摘要
目的了解冠心病患者接受经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）术后危险因素的控制情况,分析其与循证医学指南的差距.方法选择药物洗脱支架对血管重建影响的研究DESIRE单中心注册中出院后随访时间在30 d以上的所有患者,分析其入院时与随访时吸烟、体重、血压、血糖、血脂等危险因素指标的变化.结果在DESIRE注册的3763例患者中,共有3017例患者接受30 d以上的随访（随访率80.2%）,中位数随访时间为670（35～1930） d.入院时与随访时的吸烟率分别为43.5%（937/2156）和9.5%（276/2915,P《0.000 1）,入院时有吸烟的患者随访时的吸烟率仍高达18.5%（170/917）,入院时无吸烟的患者随访时的吸烟率为6.1%（71/1168）.24.3%（264/1087）的超重或肥胖患者随访时的体重高于入院时的体重.48.3%（143/296）的糖尿病患者随访时的平均空腹血糖水平高于入院时的血糖水平.在合并高血压的患者中,有33.1%（469/1419）和31.9%（453/1419）的患者在随访中收缩压与舒张压高于入院时的水平.与入院时相比,随访中有36.4%（111/184）的患者高密度脂蛋白胆固醇降低,54.1%（98/181）和56.8%（121/213）的患者低密度脂蛋白胆固醇与甘油三酯升高.结论冠心病患者血管重建术后危险因素控制还远不理想.应尽快加强冠心病血管重建术后的二级预防干预与宣传教育,努力缩小循证指南与临床实践的差距.
Objective To elucidate the profile of risk factors modification after percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG） in patients with coronary artery disease in order to scale the gap between real world practice and evidence-based guidelines. Methods 3767 patients with at least 30 days＇ followed-up after discharge in the single-center DESIRE （ Drug-Eluting Stent Impact on REvascularization）registry were enrolled to compare in-hospital and follow-up data including smoking, body weight, blood pressure, fasting blood sugar and lipid levels. Results Of the 3763 patients, 3017 （80.2%） were successfully followed up for at least one month with a median of 670 （35 - 1930） days. During follow-up, 18. 5% （170/917） of the in-hospital current smokers continued smoking, whereas 6. 1% （71/1168） of the non-current smokers during hospitalization became cigarette addict despite a marked reduction in the general rate of current smoking （43. 5% vs 9.5%, P 〈 0. 0001 ）. At follow-up, 24.3% （264/1087） of the overweight or obese patients experienced weight gain after revascularization. In patients with diabetes mellitus, 48. 3% （ 143/296 ） had higher follow-up levels of average fasting blood sugar. In patients complicated with hypertension, 33.1% （469/1419） and 31.9% （453/1419） had higher average systolic or diastolic pressures than in-hospital measurements. During follow-up, 36. 4% （111/184） had lower levels of serum high-density lipoprotein cholesterol （HDL-C）, whereas 54. 1% （98/181） and 56. 8% （121/213） patients had higher levels of serum low-density lipoprotein cholesterol （LDL-C） and triglycerlin （TG）. Conclusion Risk factors modification after coronary revascularization is far beyond optimal, with a high rate of continued smoking and poor control of body weight, blood sugar, blood pressure and serum lipids. Prompt and effective measures should be taken to enhance the secondary prevention and patient education to minimize the gap between clinical practice and evidence-based guidelines.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第16期1097-1101,共5页
National Medical Journal of China
基金
国家重点基础研究发展规划资金资助项目(2003CB517103)
