CAJ | 학술논문

目的：探索冠心病疾病管理计划的可行性和对冠心病二级预防的影响。方法将397例冠心病患者随机分为两组,疾病管理组203例,对照组194例。疾病管理组干预包括6次健康教育、电话随访、专科门诊等。对照组无上述干预,自行去专科门诊治疗。观察12月后两组患者的结果。结果两组患者临床特征,差异无统计学意义(P>0.05)。随访12月,对照组吸烟率29.9%,体重指数(BMI)(23.7±1.34)kg/m2,有氧运动比例31.9%。疾病管理组吸烟率3.4%,BM(I22.7±1.19)kg/m2,有氧运动比例63.1%。两组比较差异有统计学意义(P<0.01)。对照组血压达标率77.8%,糖化血红蛋白(HbA1C)达标率66.5%,低密度脂蛋白(LDL)水平下降(-18.4±23.5)%。疾病管理组血压达标率88.2%), HbA1C达标率85.7%,和LDL水平下降(-24.1±20.4)%。两组比较差异有统计学意义(P<0.01)。除血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARBs)外,疾病管理组服药依从性显著优于对照组(P<0.05)。疾病管理组总心血管病事件率20.2%显著低于对照组40.7%,差异有统计学意义(P<0.01)。结论冠心病疾病管理计划可显著改善冠心病患者的生活方式、提高血压、HbA1C、LDL达标率,增加服药依从性,显著降低远期心血管病事件率。
목적：탐색관심병질병관리계화적가행성화대관심병이급예방적영향。방법장397례관심병환자수궤분위량조,질병관리조203례,대조조194례。질병관리조간예포괄6차건강교육、전화수방、전과문진등。대조조무상술간예,자행거전과문진치료。관찰12월후량조환자적결과。결과량조환자림상특정,차이무통계학의의(P>0.05)。수방12월,대조조흡연솔29.9%,체중지수(BMI)(23.7±1.34)kg/m2,유양운동비례31.9%。질병관리조흡연솔3.4%,BM(I22.7±1.19)kg/m2,유양운동비례63.1%。량조비교차이유통계학의의(P<0.01)。대조조혈압체표솔77.8%,당화혈홍단백(HbA1C)체표솔66.5%,저밀도지단백(LDL)수평하강(-18.4±23.5)%。질병관리조혈압체표솔88.2%), HbA1C체표솔85.7%,화LDL수평하강(-24.1±20.4)%。량조비교차이유통계학의의(P<0.01)。제혈관긴장소전환매억제제/혈관긴장소수체길항제(ACEI/ARBs)외,질병관리조복약의종성현저우우대조조(P<0.05)。질병관리조총심혈관병사건솔20.2%현저저우대조조40.7%,차이유통계학의의(P<0.01)。결론관심병질병관리계화가현저개선관심병환자적생활방식、제고혈압、HbA1C、LDL체표솔,증가복약의종성,현저강저원기심혈관병사건솔。
Objective To investigate the feasibility and effects of disease management programmes on secondary prevention in pa-tients with coronary heart disease (CHD). Methods 397 patients with CHD were randomly divided into two groups, disease man-agement group(n=203) and control group(n=194). The intervention of disease management group included 6 times of healthy educa-tion, telephone follow-up, specialist out-patient and so on, while the control group had no the above intervention, they went to the specialist out-patient for treatment by themselves. The conditions of the two groups 12 months later were observed. Results The difference in clinical characteristics between the 2 groups was not statistically significant (P>0.05). The results of 12-month fol-low-up showed that, between the control group and the disease management group, there were statistically significant differences in smoking rate (29.9%vs. 3.4%, P<0.01), the body mass index(BMI) (23.7±1.34kg/m2 vs. 22.7±1.19kg/m2, P<0.01) and aerobic exer-cise rate (31.9%vs. 63.1%, P<0.01). Between the control group and the disease management group, there were statistically signif-icant differences in the standard-reaching rate of blood pressure (77.8% vs. 88.2%, P<0.01), standard-reaching rate of glycosylat-ed hemoglobin(HbA1C) (66.5% vs. 85.7%, P<0.01), and the reduction of low density lipoprotein(LDL) (-18.4±23.5% vs. -24.1±20.4%, P<0.01). The medication compliance was higher in the disease management group than in the control group, except for A-CEI/ARBs (P<0.05). The total cardiovascular event rate of the disease management group was 20.2%, obviously lower than 40.7%of the control group, the difference was statistically significant (P<0.01). Conclusion Disease management programmes can improve the lifestyle of patients with CHD, enhance the standard-reaching rate of blood pressure and HbA1C and LDL, increase the medi-cation compliance and reduce the long-term cardiovascular event rate significantly.