Application Of Internet+continuous Care In Patients After PCI Based On The Dual-heart Medical Model

Objectives1.To explored and analyze the current situation of negative emotions,including anxiety and depression,and the ability of self-management behavior in patients with coronary heart disease after percutaneous coronary artery intervention(PCI);2.with the comparison of nursing by the Internet+continuous care or the routine continuous nursing,to explore a more feasible and effective nursing education strategy to improve physical and psychological health of patients,improve the quality of life,and reduce the recurrence of cardiovascular events.MethodsThere are two parts in this study.1.Cross-sectional survey:300 patients with coronary heart disease treated by PCI in the First Affiliated Hospital of Shantou University Medical College were included in the study.Questionnaire survey was used for data collection to analyze the current situation of negative emotions(including anxiety and depression)of patients with coronary heart disease after PCI.Furthermore,the influencing factors of self-management behavior of patients with coronary heart disease after PCI and the correlation between self-management behavior and negative emotions were analyzed by multiple linear regression.2.Randomized controlled trial:79 patients with coronary heart disease who underwent emergency PCI for the first time in Chest Pain Center of First Affiliated Hospital of Shantou University Medical College were randomly divided into two groups,including 40 patients in experimental groups and 39 patients in control group.Patients in the experimental group were treated with internet+continuous care based on dual-heart medical model.On the other side,patients in control group were only given with routine nursing care after operation.During the follow-up visit,regularly assessments were done to evaluate the psychological state and physical symptoms of patients,which were further summarized and analyzed to provide individuality targeted intervention and health guidance for the patients.Two groups were followed up one week,one month,three months and six months after discharge.The intervention effects were evaluated by comparing the quality of life,medication compliance,psychological state,improvement of cardiac function grading and the incidence of cardiovascular adverse events one year after discharge of the two groups.Results1.Cross-sectional investigation:The actual score of self-management behavior of 300 patients was 67.85±6.46,and the score index was 50.26%.The incidence rates of anxiety and depression were 34.33%and 41.00%.The state of anxiety and depression was negatively correlated with self-management behavior,and the correlation coefficient r was-0.631 and-0.208,respectively.Multivariate regression analysis showed that Average monthly household income,complications,education degree,smoking and re-admission were the related factors affecting the self-management level of patients after PCI(P<0.05).2.Randomized controlled trial:There was no significant difference between the two groups in the basic data including sex,age,education degree,average monthly household income,medical insurance,residence,number of stents,complications,smoking and drinking(p>0.05).Before intervention,there was no significant difference in quality of life,anxiety,depression,medication compliance,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),total cholesterol(TC),triglyceride(TG),high-density lipoproteincholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)between the two groups(p>0.05).The the patients of the two groups are comparable.Six months after discharge,the scores of SAS/SDS in the experimental group were significantly lower than those in the control group(P<0.001).The scores of SF-36 scale in the experimental group were higher than that in the control group except the physiological function dimension,and the difference was statistically significant(P<0.05).The medication compliance of the experimental group was significantly better than that of the control group 3 months and 6 months after discharge(P<0.05).The improvements of heart rate,systolic blood pressure and cardiac function grade in the experimental group were better than that in the control group,and the difference between the two groups was statistically significant(P<0.05).However,there was no significant difference in the improvement of diastolic blood pressure and blood lipid level between the two groups(P>0.05).The incidence of cardiovascular adverse events was lower in the experimental group while no significant difference was observed(P>0.05).Conclusion1.The scores of self-management behavior of patients with coronary heart disease are at a low level and the incidence rates of anxiety and depression were 34.33%and 41.00%.Education degree,average monthly household income,complications,smoking and re-admission are the possible factors affecting the ability of self-behavior management of patients after PCI.2.Internet+continuous care based on dual-heart medical model can effectively improve the quality of life,treatment compliance and cardiac function of patients after PCI,and further relieving negative emotions,ameliorating physical and psychological health of patients,which is deserves to be applied widely in clinical work.