社区规范管理的稳定性冠心病患者生活质量研究

杨玲; 杜雪平

doi:10.16766/j.cnki.issn.1674-4152.003253

社区规范管理的稳定性冠心病患者生活质量研究

doi: 10.16766/j.cnki.issn.1674-4152.003253

杨玲^,,
杜雪平

首都医科大学附属复兴医院月坛社区卫生服务中心，北京 100045

基金项目:

首都卫生发展科研专项项目首发2018-3-7023

详细信息

通讯作者:
杨玲，E-mail：yangling_1212@ccmu.edu.cn

中图分类号: R541.4 R197.61
计量
- 文章访问数: 196
- HTML全文浏览量: 112
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2023-02-21
- 网络出版日期: 2024-01-13

Research on the quality of life in patients with stable coronary artery disease under standardized management in community

YANG Ling^,,
DU Xueping

Yuetan Community Health Service Center Fuxing Hospital, Capital Medical University, Beijing 100045, China

摘要

摘要: 目的分析社区规范管理的稳定性冠心病患者不同人口学特征和不同行为特征生活质量的差异，提出针对性改善措施。方法运用目的性抽样的方法选取北京市西城区月坛社区卫生服务中心2021年6月—2022年6月规范管理的75岁以下的稳定性冠心病患者980例，自行设计问卷收集受试者一般资料、合并症、依从性、危险因素控制、运动等信息；采用SF-36健康调查简表对受试者的生活质量进行评分。对比分析不同人口学特征和不同行为特征患者的生活质量。结果社区规范管理的稳定性冠心病患者SF-36量表的躯体健康总测量(PCS)平均分为84.25(75.25, 90.50)分, 心理健康总测量(MCS)平均分为84. 50(76.11, 92.72)分。是否经皮冠状动脉介入治疗的MCS差异有统计学意义(Z=-3.610, P<0.001)；是否吸烟、是否服用钙离子拮抗剂、是否服用抗血小板聚集药物、血压、低密度脂蛋白胆固醇是否达标、近期是否有心绞痛、是否运动、有无运动指导的PCS、MCS差异有统计学意义(均P<0.05)。结论全科医生应通过督促戒烟，规律服用冠心病二级预防用药，控制好血压、血糖、血脂等危险因素，指导运动等措施改善社区规范管理的稳定性冠心病患者的生活质量。
- 稳定性冠心病 /
- 社区规范管理 /
- 生活质量 /
- SF-36健康调查简表
Abstract: Objective To analyze the difference of the quality of life of patients with stable coronary artery disease with different demographic characteristics and different behavior characteristics under standardized management in community, and put forward targeted measures to improve their quality of life. Methods A total of 980 patients under 75 years of age with stable coronary artery disease and standardized management were selected from Yuetan Community Health Service Center in Xicheng District, Beijing from June 2021 to June 2022 by means of purposive sampling. A self-designed questionnaire was used to collect subjects' general data, complications, compliance, risk factor control, exercise and other information. The subjects' quality of life was scored using the MOS item short from health survey (SF-36). To compare and analyze subjects quality of life of different demographic characteristics and behavioral characteristics. Results The average score of SF-36 physical component summary (PCS) of patients with stable coronary artery disease under standardized management in community was 84.25 (75.25, 90.50) points, and the average score of mental component summary (MCS) was 84.50 (76.11, 92.72) points. There was statistical significance in MCS with or without PCI (Z=-3.610, P<0.001). There were statistically significant differences in PCS and MCS of smoking, calcium antagonists, anti-platelet aggregation drugs, regular medication, blood pressure, blood glucose, low density lipoprotein cholesterol (LDL-C) whether reach the standard or not, recent angina pectoris, exercise and with or without exercise instruction (all P<0.05). Conclusion General practitioners should improve the quality of life of patients with stable coronary artery disease by urging them to quit smoking, regularly take secondary preventive drugs for coronary artery disease, control risk factors such as blood pressure, blood sugar, blood lipids, and guiding exercise.
- Stable coronary artery disease /
- Community standard management /
- Quality of life /
- The MOS item short from health survey, SF-36

