹; 姜文兵; 沈铖姬

doi:10.16766/j.cnki.issn.1674-4152.002527

微信管理在冠心病PCI术后出院患者心脏康复护理中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002527

1.
温州市人民医院心内科，浙江温州 325000
2.
树兰(杭州)医院心内科，浙江杭州 310000

基金项目:

浙江省教育厅科研项目 Y202045061

温州市科技局基础性医疗卫生科技项目 Y20180455

详细信息

通讯作者:
陈笑茜, E-mail: Tianzhang198738@163.com

中图分类号: R541.4 R473.54
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出版历程
- 收稿日期: 2021-01-15
- 网络出版日期: 2022-09-21

Application of WeChat management in cardiac rehabilitation nursing of discharged patients with coronary heart disease after PCI

1.
Department of Cardiology, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨微信管理在冠心病经皮冠状动脉介入治疗(PCI)术后出院患者心脏康复延续性护理中的效果。方法选取2017年10月—2018年3月在温州市人民医院心内科行PCI术的冠心病出院患者100例，按随机数字表法分为对照组和观察组，各50例。对照组给予常规出院宣教和手册，观察组除常规出院宣教和手册外，建立微信群，制定8周的康复计划。分别于患者出院后3个月和6个月评价比较2组患者生活质量评分、再就诊再住院率、心血管不良事件发生率及心血管危险因素达标情况。结果观察组出院后3个月、6个月生活质量评分分别(79.22±8.52)分、(79.42±7.80)分，优于对照组的(61.38±8.29)分、(62.74±11.45)分(均P < 0.05)；观察组患者出院后6个月内再就诊次数、再住院次数及胸痛不适发生次数均低于对照组，差异有统计学意义(均P < 0.05)；观察组患者出院后3个月内、6个月内心血管不良事件总发生率分别为6.0%和12.0%，均低于对照组的22.0%、42.0%(均P < 0.05)；观察组患者出院后6个月心血管危险因素血压、低密度脂蛋白胆固醇(LDL-C)、空腹血糖达标率分别为94.0%、92.0%、98.0%，均优于对照组的70.0%、66.0%、72.0%(均P＜0.05)。结论采取微信管理的延续护理方式能有效控制冠心病PCI术后出院患者的主要心血管危险因素，降低再就诊、再住院率，减少心血管不良事件的发生，提高生活质量，有利于改善患者预后。
- 微信管理 /
- 延续护理 /
- 冠心病 /
- 经皮冠状动脉介入治疗术后
Abstract: Objective To explore the effect of WeChat management in continuous nursing care of discharged patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods A total of 100 patients with coronary heart disease who underwent PCI in the Department of Cardiology of Wenzhou People's Hospital from October 2017 to March 2018 were selected. They were divided into the control group and observation group with 50 patients in each group according to the random number table method. The control group was given conventional discharge and manual, whereas the observation group established a WeChat group and made an 8-week rehabilitation plan in addition to routine discharge education and manual. The quality of life score, rehospitalisation rate, incidence of cardiovascular adverse events and compliance of cardiovascular risk factors were evaluated and compared between the two groups at 3 and 6 months after discharge. Results The quality of life scores of the observation group were (79.22±8.52) points and (79.42±7.80) points at 3 and 6 months after discharge, which were better than those of the control group [(61.38±8.29) points and (62.74±11.45) points, respectively, all P < 0.05]. The frequency of revisit and rehospitalisation and frequency of chest pain within 6 months after discharge in the observation group were all lower than those in the control group (all P < 0.05). The total incidence of adverse cardiovascular events in the observation group was 6.0% and 12.0% within 3 and 6 months after discharge, respectively, which were lower than those in the control group (22.0% and 42.0%, all P < 0.05). At 6 months after discharge, the compliance rates of cardiovascular risk factors such as blood pressure, LDL-C and fasting blood glucose in the observation group were 94.0%, 92.0% and 98.0%, respectively, which were better than those in the control group (70.0%, 66.0% and 72.0%, all P < 0.05). Conclusion The continuous nursing method of WeChat management can effectively control the main cardiovascular risk factors of patients discharged after PCI, reduce the rate of revisit and rehospitalisation, reduce the occurrence of cardiovascular adverse events, improve the quality of life and benefit the prognosis of patients.
- WeChat management /
- Continuing care /
- Coronary heart disease /
- After Percutaneous Coronary Intervention

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表 1 2组患者生活质量评分比较(x±s，分)

Table 1. Comparison of quality of life scores between two groups (x±s, scores)

组别	例数	生活质量评分			F值	P值
组别	例数	入院时	出院后3个月	出院后6个月	F值	P值
观察组	50	35.84±6.19	79.22±8.52^a	79.42±7.80^ab	718.867	＜0.001
对照组	50	34.88±6.42	61.38±8.29^a	62.74±11.45^ab	308.593	＜0.001
t值		0.761	10.612	8.514
P值		0.448	＜0.001	＜0.001
注：与入院时比较，^aP＜0.05；与出院后3个月比较，^bP＞0.05。

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表 2 2组患者再就诊和再住院、胸痛不适发生次数情况比较[M(P₂₅, P₇₅)]

