摘要
研究背景：
冠心病是严重危害人类健康的常见疾病,一直雄踞世界的主要死亡原因前列。我国近年来的发病呈逐年增长趋势。冠心病也给社会和家庭带来了沉重的医疗费用负担,冠心病的预防和控制,一直是卫生管理领域一个重要的课题。
冠心病二级预防是冠心病防治工作的基本策略之一。具体措施可归结为二个方面：优化的药物治疗和认真改善生活方式(戒烟、健康膳食、适当体力劳动、控制体重、调节血脂、控制血压)。优化药物包括使用阿司匹林、β-受体阻滞剂、血脂调节药(主要是他汀类)和ACEIs/ARB等。然而相当多的冠心病患者二级预防药物的依从性并不乐观,从而降低了药物治疗的效能致使预后不佳。
中医学对于冠心病的认识有着系统的理论,长期的临床实践证实了其对冠心病治疗的巨大优势。中医的“治未病”思想,如“未病先防、既病防变、病后防复”,对冠心病的防治有着极其重要的影响。
对慢性非传染性疾病进行健康管理是公认的有效措施,但目前国内冠心病中西医结合的类似健康管理平台明显不足。
研究目的：
通过调研,完成冠心病PCI术后健康管理系统的需求分析报告,结合现代计算机信息技术,开发一套具有中医特色的,集预防、诊疗、随访、宣教于一体的,系统化、智能化、网络化的冠心病PCI术后健康管理系统,以此为平台,实现对冠心病PCI术后患者全面、连续、主动、积极的健康管理,以期加强冠心病PCI术后患者自我管理能力、控制危险因素、提高冠心病PCI术后二级预防药物使用的依从性,以促进健康,延缓疾病进程,减少并发症,降低伤残率,延长寿命,提高生活质量；同时通过本研究积累的数据库资料的统计分析,为探讨冠心病PCI术后患者的中、西医临床特征,丰富中、西医理论内涵提供依据；为临床选择有效、经济、合理的防治措施决策提供参考依据,为该领域的临床及社区医疗卫生工作提供有意义的参考及研究思路。
研究方案：
采用理论研究和验证研究相结合的方式进行,本研究共3个部分：
首先对冠心病PCI术后健康管理相关的理论的研究。对冠心病及PCI手术治疗、术后二级预防及中西医健康管理理论进行文献研究,并对现阶段的各种健康管理体系进行探讨。
第二部分以专家调研、讨论会等形式,完成冠心病PCI术后健康管理系统的需求分析调研,给出需求报告,设定系统开发的功能目标、性能目标,并探讨其可行性。在软件工程师的协助下完成以数据库系统为主要依托平台的中西医结合健康管理系统。
第三部分是对建立的系统平台进行验证研究,探讨其实用性,发现不足,以期今后进一步完善。
研究结果：
文献研究方面,通过文献研究,发现我国冠心病防治面临极大的压力,挤占了巨额的卫生医疗资源,严重影响着我国社会、经济的可持续发展战略。虽然目前介入治疗成为冠心病血运重建的重要手段,但术后的健康管理存在不足,术后的二级预防药物使用不足,依从性不够。忽略了患者术后改善生活方式的重要性、健康宣教力度不够、对患者术后的心理变化不够重视。此外,通过总结中医中药文献,认识到中医学对于冠心病的认识有着系统的理论,长期的临床实践证实了其对冠心病治疗的巨大优势。中医的“治未病”思想,注重精神、生理调养并重的思维模式,重视情志、环境、生活习惯等因素在疾病发生、发展、预后方面所起的作用等对冠心病的防治有着极其重要的影响。最后,通过对健康管理文献的研究,发现目前国内虽然有一些类似的慢性疾病管理平台,但有不少明显的不足之处,故构建更为科学、合理的中西医结合的冠心病PCI术后健康管理系统显得尤为必要。
系统研发方面,通过对临床、护理、科研、软件开发工程师、患方等多方面从业人员的调研、座谈,形成了本系统构建的需求分析报告,制定了系统开发的功能目标与性能目标,并对其可行性进行了论证。按照上述要求,在软件开发工程师的协助下完成了系统开发,冠心病PCI术后健康管理系统由病历系统、门诊随访系统、健康宣教系统、大众传媒平台系统和效果评估系统等几部分组成。并辅之以健康教育讲座、博客、微博等平台开展健康教育,介绍冠心病相关防治常识、中医体质学说、饮食养生、八段锦、五禽戏等内容,帮助患者树立健康的生活方式,减少并发症。
系统验证方面,通过选择符合标准的冠心病患者进行验证,测试系统的运行情况,结果表明,我们开发的冠心病PCI术后健康管理系统其功能基本达到了需求分析所设定的目标,同时通过运行系统,对收集的数据进行统计分析,得到了一些较为有价值的信息；通过与对照组对比,纳入健康管理系统的患者的服药依从性、心理评分、自我效能评分、西雅图心绞痛量表评分经统计学检验均优于对照组,显示了该健康管理系统的有效性。
研究结论：
1.目前我国冠心病防控工作任务繁重,构建中西医结合的冠心病PCI术后健康管理系统有其必要性、紧迫性。
2.中西医结合的冠心病PCI术后健康管理系统对于加强疾病健康管理、收集整理相关数据、改善预后均有重要意义。
3.本研究形成的健康管理系统具有明显的中医特色,具有整合患者信息、数据分析的功能,具有网络化、智能化的的特点,而且能够结合飞信、博客、微博等大众传媒加强对冠心病患者的术后健康管理系统,是冠心病防治领域的一种有益探索与创新。