HTML全文

表 1 980例社区规范管理的稳定性冠心病患者SF-36量表各维度得分(分)

Table 1. Scores of each dimension of SF-36 scale in 980 patients with stable coronary artery disease under standardized management in community (points)

SF-36量表健康维度	最小值	最大值	得分[M(P₂₅, P₇₅)]
子维度
生理机能	0	100.00	90.00(80.00, 95.00)
生理职能	0	100.00	100.00(75.00, 100.00)
躯体疼痛	10.00	100.00	100.00(74.00, 100.00)
总体健康	0	100.00	67.00(52.00, 77.00)
精力	20.00	100.00	80.00(70.00, 90.00)
社会功能	22.22	100.00	88.89(77.78, 100.00)
情感职能	0	100.00	100.00(100.00, 100.00)
精神健康	8.00	100.00	80.00(68.00, 88.00)
综合维度
躯体健康总测量	18.50	100.00	84.25(75.25, 90.50)
心理健康总测量	15.56	100.00	85.50(76.11, 92.72)

下载: 导出CSV

表 2 不同人口学特征稳定性冠心病患者生活质量评分比较[M(P₂₅, P₇₅)，分]

Table 2. Comparison of quality of life scores among patients with stable coronary heart disease with different demographic characteristics[M(P₂₅, P₇₅), points]

项目	例数	PCS	Z值	P值	MCS	Z值	P值
性别			-2.703	0.007		-1.793	0.073
男性	535	85.00(77.25, 91.25)			86.22(76.58, 93.25)
女性	445	83.00(72.75, 90.00)			84.22(75.92, 91.50)
年龄			-2.134	0.033		-0.638	0.524
<65岁	348	82.63(68.56, 90.50)			81.94(71.47, 91.50)
≥65岁	632	80.25(68.00, 87.75)			83.86(73.67，90.75)
冠心病类型为急性心肌梗死			-0.545	0.586		-1.956	0.050
是	81	83.63(65.38，88.88)			81.10(69.83, 89.31)
否	899	81.25(68.50, 88.75)			83.47(72.69, 91.25)
冠心病类型为不稳定性心绞痛			-1.223	0.221		-2.273	0.023
是	576	81.25(69.75, 89.25)			84.44(74.72, 91.86)
否	404	81.25(65.63, 87.75)			81.94(69.42, 89.25)
经皮冠状动脉介入治疗			-1.426	0.154		-3.610	<0.001
是	181	83.00(68.50, 90.00)			87.19(79.86, 93.50)
否	799	80.75(68.00, 88.00)			82.60(71.72, 90.47)
患有高血压			-0.521	0.603		-0.301	0.764
是	792	81.25(67.75, 88.75)			83.74(72.19, 91.00)
否	188	81.25(71.75, 88.75)			82.72(73.86, 91.00)
患有糖尿病			-1.995	0.046		-0.679	0.497
是	453	80.25(65.50, 87.50)			83.33(72.18, 91.00)
否	527	81.75(71.00, 89.19)			83.69(72.75, 90.94)
患有脑梗死			-1.170	0.242		-2.130	0.033
是	114	79.00(65.00, 87.50)			81.67(68.71, 89.28)
否	866	81.50(68.50, 88.75)			83.86(72.92, 91.47)
患有肾功能不全			-2.501	0.012		-0.328	0.743
是	27	77.50(49.86, 85.25)			84.97(72.90, 88.75)
否	953	81.25(68.50, 88.94)			83.33(72.44, 91.19)
患有骨关节病			-4.676	<0.001		-1.316	0.188
是	146	77.50(61.75，85.00)			84.08(68.78, 90.88)
否	834	81.75(69.75, 89.25)			83.33(72.72, 91.00)

下载: 导出CSV

表 3 不同行为特征稳定性冠心病患者生活质量评分比较[M(P₂₅, P₇₅)，分]