Table 2. Comparison of the frequency of revisit and rehospitalization, chest pain and discomfort between the two groups [M(P₂₅, P₇₅)]

组别	例数	再就诊次数	再住院次数	胸部不适发生次数
观察组	50	0(0, 0)	0(0, 0)	0(0, 0)
对照组	50	0(0, 1)	0(0, 1)	1(0, 2)
Z值		-2.748	-3.546	-3.730
P值		0.006	＜0.001	＜0.001

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表 3 2组患者不良心血管事件发生情况比较[例(%)]

Table 3. Comparison of adverse cardiovascular events between two groups [case (%)]

组别	例数	出院后3个月内				出院后6个月内
组别	例数	心肌梗死	心力衰竭	心绞痛	总发生数	心肌梗死	心力衰竭	心绞痛	总发生数
观察组	50	2(4.0)	0	1(2.0)	3(6.0)	4(8.0)	1(2.0)	1(2.0)	6(12.0)
对照组	50	5(10.0)	2(4.0)	4(8.0)	11(22.0)	8(16.0)	6(12.0)	7(14.0)	21(42.0)
χ²值		0.614	0.510	0.842	5.316	1.515	2.458	3.397	11.416
P值		0.433	0.475	0.359	0.021	0.218	0.117	0.065	0.001

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表 4 2组患者心血管危险因素达标情况比较[例(%)]

Table 4. Comparison of cardiovascular risk factors in two groups [case (%)]

组别	例数	入院时			出院后3个月			出院后6个月
组别	例数	血压	LDL-C	空腹血糖	血压	LDL-C	空腹血糖	血压	LDL-C	空腹血糖
观察组	50	15(30.0)	28(56.0)	28(56.0)	44(88.0)	42(84.0)	46(92.0)	47(94.0)	46(92.0)	49(98.0)
对照组	50	19(38.0)	26(52.0)	24(48.0)	40(80.0)	37(74.0)	41(82.0)	35(70.0)	33(66.0)	36(72.0)
χ²值		0.713	0.161	0.641	1.190	1.507	2.210	9.756	10.187	13.255
P值		0.398	0.688	0.423	0.275	0.220	0.137	0.002	0.001	＜0.001

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参考文献(19)

