邓雯予 邹晓鸿 王海琴

摘 要 目的：了解医联体制度下社区PCI术后冠心病患者二级预防药物治疗依从性及危险因素控制情况。方法：选取社区卫生服务中心服务范围内签约了“1+1+1”服务的108名PCI术后患者，年龄38～89岁，平均年龄（67.96±9.31）岁。其中男性76例，占70.37%，女性32例，占29.63%。评估患者冠心病二级预防相关情况。结果：医联体体制下PCI术后患者中药物依从性顺序为阿司匹林/西洛他唑96.30%，氯吡格雷82.40%，他汀类药物75.93%，β受体阻滞剂66.67%、ACEI/ARB 62.96%；患者血压比术前有所下降，差异有统计学意义（P<0.05）；患者目前饮酒和吸烟的比例低于术前，差异均有统计学意义（P<0.05）。结论：在医联体框架及“1+1+1”签约服务模式下，社区PCI术后患者冠心病二级预防药物治疗依从性高，患者术后血压和生活方式改变方面有所改善。

关键词 冠心病；医联体；PCI术后；二级预防

中图分类号：R541.4 文献标志码：A 文章编号：1006-1533（2018）12-0051-03

Follow-up analysis of secondary prevention of coronary heart disease of postoperative patients with PCI in a community under the medical conjoined system

DENG Wenyu， ZOU Xiaohong， WANG Haiqin

（General Medical Department of Lingyun Community Health Service Center of Xuhui District， Shanghai 200237， China）

ABSTRACT Objective： To understand the compliance of secondary prevention drug treatment and the control of risk factors in patients with coronary heart disease after PCI under the medical conjoined system. Methods： A total of 108 postoperative PCI patients who had contracted for “1+1+1” service within the scope of the community health service center were selected， and the age was 38～89 years old， with an average age of （67.96±9.31） years. Of these， 76 were males， accounting for 70.37%， and 32 were females， accounting for 29.63%. The secondary prevention of coronary heart disease was evaluated. Results： The order of drug compliance in the postoperative patients with PCI under the medical conjoined system was 96.30% for aspirin/cilostazol， 82.40% for clopidogrel， 75.93% for statins， 66.67% for β-blockers and 62.97% for ACEI/ARB； the blood pressure of patients was lower than before surgery， and the difference was statistically significant（P<0.05）； the proportion of alcohol drinking and smoking was lower than that before operation， and the difference was statistically significant（P<0.05）. Conclusion： Under the medical conjoined framework and the “1+1+1” contracted service mode， postoperative patients with PCI in the community have a high level of adherence to secondary prevention medications for coronary heart disease and the patients postoperative blood pressure and lifestyle changes have been improved.

KEY WORDS coronary heart disease； medical conjoined system； after PCI operation； secondary prevention

冠狀动脉疾病（Coronary artery disease，CAD）是目前危害人类健康的主要疾病之一。随着社会经济的发展，人们生活方式发生了巨大的变化；尤其是人口老龄化进程的加速，使得心血管病危险因素有升高趋势，导致了近十余年来冠心病死亡率呈上升态势[1]。经皮冠状动脉介入治疗（Percutaneous Coronary Intervention，PCI）作为目前治疗急性心肌梗死的有效手段已得到广泛应用。尽管PCI可以使血管再通、改善心肌缺血、有效缓解症状，但不能阻止冠状动脉粥样硬化的进程，术后仍然需要通过规范化的冠心病二级预防策略来减缓动脉粥样硬化的进程，改善预后状况[2]。医疗联合体（下简称医联体）是指在一定区域内，以一家综合实力较强的三级医院为核心，联合区域内的二级医院、社区卫生服务中心等医疗机构组建成责任与利益共享的联合体。本文旨在分析在医联体制度下，PCI术后患者的冠心病二级预防用药依从性及危险因素控制情况。……