冠心病病人PCI术后主要不良心血管事件的危险因素分析及基于老年综合评估与思维导图的护理干预效果研究OA

Objective:To investigate the risk factors for major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI),and to evaluate the intervention effect of nursing care combining comprehensive geriatric assessment(CGA)and mind map-based health education.Methods:A total of 314 CHD patients who received PCI treatment in the hospital from March 2023 to May 2024 were enrolled as study subjects.They were divided into the MACE group(n=97)and the non-MACE group(n=217)according to whether MACE occurred.Logistic regression was used to analyze the influencing factors,and a Nomogram model was constructed.The prediction model was evaluated using the receiver operating characteristic(ROC)curve,calibration curve and decision curve.The surviving patients in the MACE group(n=78)were selected as the study population and divided into the observation group(n=39)and the control group(n=39)according to the intervention mode.The patients in control group received routine intervention,while the patients in observation group were given CGA combined with mind map-based health education on the basis of the control group.The prognosis of the two groups was compared.Results:Logistic regression analysis showed that N-terminal pro-B-type natriuretic peptide(NT-proBNP)>100 pg/mL,increased left ventricular posterior wall thickness(LVPWT),increased interventricular septal thickness(IVST),C-reactive protein(CRP)≥5 mg/L,increased 24-hour mean diastolic blood pressure variability(24 h DBPV),increased 24-hour systolic blood pressure variability(24 h SBPV),and complicated hypertension were all independent risk factors for MACE in CHD patients after PCI(P<0.05).The Nomogram model indicated that IVST had the best diagnostic performance for MACE in patients.ROC results showed that the area under the curve(AUC)of the model was 0.932[95%CI(0.902,0.962)].The calibration curve and decision curve suggested that the model had favorable accuracy.After intervention,the time to get out of bed,activity time and hospital stay in the observation group were shorter than those in the control group,and the 3-month readmission rate was lower than that in the control group(all P<0.05).The cardiopulmonary function indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),oxygen pulse and anaerobic threshold]and exercise tolerance(time to reach exercise endpoint,number of cases with exercise-induced angina pectoris,maximum heart rate,number of positive exercise test cases)in the observation group were better than those in the control group(all P<0.05).The Barthel Index(BI)score,Cardiovascular Health Behavior Score(CHS)score in the observation group were all higher than those in the control group(P<0.05).Conclusions:NT-proBNP>100 pg/mL,increased LVPWT,increased IVST,CRP≥5 mg/L,increased 24 h DBPV,increased 24 h SBPV and complicated hypertension are all independent risk factors for MACE in CHD patients after PCI,and all have predictive value.The nursing model of CGA combined with mind map-based health education can effectively accelerate the rehabilitation process and improve the prognosis of patients.