Study On Intermediate Care For Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention

ObjectiveTo investigate the intermediate care demand situation of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI), key technologies of intermediate care were elucidated; To clarify admission and discharge criteria of intermediate care for patients with AMI and the intermediate care model of them;To evaluate the effect of intermediate care on cardiovascular risk factors controlling,exercise tolerance, living quality, mental state and self-care ability.Methods1. Questionnaire survey: Self-designed questionnaire was used to investigate intermediate care demands of 139 patients with AMI after PCI in a hospital; Influencing factors of their living quality were analyzed; Key technologies of intermediate care of patients with AMI after PCI were elucidated.2. Expert consultation: 15 cardiology medical experts and nursing experts were selected, to determine admission and discharge criteria of intermediate care for patients with AMI after PCI and the intermediate care model of them.3. Evaluation of intervention effectiveness: 94 patients with AMI after PCI were randomly divided into observation group and control group. Patients in the observation group were treated by home-based intermediate care based on a network platform, patients in the control group were treated by routine clinical follow-up. After 4 weeks, the risk factors of cardiovascular disease, exercise tolerance, living quality, mental state and self-care ability of patients in two groups were analyzed.Results1. China questionnaire of quality of life in patients with cardiovascular diseases(CQQC) scores of patients with AMI after PCI was 73.45±15.37, lower than normal people,56.12% of them with poor living quality.2. 37.41% of patients with AMI after PCI had anxiety, 41.72% of patients with AMI after PCI had depression, and the incidence of anxiety and depression increased with age.3. Up to 100% of patients with AMI after PCI had demands of health education and rehabilitation guidance, more than 80% of them had demands of dietary counseling and medication guidance; But 63.31% of patients with AMI after PCI had never heard of intermediate care, there had significantly differences in the perception of intennediate care among patients of different ages.4. The factors influencing living quality were analyzed by multivariate logstic regression analysis; factors related to living quality of patients with AMI after PCI were (in terms of relevance): waist-hip ratio, postoperative medication, exercise intensity, exercise time, depression and anxiety. So the key techniques of intermediate care should include:rehabilitation exercise, dietary counseling, drug administration and psychological care.5. According to three rounds of expert consultation, 11 primary indicators and 34 secondary indicators were cleared in admission and discharge criteria of intermediate care for patients with AMI after PCI, and the intermediate care model of patients with AMI after PCI were established.6. According to the needs and key technologies of patients with intermediate care, an intermediate care service system for patients with AMI after PCI was established.According to admission and discharge criteria and mode of intermediate care, the intermediate care was provided to patients with AMI after PC.I. The results showed that,after 4 weeks of intervention, self-care ability, athletic endura, living quality, anxiety and depression scores of patients in observation group were significantly better than control group (P<0.05).Conclusions1. Living quality of patients with AMI after PCI were lower than normal people, some of them with anxiety and (or) depression, although most patients have high demands for intermediate care, but their awareness of intermediate care are generally low.2. Through clarify admission and discharge criteria and mode of intermediate care for patients with AMI after PCI, to establish an AMI intermediate care service system, it can improve self-care ability, athletic endurance, living quality of patients effectively, reduce anxiety and depression of them.