ABSTRACT
Objective To explore the influencing factors of readmission in coronary heart disease patients with heart failure by constructing a multilevel Cox regression model. Methods A total of 1 433 coronary heart disease patients with heart failure were consecutively enrolled, from two hospitals in Shanxi Province from January, 2014 to December, 2017. Patients’ medical records (including baseline data, examination and treatment) were recorded and patients were followed up. The median follow-up period was 23 months. Univariate Cox regression analysis and mutivariate Cox regression analysis were used to screen the independent variables. Two-level Cox regression model was used to analyze the influencing factors. Results Rehospitalization occurred in 436(30.4%) cases. Two-level Cox regression model showed that advanced age(HR=1.010, 95% CI:1.001-1.019, P=0.032), male(HR=1.234, 95% CI: 1.009-1.509, P=0.040), physical labor(HR=1.458, 95% CI: 1.036-2.050, P=0.030),urban medical insurance (HR=1.513, 95% CI: 1.120-2.043, P=0.007), and prolonged QRS interval (HR=1.004, 95% CI:1.001-1.008, P=0.018) were independent risk factors for readmission coronary heart disease patients with heart failure. High urine specific gravity(HR=0.000, 95% CI:0.000-0.059, P=0.021) was a protective factor. Conclusions The age, gender, occupation, urban medical insurance, QRS intervall, and urine specific gravity are influencing factors of readmission in coronary heart disease patients with heart failure. Strengthening clinical nursing and monitoring and perfecting social security system can reduce the occurrence of patients’ rehospitalization.
ABSTRACT
· AIM:To investigate the clinical efficacy of phacoemulsification (Phaco) and intraocular lens (IOL) implantation combined with goniosychialysis in the treatment of acute primary angle-closure glaucoma (APACG) with cataract.· METHODS:In this prospective randomized clinical trial,60 eyes of 60 patients with APACG and coexisting cataract were randomized to the control group (30 patients,30 eyes) or the study group (30 patients,30 eyes) and completed the trial.All the two groups were treated with phacoemulsification and intraocular lens implantation,and the control group (30 patients,30 eyes) was combined with trabeculectomy,while the study group (30 patients,30 eyes) was treated with the goniosychialysis.All patients were followed up for 2mo.The preoperative and postoperative best corrected visual acuity (BCVA),intraocular pressure (IOP),anterior chamber depth (ACD),anterior chamber angle(ACA) and complications were compared.· RESULTS:There were no statistically significant differences between the 2 groups in BCVA,IOP,ACD,ACA before surgery(P＞ 0.05).The postoperative BCVA,lOP,ACD and re-opening anterior chamber angle (ACA) in two groups were all improved,and the differences had statistical significance (P ＜ 0.001).BCVA,ACD,re-opening ACA of research group were significantly better than those of the control group (P＜0.05).The decreased IOP of the study group were more than the control group and the complications of the control group were more than the study group,but there was no statistical difference in the postoperative IOP and complications between two groups (P＞0.05).· CONCLUSION:The phacoemulsification and IOL implantation combined with goniosychialysis can improve the vision of patients,decrease IOP,increase ACD,and re-opening anterior chamber angle (ACA) in patients with APACG combined with cataract.It has a positive clinical effect.