ABSTRACT
Objective@#To investigate the effect of early multi-dimensional cardiac rehabilitation (CR) nursing mode on patients after percutaneous coronary intervention (PCI).@*Methods@#From August 2017 to July 2018, 100 patients with coronary heart disease (CHD) underwent PCI in the Department of Cardiology, the Third Affiliated Hospital of Sun Yat-sen University were selected as subjects. According to the random number table, the patients were divided into control group and observation group, 50 in each group. The control group received routine CR nursing intervention, and the observation group was given early multi-dimensional CR nursing mode for intervention. All patients were followed up for 6 months. The incidence of major cardiovascular adverse events (MACE) was observed 1 month and 6 months of follow-up. Patients with somatization were evaluated on the 2nd day after PCI and in the first month of follow-up using the Somatic Self-rating Scale (SSS). In the first month and the 6th month of follow-up, patient compliance was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8).@*Results@#During the study period, 3 patients were detached from each group, and there were 47 patients in both groups who completed the study. The incidence of MACE in the control group in 1 month and 6 months was 8.51% (4/47) and 4.26% (2/47), respectively. The incidence of MACE in the observation group was 10.64% (5/47) and 4.26%, (2/47) respectively. There was no significant difference in the incidence of MACE between the two groups (χ2 value was 0.123, 0.000, P>0.05). In the first month of follow-up, the SSS scores of the control group (34.32±6.59) and the observation group (31.04±7.04) were lower than those of the second day after surgery (37.21±6.19, 37.43±7.29), and the difference was statistically significant (t value was 4.633, 2.660, P<0.05). The SSS scores of the observation group were lower than those of the control group, and the difference was statistically significant (t value was 2.330, P<0.05). In the first month of follow-up, there was no significant difference in MMAS-8 score between the two groups (P>0.05). In the 6th month of follow-up, the MMAS-8 score (5.72±0.62) in the control group was lower than the first month of follow-up (6.93±0.54), and the difference was statistically significant (t value was 10.028, P<0.05). The MMAS-8 score of the control group was lower than that of the observation group (6.89±0.58), and the difference was statistically significant (t value was 9.490, P<0.05). There was no significant difference in MMAS-8 score between the observation group in the first month of follow-up and the sixth month of follow-up (P>0.05).@*Conclusion@#Early multi-dimensional CR nursing mode has a limited effect on improving the incidence of MACE in patients after PCI, but it can effectively reduce the somatization symptoms of patients and maintain good medication compliance.
ABSTRACT
Objective By analyzing the pancreas islet function characteristics of initial diagnosed type 2 diabetes patients to provide guidance of selecting hypoglycemic drugs to lower the risk occurrence of main cardiovascular adverse event(MACE)in patients with coronary arterial atherosclerotic cardiac disease (coronary disease) combined with diabetes mellitus. Methods The clinical data of 769 initial diagnosed type 2 diabetic patients admitted to Tianjin Hongqiao Hospital from January 2013 to July 2018 were retrospectively analyzed. The patients were divided into a synchronous group (542 patients) and a non-synchronous group (227 patients) according to whether the insulin and C-peptide secretion peak times were synchronized or not. The pancreas islet function characteristics of the two groups were analyzed, the differences in the levels of total cholesterol (TC), triacylglycero(TG), glycosylated hemoglobin (HbA1c),oral glucose tolerance test (OGTT), serum insulin release (INS), C-peptide detection index, peak times of insulin and C-peptide, insulin resistance index of steady state model (HOMA-IR), steady-state insulin secretion index (HOMA-β) , and quantitative insulin sensitivity test index (QUICKI) were compared between the two groups; Logistic binary regression analysis was used to screen out the risk factors that could be related to the impact of whether the peak value times of insulin and C peptide being synchronous or not in initial diagnosed type 2 diabetic patients. Results The TC in the synchronous group was significantly higher than that in the non-synchronous group (mmol/L: 4.96±1.20 vs. 4.78±1.06), and the HbA1c was obviously lower than that in non-synchronous group (0.077 5±0.016 6 vs. 0.082 7±0.018 6), the differences being statistically significant (all P<0.05). The blood glucose, insulin levels of the two groups gradually increased with time and peaked at 120 minutes, and then went down, and the blood glucose level of the synchronous group was significantly lower than that of the non-synchronous group (mmol/L:15.52±3.39 vs. 16.18±3.97), while the levels of insulin in the synchronous group were significantly higher than those in the non-synchronous group (mU/L: 92.19±78.34 vs. 55.99±49.86, both P<0.05). After 120 minutes, the level of C-peptide in synchronous group was significantly higher than that in non-synchronous group (μg/L: 2.34±0.52 vs. 2.16±0.59), and lasted to 180 minutes (μg/L: 9.96±4.71 vs. 8.99±4.33). The peak time of insulin in the synchronous group was significantly delayed than that in non-synchronized group (minutes: 125.54±28.02 vs. 93.30±40.91), but the C-peptide secretion peak time was earlier (minutes: 125.54±28.07 vs. 145.11±32.61), the differences being statistically significant (all P<0.05). There were no significant differences in HOMA-IR, QUICKI between the two groups [HOMA-IR:(4.31±3.35)% vs. (4.15±3.46)%, QUICKI: 0.32±0.04 vs. 0.33±0.05, both P>0.05], and the HOMA-β of synchronous group was significantly higher than that in the non-synchronous group [(88.64±67.53)% vs. (76.59±69.41)%, P<0.05], ISI in synchronous group was significantly lower than that in non-synchronous group (3.98±0.66 vs. 4.14±0.74, P<0.05). Logistic regression analysis showed that the factors of affecting the synchronization of insulin and C-peptide release were insulin peak time and C-peptide peak time [insulin peak time: odds ratio (OR) = 1.077, 95% confidence interval (95% CI)=1.066-1.088; peak time of C peptide: OR=0.928, 95%CI=0.918-0.938]. Conclusion The degree of insulin resistance in synchronous group is higher than that in non-synchronous group; and the secretion function of pancreas islet beta cells in non-synchronous group is lower than that in synchronous group; the more stronger insulin resistance is, the more synchronous the release curve of insulin and C-peptide is.