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
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- 文章访问数: 107
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- 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

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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)

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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)

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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。

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