4.通过验证研究,证实了本系统具有实用性、创新性,通过系统干预后的冠心病患者在服药依从性、心理抑郁状态、自我效能、西雅图心绞痛量表积分等方面得到了改善。
5.由于条件随访时间较短,收集的样本含量较小,本研究调研难免有一定的不足之处,后继研究应该进一步完善。
Background
Coronary Heart Disease (CHD) is a serious illness to human health and the incidence is increasing in recent years in China. Coronary heart disease has brought a heavy burden of medical expenses to the society and the family. How to prevention and control this kind of disease has been an important issue in the field of health management.
The secondary prevention of coronary heart disease is one of the basic strategies of disease prevention and control and two specific measures can be attributed to it. One is optimized drug treatment and the second is improving heslthy lifestyle (smoking cessation, healthy diet, proper physical exercise, weight control, regulated blood lipids, blood pressure control). The oral drugs includs aspirin, beta-blockers, lipid regulating drugs (statins) and ACEIs/ARB. However, a number of patients with coronary heart disease has a poor of drug compliance in CHD's secondary prevention, which reduced the effectiveness of drug treatment.
Chinese medicine has a systematic theoretical about coronary heart disease and a long-term clinical practice confirmed the advantages in treatmenting coronary heart disease. Some of Chinese medicine's theories such as "treating potential risks" and "health lifestyles" has an important influence on the prevention and treatment of coronary heart disease.
Health management has been recognized as an effective measure on chronic non-communicable diseases control, however there is a lot of deficiency in the management of coronary heart disease with integrative medicine.
Objectives
Firstly, generating a needs analysis report on how to construct a excellent health management system about patients after PCI sugery. The secondly, developing a electronic management software which characterized with traditional Chinese medicine and intergrated a bundle of function such as prevention, diagnosis and treatment disease, follow-up mission.
