心肌血运重建出院患者随访现况研究

doi:10.3969/j.issn.1007-9572.2016.26.016

摘要/Abstract

摘要： 目的　了解心肌血运重建出院患者的随访现况，并探讨在手术实施医院随访者与非手术实施医院随访者的依从性、安全性及经济性。方法　选取2013年度在首都医科大学附属北京安贞医院出院的心肌血运重建患者1 925例，其中经皮冠状动脉介入术（PCI）1 534例，冠状动脉旁路移植术（CABG）391例。根据患者随访机构不同分为手术实施医院组与非手术实施医院组，手术实施医院组数据来源于本院医院信息系统（HIS），包括门诊及再住院信息；非手术实施医院组数据来源于北京市医保数据，包括门诊与再住院信息。通过随访率、随访次数及人均随访次数指标对不同随访时间、不同随访地点及不同手术方式的人群随访现况进行描述。并记录患者二级预防药物服用率、主要不良心血管事件（MACE）发生率和门诊费用及住院费用。结果　1 925例患者平均随访率为94.27%，随访次数共计41 774次，人均22次。手术实施医院组1 011例（52.52%），平均随访率为94.49%，随访次数共计19 834次，人均20次；非手术实施医院组914例（47.48%），平均随访率为94.04%，随访次数共计21 940次，人均24次。PCI患者随访率为94.50%，随访次数共计32 984次，人均22次；CABG患者平均随访率为93.39%，随访次数共计8 790次，人均23次。患者阿司匹林服用率为71.90%（1 384/1 925），氯吡格雷服用率（仅为PCI患者的服用率）为86.11%（1 321/1 534），他汀类药物服用率为77.40%（1 490/1 925），β-受体阻滞剂服用率为60.16%（1 158/1 925），血管紧张素转化酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARBs）服用率为43.43%（836/1 925），双联抗血小板药物服用率（指同时服用阿司匹林和氯吡格雷，仅为PCI患者的服用率）为67.34%（1 033/1 534）。手术实施医院组和非手术实施医院组他汀类药物、ACEI/ARBs服用率比较，差异均无统计学意义（P>0.05）；手术实施医院组氯吡格雷服用率低于非手术实施医院组，阿司匹林、β-受体阻滞剂、双联抗血小板药物服用率均高于非手术实施医院组（P0.050）。结论　心肌血运重建出院患者平均随访率为94.27%，人均22次/年。52.52%出院患者继续于手术实施医院进行随访，规范服用二级预防药物比例总体较好，但β-受体阻滞剂与ACEI/ARBs的依从性有待进一步提升，MACE发生率为7.74%。非手术实施医院需进一步强化随访知识，提升其药物治疗的依从性及安全性，分流随访人群，使医疗资源更合理利用。

关键词: 心肌血管重建术, 随访研究, 现况研究

Abstract: Objective　To understand the follow-up situations of myocardial revascularization patients after discharge and discuss the compliance，safety and economic efficiency.Methods　1 925 cases of myocardial revascularization patients discharged from Beijing Anzhen Hospital，Capital Medical University in 2013 were selected，including 1 534 cases of percutaneous coronary intervention（PCI）and 391 cases of coronary artery bypass grafting（CABG）.According to follow-up institutions，patients were divided into implementation of operation hospital group and non-implementation of operation hospital group.The data of implementation of operation hospital group were collected from the HIS of this hospital，including outpatient and re-hospitalization information.The data of non-implementation of operation hospital group were collected from the data of Beijing medical insurance，including outpatient and re-hospitalization information.The current situations of follow-up of populations at different follow-up times，sites and operation method were described through indexes of follow-up rate，follow-up frequency and average follow-up frequency.Secondary prevention drug taking rate，incidence rate of major adverse cardiac events（MACE），outpatient fees and hospitalization expenses of patients were recorded.Results　The average follow-up rate of 1 925 cases of patients was 94.27%.The frequency of follow-up totaled 41 774 times，with an average of 22 times.The implementation of operation hospital group had 1 011 cases（52.52%）with an average follow-up rate of 94.49%.The frequency of follow-up totaled 19 834 times，with an average of 20 times.The non-implementation of operation hospital group had 914 cases（47.48%） with an average follow-up rate of 94.04%.The frequency of follow-up totaled 21 940 times of follow-up，with an average of 24 times.The follow-up rate of PCI patients was 94.50% and the frequency of follow-up totaled 32 984 times，with an average of 22 times.The follow-up rate of CABG patients was 93.39% and the frequency of follow-up totaled 8 790 times，with an average of 23 times.The taking rate of aspirin was 71.90%（1 384/1 925）.The taking rate of clopidogrel（only the taking rate of PCI patients） was 86.11%（1 321/1 534）.The taking rate of statins was 77.40%（1 490/1 925）.The taking rate of β-receptor blocker was 60.16%（1 158/1 925）.The taking rate of ACEI/ARBs was 43.43%（836/1 925）.The taking rate of dual anti-platelet（which meant to take aspirin and clopidogrel at the same time，only the taking rate of PCI patients）was 67.34%（1 033/1 534）.The implementation of operation hospital group and non-implementation of operation hospital group were compared in the taking rates of statins and ACEI/ARBs，the differences had no statistical significance（P>0.05）.The taking rate of clopidogrel in implementation of operation hospital group was lower than that in non-implementation of operation hospital group and taking rates of aspirin，β-receptor blocker and dual anti-platelet in implementation of operation hospital group were higher than those in non-implementation of operation hospital group（P<0.05）.149 cases of patients appeared MACE during the follow-up period，with the incidence rate of 7.74%.The incidence rate of MACE in implementation of operation hospital group was 7.22%（73/1 011）and the incidence rate of MACE in non-implementation of operation hospital group was 8.32%（76/914）.The occurrence rates of primary endpoint and secondary endpoint were compared and the difference had no statistical significance（χ2=0.429，P=0.513；χ2=0.366，P=0.545）.The average outpatient fee was（10 166±3 198） yuan and the hospitalization expenses per capita was 11 665（6 862,35 185）yuan.The average outpatient fee of implementation of operation hospital group was higher than that of non-implementation of operation hospital group and the difference had statistical significance（t=9.428，P<0.001）.The hospitalization expenses of implementation of operation hospital group and non-implementation of operation hospital group were compared and the difference had no statistical significance（z=-0.536，P>0.050）.Conclusion　The average follow-up rate of myocardial revascularization patients after discharge is 94.27%，with an average of 22 times/year.52.52% of the discharged patients were continuously followed up in the implementation of operation hospital，with better total ratio of normatively taking secondary prevention drugs，but the compliance of ACEI/ARBs drugs and β-receptor blocker needed to be improved further，with the incidence rate of MACE of 7.74%.Non-implementation of operation hospital needs to further strengthen follow-up knowledge，improve the compliance and safety of drug treatment，decentralize follow-up population so as to make useful utilization of medical resources.

Key words: Myocardial revascularization, Follow-up studies, Cross-sectional studies

石越, 郑铁, 赵铁夫, 闫振娴, 张乐辉. 心肌血运重建出院患者随访现况研究[J]. 中国全科医学, 2016, 19(26): 3210-3214.

SHI Yue, ZHENG Tie, ZHAO Tie-fu, YAN Zhen-xian, ZHANG Le-hui. Cross-sectional Study on the Follow-up of Myocardial Revascularization Patients after Discharge[J]. Chinese General Practice, 2016, 19(26): 3210-3214.

参考文献

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