[1]	胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告2018》概要[J]. 中国循环杂志, 2019, 34(3): 209-220. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201903002.htm HU S S, GAO R L, LIU L S, et al. Summary of China cardiovascular disease report 2018[J]. Chinese Circulation Journal, 2019, 34(3): 209-220. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201903002.htm
[2]	郝云霞, 周政, 刘庆荣, 等. 从心血管专科发展看护理在心脏康复中的作用[J]. 中华护理杂志, 2015, 50(6): 645, 649. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201506001.htm HAO Y X, ZHOU Z, LIU Q R, et al. The role of nursing in cardiac rehabilitation viewed from the development of cardiovascular specialties[J]. Chinese Journal of Nursing, 2015, 50(6): 645, 649. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201506001.htm
[3]	马冬冬. 心脏康复的现状与进展[J]. 齐鲁护理杂志, 2019, 25(1): 13-15. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL201901004.htm MA D D. Current status and progress of cardiac rehabilitation[J]. Journal of Qilu Nursing, 2019, 25(1): 13-15. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL201901004.htm
[4]	MCHORNEY C A, WARE J E, RACZEK A E. The MOS 36-Item Short-Form Health Survey (SF-36): Ⅱ. Psychometric and clinical tests of validity in measuring physical and mental health constructs[J]. Medical care, 1993, 31(3): 247-263. doi: 10.1097/00005650-199303000-00006
[5]	ROBERTSON R J, GOSS F L, METZ K F. Perception of physical exertion during dynamic exercise: A tribute to Professor Gunnar A.V. Borg[J]. Perceptual and Motor Skills, 1998, 86(1): 183-191. doi: 10.2466/pms.1998.86.1.183
[6]	朱艳, 李萍, 余海萍. 老年冠心病患者介入术后延续性护理需求程度及影响因素研究[J]. 护理实践与研究, 2018, 15(24): 20-22. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ201824009.htm ZHU Y, LI P, YU H P. Study on the degree of interventional continuation care needs and influencing factors in elderly patients with coronary heart disease[J]. Nursing Practice and Research, 2018, 15(24): 20-22. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ201824009.htm
[7]	傅拥军, 菅颖, 胡慧群. 急性心肌梗死经PCI术后行延续性护理对患者心理状态和服药依从性的影响[J]. 中华全科医学, 2018, 16(2): 326-329. doi: 10.16766/j.cnki.issn.1674-4152.000091 FU Y J, JIAN Y, HU H Q. Effect of the continuation of nursing care for acute myocardial infarction after PCI on patients ' psychological status and medication adherence[J]. Chinese Journal of General Practice, 2018, 16(2): 326-329. doi: 10.16766/j.cnki.issn.1674-4152.000091
[8]	刘曼, 刘晓亭, 董博, 等. 延续性护理对冠心病患者抑郁情绪影响的系统评价[J]. 护理学报, 2017, 24(1): 47-52. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201701012.htm LIU M, LIU X T, DONG B, et al. Systematic evaluation of the effects of continuation care on depressive mood in CAD patients[J]. Journal of Nursing, 2017, 24(1): 47-52. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201701012.htm
[9]	江琳, 孙青, 张雅丽. 基于微信平台的延续护理在冠心病介入术后患者中的应用[J]. 护理管理杂志, 2017, 17(2): 140-142. https://www.cnki.com.cn/Article/CJFDTOTAL-HLGL201702028.htm JIANG L, SUN Q, ZHANG Y L. Application of continuation nursing based on WeChat platform in patients after coronary heart disease[J]. Journal of Nursing Administration, 2017, 17(2): 140-142. https://www.cnki.com.cn/Article/CJFDTOTAL-HLGL201702028.htm
[10]	王秀峰, 罗卫华, 丁燕, 等. 社区微信延续性护理对冠心病PCI术后患者健康行为及生活质量的影响[J]. 上海医药, 2020, 41(16): 50-53, 56. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY202016019.htm WANG X F, LUO W H, DING Y, et al. Effect of community WeChat continuation care on health behavior and quality of life of patients after PCI[J]. Shanghai Medical & Pharmaceutical Journal, 2020, 41(16): 50-53, 56. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY202016019.htm
[11]	RYTTERSTRM P, OVOX S M, WRDIG R, et al. Impact of suicide on health professionals in psychiatric care mental healthcare professionals ' perceptions of suicide during ongoing psychiatric care and its impacts on their continued care work[J]. Int J Ment Health Nu, 2020, 29(5): 982-991. doi: 10.1111/inm.12738
[12]	余丹, 钟清玲, 王乾沙, 等. 移动医疗在维持性血液透析病人延续护理中的应用进展[J]. 护理研究, 2020, 34(18): 3268-3271. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202018015.htm YU D, ZHONG Q L, WANG Q S, et al. Progress in the application of mobile medicine in the continuation care of maintenance hemodialysis patients[J]. Chinese Nursing Research, 2020, 34(18): 3268-3271. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202018015.htm
[13]	李娅, 赵正凯, 杨浩, 等. 心理护理结合延续护理对外周血管介入治疗患者生活质量及并发症的影响[J]. 国际护理学杂志, 2020, 39(17): 3083-3086. LI Y, ZHAO Z K, YANG H, et al. Effect of psychological nursing combined with continuation nursing on the quality of life and complications of patients with peripheral vascular interventional therapy[J]. International Journal of Nursing, 2020, 39(17): 3083-3086.
[14]	宋秋香, 孙慧卿, 康海芬, 等. 以奥马哈系统为框架的延续性护理在肠造口病人中的应用[J]. 护理研究, 2020, 34(17): 3168-3170. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202017037.htm SONG Q X, SUN H Q, KANG H F, et al. Application of continuity care framed by the Omaha system in patients with enterostomy[J]. Chinese Nursing Research, 2020, 34(17): 3168-3170. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202017037.htm
[15]	李霞, 杨蕊, 陈飞飞. 远程网络延续护理改善慢性心力衰竭患者心功能和生活质量的研究[J]. 中国护理管理, 2021, 21(3): 414-419. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202103022.htm LI X, YANG R, CHEN F F. Improving heart function and quality of life in patients with chronic heart failure[J]. Chinese Nursing Management, 2021, 21(3): 414-419. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202103022.htm
[16]	MCPHERSON T D, WALBLAY K A, ROOP E, et al. Notes from the field: Candida auris and carbapenemase-producing organism prevalence in a pediatric hospital providing long-term transitional care-Chicago, Illinois, 2019[J]. MMWR, 2020, 69(34): 1180-1186.
[17]	贺彩玲, 张佳惠, 南丽萍. 基于微信平台的延续性护理在单髁置换术后病人中的应用[J]. 护理研究, 2020, 34(17): 3179-3181. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202017041.htm HE C L, ZHANG J H, NAN L P. Application of continuity care based on WeChat platform in patients after single condyle replacement[J]. Chinese Nursing Research, 2020, 34(17): 3179-3181. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202017041.htm
[18]	高翠翠, 曾华韫, 钟晓琴, 等. 基于微信小程序的延续性护理对维持性血液透析患者钙磷代谢及饮食依从性的影响[J]. 护理实践与研究, 2020, 17(17): 89-91. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202017035.htm GAO C C, ZENG H Y, ZHONG X Q, et al. Effect of continuation care based on WeChat mini-program on calcium and phosphorus metabolism and dietary compliance in maintenance hemodialysis patients[J]. Nursing Practice and Research, 2020, 17(17): 89-91. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202017035.htm
[19]	杨秋玲, 孙爱莲, 吕卫娜, 等. 互联网+医疗管理模式对妊娠期糖尿病孕妇妊娠结局的影响[J]. 河北医药, 2020, 42(20): 3102-3105. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ202020014.htm YANG Q L, SUN A L, LYU W N, et al. The influence of the Internet + medical management model on pregnancy outcomes in pregnant women with gestational diabetes[J]. Hebei Medical Journal, 2020, 42(20): 3102-3105. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ202020014.htm