Table 3. Comparison of quality of life scores among patients with stable coronary heart disease with different behavioral characteristics[M(P₂₅, P₇₅), points]

项目	例数	PCS	Z值	P值	MCS	Z值	P值
吸烟			-2.697	0.007		-2.270	0.023
是	259	83.50(74.25, 90.50)			84.72(73.94, 93.25)
否	721	80.25(67.69, 88.00)			83.19(72.13, 90.56)
服用β受体阻滞剂			-0.465	0.642		-0.940	0.347
是	476	81.00(67.75, 88.50)			83.17(72.36, 90.47)
否	504	81.25(69.75, 89.00)			84.19(72.67, 91.47)
服用硝酸酯类药			-0.928	0.353		-0.836	0.403
是	301	80.50(67.50, 89.25)			83.17(71.14, 91.47)
否	679	81.50(68.94, 88.75)			83.47(73.14, 91.00)
服用钙离子拮抗剂			-2.270	0.023		-2.700	0.007
是	451	80.00(64.75, 87.50)			82.19(69.42, 90.47)
否	529	82.25(70.50, 90.00)			84.24(75.91, 92.00)
服用抗血小板聚集药			-3.093	0.002		-4.833	<0.001
是	690	82.25(68.75, 90.00)			84.44(73.86, 91.86)
否	290	80.00(66.75, 86.75)			80.47(70.47，89.68)
服用降脂药			-0.954	0.340		-0.637	0.524
是	713	81.50(68.00, 89.00)			83.33(72.56, 91.25)
否	267	80.50(68.38, 87.75)			83.75(72.18, 91.00)
服用ACEI/ARB			-0.463	0.643		-2.102	0.036
是	409	81.75(67.50, 89.25)			85.83(72.67, 92.50)
否	571	80.50(69.25, 88.00)			82.19(72.36, 90.25)
服药依从性			-2.495	0.013		-1.389	0.165
是	913	81.25(68.50, 89.00)			83.44(72.56, 91.00)
否	67	78.50(67.25, 85.00)			83.72(72.04, 89.47)
LDL-C达标			-3.615	<0.001		-2.119	0.034
是	716	82.50(69.75, 89.25)			83.96(73.10, 91.50)
否	264	77.75(64.25, 86.75)			82.17(69.69, 90.00)
血压达标			-4.113	<0.001		-3.742	<0.001
是	908	81.75(69.25, 89.25)			83.97(72.93, 91.50)
否	72	74.50(58.25, 82.63)			78.19(69.36, 84.22)
血糖达标			-3.031	0.002		-1.482	0.138
是	826	82.75(71.00, 90.00)			83.44(72.69, 92.25)
否	154	79.00(64.75, 86.75)			83.44(72.17, 89.75)
近期发作心绞痛			-5.092	<0.001		-2.302	0.021
是	78	68.00(53.75, 81.44)			79.06(64.15, 87.88)
否	901	81.75(70.00, 89.25)			83.69(73.15, 91.25)
运动			-2.874	0.004		-2.762	0.006
是	732	81.75(69.00, 89.25)			84.22(72.55, 91.50)
否	248	78.75(64.75, 86.75)			81.94(72.36, 89.25)
运动指导			-3.977	<0.001		-3.232	0.001
是	396	82.25(71.00, 91.75)			85.10(72.61, 93.06)
否	584	80.25(66.25, 87.50)			82.92(72.42, 89.25)
注：ACEI/ARB为血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂。

下载: 导出CSV

参考文献(26)

