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Izvajanje sekundarne preventive po srcnem infarktu
Avtor: Erik Škof Matjaž Špan, Mateja Štrlek
Mentor: prof. dr. Irena Keber, dr. med.
Somentor: mag. Barbara Gužic, dr. med.
IZHODIŠCA: Ogroženost pred ponovnimi akutnimi koronarnimi dogodki pri bolnikih po srcnem infarktu lahko zmanjšamo s sekundarno preventivo, ki zajema odstranjevanje dejavnikov tveganja, in ustreznim zdravljenjem z zdravili.
NAMEN DELA: Doktrinarna stališca sekundame preventive so znana, nimamo pa dovolj podatkov, kako se uvajajo v Sloveniji. Zato smo v naši raziskavi proucevali izvajanje in ucinke sekundame preventive pri dveh skupinah bolnikov po srcnem infarktu: bolnikih, vodenih v klinicni ustanovi in bolnikih, vodenih v splošnih bolnišnicah.
METODE DELA: Od 770 nakljucno izbranih bolnikov, ki so preboleli srcni infarkt v obdobju 1.1.1989 do 31.12 1995, se je vabilu k sodelovanju odzvalo 320 bolnikov (247 moških in 73 žensk, povprecna starost je bila 63 let). Od infarkta do vkljucitve v raziskavo je v povprecju minilo pet let. Bolnikov, ki so bili po srcnem infarktu vodeni v klinicni ustanovi v Ljubljani, je bilo 180, tistih, ki so bili vodeni v splošnih bolnišnicah pa 140 (v Izoli 66 in na Jesenicah 74). Z anketo, klinicnim pregledom in krvnimi preiskavami smo zbrali podatke o kajenju, telesni dejavnosti, prehrambenih navadah, krvnem tlaku, telesni teži, holesterolu in sladkorju v krvi.
REZULTATI: Med vsemi bolniki je 86% kadilcev opustilo kajenje, 22% bolnikov je bilo telesno nedejavnih, brez varovalne prehrane jih je bilo 40%, 23 % jih je imelo povišan krvni tlak, debelih je bilo 27%, povišano vrednost krvnega holesterola (nad 5.2 mmol/1) je imelo 68%, povišan krvni sladkor pa 52% bolnikov. 83% bolnikov je prejemalo antitromboticna zdravila, 47% adrenergicne zaviralce, 31 % pa zaviralce angotenzinske konvertaze. Pri vseh dejavnikih tveganja, razen pri redni telesni dejavnosti, so bili rezultati boljši pri bolnikih, ki so bili po srcnem infarktu zdravljeni v klinicni ustanovi. Ti so imeli znacilno vecji delež bolnikov, ki so opustili kajenje (91 % v primerjavi s 77%), vec jih je imelo varovalno prehrano (69% v primerjavi z 48%), vec jih je imelo urejen krvni tlak (79% v primerjavi z 42%), manj je bilo debelih (21 % v primerjavi s 36%), vec jih je imelo željene vrednosti krvnega holesterola (41% v primerjavi z 21%) ter krvnega sladkorja (57% v primerjavi s 37%), kot bolniki, ki so bili zdravljeni v splošnih bolnišnicah. Pri prvih je bil tudi znacilno vecji delež bolnikov zdravljenih z antitromboticnimi zdravili (90% v primerjavi s 75%) in adrenergicnimi zaviralci (56% v primerjavi s 36%), kot pri slednjih.
ZAKLJUCKI: Izvajanje sekundame preventive pri našem vzorcu bolnikov po srcnem infarktu je zadovoljivo, vendar pa ni enotno. Primerjava med bolniki, ki so bili po srcnem infarktu vodeni v klinicni ustanovi in tistimi, ki so bili vodeni v splošnih bolnišnicah, je pokazala, da je bila urejenost skoraj vseh dejavnikov tveganja pri bolnikih, ki so bili vodeni v klinicni ustanovi, boljša
[Abstract / English version]
The application of secondary preventive measures after myocardial infarction
Author: Erik Škof Matjaž Špan, Mateja Štrlek
Mentor: prof. dr. Irena Keber, dr. med.
Co-mentor: mag. Barbara Gužic, dr. med.
BACKGROUND: We can reduce coronary morbidity and mortality in patients after myocardial infarction with application of secondary prevention measures and proper medical treatment. The methods and principles of secondary prevention are well known, but there is lack of data about their use in medical practice.
OBJECTIVES: We studied effects of secondary prevention in two groups of patients after myocardial infarction: in the patients, who were supervised in the university hospital and patients, supervised in general hospitals.
METHODS: 320 patients 247 men and 73 women, with average 63 years of age, out of 770 randomly gathered who had suffered myocardial infarction in the period from 1.1.1989 to 31.12.1995 agreed to participate in the study. The average period after index myocardial infarction was five years. There were 180 patients followed in the university hospital and 140 patients followed in general hospitals. We gathered the data about smoking and eating habits, physical activities, blood pressure, body weight, blood cholesterol and fasting glucose levels with questionnaire, clinical examination and blood analyses.
RESULTS: Among all patients 86% gave up smoking, 22% were physically inactive, 40% had no protective diet, 23% had elevated blood pressure, 27% were obese, 68% had high total blood cholesterol level and 52% had high blood sugar, 83% were treated with antithrombotic drugs, 47% received beta-blocking agents and 31% with angiotenzin-converting enzyme inhibitors. Comparison between two groups of patients showed that significantly more patients from clinical hospital gave up smoking (91% vs. 77%), had protective diet (69% vs. 48%), had normal blood pressure (79% vs. 42%), fewer were obese (21 % vs. 3 6%), more of them had normal total blood cholesterol (41 % vs. 21%) and blood sugar (57% vs. 37%), but fewer were regularly physically active. Preventive treatment with antithrombotic drugs and beta- blocking agents were also more adequate in the group from the university hospital than in the groups from general hospitals (90% vs. 75%, 56% vs. 36%, respectively)
CONCLUSION: The results showed that the application of secondary preventive measures after myocardial infarction is in general satisfactory in our study group but the difference exists among the university and general hospitals: the management of risk factors and preventive treatment with drugs was better in the university hospital than in general hospitals.