As a platform to achieve the coronary heart disease patients after PCI comprehensive, continuous, active, positive health management in order to strengthen self-management skills of patients with coronary heart disease after PCI, the control of risk factorsdatabase data statistics accumulated by this study improve compliance after PCI with coronary heart disease secondary prevention of drug use, in order to promote health, to delay disease progression and reduce complications, reduce the rate of disability, prolong life, improve quality of life;analysis, to explore in patients with coronary heart disease after PCI in the clinical features of Western medicine, rich connotation of Western theory to provide a basis; valid for clinical, economic, reasonable preventive measures to make some decisions in this field of clinical and community healthhealth workers to provide a meaningful reference and research ideas.
Des ign
Combination of theoretical and empirical research, this study of three parts:
First the theory related to health management of coronary heart disease after PCI. Surgical treatment of coronary heart disease and PCI after secondary prevention and health of Chinese and Western management theory literature, and present various health management system to explore.
The second part of the expert research, seminars and other forms, completed after PCI with coronary heart disease and health management system needs analysis research, given the demand for the report, set the system functions developed goals, performance objectives, and to explore its feasibility. The assistance of software engineers Integrative Medicine health management system mainly relying on the platform to the database system.
The third part is to establish a system platform empirical research, to explore its usefulness, found insufficient, in order to further improve in the future.
Result
Literature, the literature and found that coronary heart disease prevention and control in China face great pressure, squeeze out a huge amount of health care resources, a serious impact on China's social, economic and sustainable development strategies. Although interventional treatment become an important means of revascularization of coronary heart disease, but the postoperative health management deficiencies, lack of postoperative secondary prevention of drug use, compliance is not enough. Ignored patients to improve the importance of lifestyle, health education is not enough, not pay enough attention to the psychological changes of patients. In addition, by summarizing the literature of Chinese medicine, to recognize that the theory of Chinese medicine system for the understanding of coronary heart disease has long-term clinical practice confirmed the great advantages for the treatment of coronary heart disease. Chinese medicine,"treating disease" ideological, spiritual, physiological and nursed back to health and try mode of thinking, the emphasis on emotional, environmental, and lifestyle factors such as disease, development and prognosis with regard to the role of prevention and treatment of coronary heart disease is extremely important the impact. Finally, the health management literature, the present, although there are some similar chronic disease management platform, but there are a lot of obvious inadequacies, it is to build a more scientific and reasonable integrative medicine after PCI for coronary heart disease health management system is particularly necessary.
System research and development, through research, clinical care, research, software development engineers, the risk of side, and many other practitioners discussion, the formation of the system build needs analysis to develop a functional goals and performance objectives of the system development and demonstrated its feasibility. In accordance with the above requirements, system development with software development engineers. The health management system are maded up by the medical records system, outpatient follow-up system, health education, mass media platform and impact assessment system and supported by health education seminars, blog, microblogging platforms such as health education, popularization of coronary heart disease prevention and treatment of common sense.
System empirical aspects to empirical test operation of the system by selecting the standard in patients with coronary heart disease, the results show that we have developed coronary heart disease after PCI health management system functions basically reached the target set by the needs analysis, through operating system, the data collected for statistical analysis, got some valuable information. The experimental group is better than the control group in Medication adherence, psychological rating, self-efficacy score, the Seattle Angina Scale scores. The result showed that our health management system is effective.
Conclusion
(1) coronary heart disease prevention and control in China and tasks, to build integrative medicine after PCI for coronary heart disease health management system is necessary to urgency.
(2)Coronary heart disease after PCI of integrative medicine and health management system strengthening disease health management, collection, compilation of relevant data have an important place to improve the prognosis.
(3) In this study, the system has the characteristics of traditional Chinese medicine, with integrated patient information, data analysis, network, intelligent features, and capable of binding to flying letters, blog, microblogging and other mass media to strengthen coronary heart disease the postoperative patient health management system is a useful exploration in the field of prevention of coronary heart disease and Innovation.
(4) due to limited conditions, the research will inevitably have a certain inadequacies, such as the research object is limited to the Guangdong Provincial Hospital, the views collected inevitably have a little bias, should further improve in the future.
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