[1]	刘玲芳, 黄惠桥. 冠心病病人生活质量评价及其影响因素研究进展[J]. 护理研究, 2018, 32(4): 517-519. LIU L F, HUANG H Q. Research progress on quality of life evaluation for patients with coronary heart disease and its influencing factors[J]. Chinese Nursing Resarch, 2018, 32(4): 517-519.
[2]	胡菁菁. 冠心病患者生活质量现状及影响因素研究-基于Wilson-Cleary生活质量模型[D]. 杭州: 杭州师范大学, 2019. HU J J. Quality of life and its predictors among patients with coronary heart disease: based on the Wilson-Cleary health-related quality of life model[D]. Hangzhou: Hangzhou Normal University, 2019.
[3]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 稳定性冠心病基层诊疗指南(2020年)[J]. 中华全科医师杂志, 2021, 20(3): 265-273. Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Practice, et al. Guideline for primary care of stable coronary artery disease(2020)[J]. Chin J Gen Pract, 2021, 20(3): 265-273.
[4]	邹彩霞, 窦洪珊, 朱晓莉. 老年综合评估对冠心病患者生活质量的作用分析[J]. 中国循证心血管医学杂志, 2020, 12(5): 609-611. ZOU C X, DOU H S, ZHU X L. Analysis of the geriatric comprehensive evaluation of nursing for elderly patients with coronary heart disease quality of life[J]. Chin J Evid Based Cardiovasc Med, 2020, 12(5): 609-611.
[5]	王玲, 陈诗, 陈伟文, 等. 基于SF-36量表的中老年社区居民生活质量现状及影响因素研究[J]. 应用预防医学, 2020, 26(4): 273-278. WANG L, CHEN S, CHEN W W, et al. Quality of life and its influencing factors among community-dwelling middleaged and older residents based on SF-36 scale[J]. Applied Prev Med, 2020, 26(4): 273-278.
[6]	BENJAMIN E J, VIRANI S S, CALLAWAY C W, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association[J]. Circulation, 2018, 137(12): e67-e492.
[7]	KUMAR S, DE LUSIGNAN S, MCGOVERN A, et al. Ischaemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care[J]. BMJ, 2018, 360: k342. DOI: 10.1136/bmj.k342.
[8]	KHAN M S, BUTLER J, GREENE S J. Patient-reported outcomes for heart failure with preserved ejection fraction: conducting quality studies on quality of life[J]. Eur J Heart Fail, 2020, 22(6): 1019-1021. doi: 10.1002/ejhf.1762
[9]	REDDY YNV, RIKHI A, OBOKATA M, et al. Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity[J]. Eur J Heart Fail, 2020, 22(6): 1009-1018. doi: 10.1002/ejhf.1788
[10]	GECAITE-STONCIENE J, BUNEVICIUS A, BURKAUSKAS J, et al. Validation of the multidimensional fatigue inventory with coronary artery disease patients[J]. Int J Environ Res Public Health, 2020, 17(21): 8003. DOI: 10.3390/ijerph17218003.
[11]	ARANTES E C, DESSOTTE C A M, DANTAS R A S, et al. Educational program for coronary artery disease patients: results after one year[J]. Rev Bras Enferm, 2018, 71(6): 2938-2944. doi: 10.1590/0034-7167-2017-0280
[12]	ZHANG W X, ZHANG B Y, ZHANG H Y, et al. Analysis of the influence of network continuous care on the quality of life of patients with coronary artery disease (CAD) after PIC[J]. Biomed Res Int, 2022: 3046554. DOI: 10.1155/2022/3046554.
[13]	HENRY T D, BAIREY MERZ C N, WEI J, et al. Autologous CD34⁺ stem cell therapy increases coronary flow reserve and reduces angina in patients with coronary microvascular dysfunction[J]. Circ Cardiovasc Interv, 2022, 15(2): e010802. DOI: 10.1161/CIRCINTERVENTIONS.121.010802.
[14]	王燚. 某三级综合医院门诊常见冠心病患者生活质量影响因素及健康管理策略分析[D]. 重庆: 中国人民解放军陆军军医大学, 2020. WANG Y. Analysis of influencing factors of quality of life and health management strategies of outpatients with coronary artery disease in a tertiary general hospital[D]. Chongqing: PLA Army Medical University, 2020.
[15]	OZATA UYAR G, BEYAZ COSKUN A, GOKALP G, et al. Association of Mediterranean diet and anthropometric measures with quality of life in coronary artery disease patients[J]. Nutr Hosp, 2019, 36(3): 674-680.
[16]	MUSAYEV S. Evaluation of the quality of life after revascularization and reconstructive operations on mitral valve in patients with coronary heart disease[J]. Georgian Med News, 2022(330): 110-114.
[17]	GIERSZEWSKA K, JAWORSKA I, SKRZYPEK M, et al. Quality of life in patients with coronary artery disease treated with coronary artery bypass grafting and hybrid coronary revascularization[J]. Cardiol J, 2018, 25(5): 621-627. doi: 10.5603/CJ.a2017.0081
[18]	PACARIC S, TURK T, ERIC I, et al. Assessment of the quality of life in patients before and after coronary artery bypass grafting (CABG): a prospective study[J]. Int J Environ Res Public Health, 2020, 17(4): 1417. doi: 10.3390/ijerph17041417
[19]	IBANEZ B, JAMES S, AGEWALL S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2018, 39(2): 119-177.
[20]	刘小伟, 王江挺, 杜常青, 等. 老年冠心病患者二级预防用药依从性及其相关因素分析[J]. 心电与循环, 2020, 39(5): 438-441. LIU X W, WANG J T, DU C Q, et al. The compliance of secondary prevention drug therapy and related factors in elderly patients with coronary heart disease[J]. Journal of Electrocardiology and Circulation, 2020, 39(5): 438-441.
[21]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 冠心病心脏康复基层诊疗指南(2020年)[J]. 中华全科医师杂志, 2021, 20(2): 150-165. Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Practice, et al. Guideline for primary care of cardiac rehabilitation of coronary artery disease (2020)[J]. Chin J Gen Pract, 2021, 20(2): 150-165.
[22]	马建新, 熊小伟, 方玮, 等. 心脏康复综合管理对老年稳定性冠心病患者运动耐量及生活质量的影响[J]. 解放军预防医学杂志, 2020, 38(12): 20-22. MA J X, XIONG X W, FANG W, et al. Effects of cardiac rehabilitation comprehensive management on exercise tolerance and quality of life in elderly patients with stable coronary artery disease[J]. J Prev Med Chin PLA, 2020, 38(12): 20-22.
[23]	WEN Y, ZHANG X, LAN W, et al. Effects of cardiac rehabilitation on cardiac function and quality of life in patients with ischemic nonobstructive coronary artery disease and diabetes mellitus[J]. Biomed Res Int, 2022: 3487107. DOI: 10.1155/2022/3487107.
[24]	HE C J, ZHU C Y, ZHU Y J, et al. Effect of exercise-based cardiac rehabilitation on clinical outcomes in patients with myocardial infarction in the absence of obstructive coronary artery disease (MINOCA)[J]. Int J Cardiol, 2020, 315: 9-14. doi: 10.1016/j.ijcard.2020.05.019
[25]	邵惠弟, 钟小华, 沈爱娟, 等. 叙事护理对老年慢性病患者心理状态及生活质量的影响[J]. 中华全科医学, 2021, 19(9): 1600-1603. doi: 10.16766/j.cnki.issn.1674-4152.002121 SHAO H D, ZHONG X H, SHEN A J, et al. Influence of narrative nursing on mental state and quality of life of elderly patients with chronic diseases[J]. Chinese Journal of General Practice, 2021, 19(9): 1600-1603. doi: 10.16766/j.cnki.issn.1674-4152.002121
[26]	袁雯, 周霄云, 张雅丽. 中医护理技术对冠心病患者心理状况、生活质量及睡眠质量的影响[J]. 中华全科医学, 2020, 18(1): 150-153. doi: 10.16766/j.cnki.issn.1674-4152.001191 YUAN W, ZHOU X Y, ZHANG Y L. Effect of TCM nursing technology on psychological status, quality of life and sleep quality of patients with coronary heart disease[J]. Chinese Journal of General Practice, 2020, 18(1): 150-153. doi: 10.16766/j.cnki.issn.1674-4152.001191