我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

慢性心力衰竭患者医院与社区联合规范化管理的效果评价

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第1期
页码:
77-80
栏目:
临床研究
出版日期:
2013-12-02

文章信息/Info

Title:
Evaluation of hospital and community management in patients with chronic heart failure
作者:
张文全; 王明瑜; 徐佑龙; 郜俊清; 刘 鸣; 刘宗军; 金惠根
(上海市普陀区中心医院、上海中医药大学附属普陀医院心内科，上海 200062)
Author(s):
ZHANG Wen-quan;  WANG Ming-yu;  XU You-long;  GAO Jun-qing;  LIU ming;  LIU Zong-jun;  JIN Hui-gen
(Department of Cardiology, Putuo District Center Hospital, Shanghai 200062, China)
关键词:
心力衰竭; 慢性; 社区; 管理
Keywords:
heart failure;  chronic;  community;  disease management
分类号:
R541.61
DOI:
-
文献标识码:
A
摘要:
目的:探讨医院与社区联合对慢性心力衰竭(CHF)患者进行规范化管理的效果和管理模式的可行性。方法:以上海市普陀区下辖的10个社区作为研究基地，计划入选2009年9月~2011年3月于上海市普陀区中心医院就诊的NYHA心功能分级Ⅱ~Ⅳ级的CHF患者120例，以社区为基本单元，采用随机分组方法，将其分为干预组（共5个社区，59例患者）和普通随访组（共5个社区，57例患者）。干预组由中心医院对社区医生进行规范化心衰诊疗培训，由社区医生对患者进行管理，同时由区中心医院定期举办心衰(HF)知识讲座和HF自我管理教育；普通随访组进行常规门诊随访。观察两组患者18个月后HF知晓率、规范化药物使用率、日常生活管理、心功能改善情况、心脏事件、再次住院率、平均住院天数有无显著差异；观察干预组干预前后HF知晓率、规范化药物使用率、日常生活管理和心功能情况有无显著差异。结果:两组患者的基线特征无统计学差异。接受规范化管理后，干预组与普通随访组比较：HF知晓率（100% vs. 81%,P<0.05）、规范化服药率［利尿剂(92% vs. 54%,P<0.05)、β受体阻滞剂（95% vs. 58%,P<0.05）、血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）（93% vs. 58%,P<0.05）］、自我日常生活管理率［限盐、控制饮食(92% vs. 25%,P<0.05)、戒烟（52% vs. 25%,P<0.05）、适量运动（51% vs. 18%,P<0.05）、监测血压心率（93% vs. 23%,P<0.05）］、左室射血分数（LVEF）［(47±4)% vs.(42±6)%,P<0.05］、NYHA心功能Ⅰ~Ⅱ级(68% vs. 49%，P<0.05)］、再次住院率（34% vs. 54%,P<0.05）、住院天数［(8.3±2.2) d vs. (9.2±2.1) d,P<0.05］均有显著差异，两组心脏事件发生率（8% vs. 9%）无统计学差异；干预组试验后均优于试验前。结论: 医院与社区相结合的CHF规范化防治的管理模式是一种有效可行的方式，可以提高患者对疾病的认知率，规范化服药率和自我管理能力，降低再次住院率，缩短住院天数，从而获得较好的社会经济效益。
Abstract:
AIM:To evaluate the efficacy and feasibility of hospital and community management in patients with chronic heart failure. METHODS: Ten communities in Putuo District were included in this study and a total of 120 patients with heart failure (New York Heart Function II-IV) visiting Putuo District Center Hospital from September 2009 to March 2011 were investigated. The patients were divided into two groups: management group (n=59) and control group (n=57). In the management group, the community hospital doctors were trained according to the standardized guidelines for the management of heart failure. Patients received self-care education by center hospital doctors, whereas patients in the control group were treated without special training. The two groups were observed in the aspects of patients’ knowledge about heart failure, standardized medication, level of self-care in daily life, major adverse cardiac events, and hospitalization time. RESULTS: No significant differences were observed between groups at baseline. After an 18-month follow-up, the rate of patients’ knowledge about heart failure (100% vs. 81%, P<0.05), rate of standardized medication ［diuretics (92% vs. 54%, P<0.05), beta-blockers (95% vs. 58%, P<0.05), ACEI/ARB (93% vs. 58%, P<0.05)］ and rate of self-care in daily life ［salt restriction (92% vs. 25%, P<0.05), stopping smoking (52% vs. 25%, P<0.05), physical exercise (51% vs. 18%, P<0.05), blood pressure and heart rate monitoring (93% vs. 23%, P<0.05)］, and days of hospitalization ［(8.3±2.2) days vs. (9.2±2.1) days, P<0.05］ in the management group were higher than those in the control group. The rate of MACE was lower (8% vs. 9%, P>0.05) in the management group than in the control group. CONCLUSION: Hospital and community management in patients with chronic heart failure is feasible and effective.

参考文献/References

[1]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志, 2007,35(12):1076-1095.
[2]Newhouse RP,Dennison Himmelfarb C,Morlock L,et al.A phased cluster-randomized trial of rural hospitals testing a quality collaborative to improve heart failure care: organizational context matters[J].Med Care,2013,51(5):396-403.
[3]Shchekochikhin DY,Schrier RW,Lindenfeld J,et al.Outcome differences in community- versus hospital-acquired hyponatremia in patients with a diagnosis of heart failure[J].Circ Heart Fail,2013,6(3):379-386.
[4]Anker SD,Koehler F,Abraham WT.Telemedicine and remote management of patients with heart failure[J].Lancet,2011,378(9792):731-739.
[5]Mosterd A,Hoes AW.Clinical epidemiology of heart failure[J].Heart,2007,93(9):1137-1146.
[6]Bonarek-Hessamfar M,Benchimol D,Lauribe P,et al.Multidiciplinary network in heart failure management in a community-based population:results and benefits at 2 years[J].Int J Cardiol,2009,134(1):120-122.
[7]McMurray JJ,Adamopoulos S,Anker SD,et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012:The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology.Developed in collaboration with the Heart Failure Association (HFA) of the ESC[J].Eur Heart J,2012,33(14):1787-1847.
[8]Hunt SA,American College of Cardiology, American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)[J].J Am Coll Cardiol,2005, 46(6):e1-e82.
[9]李 锦,王引利,余秀琼,等.三级甲等医院指导下慢性心力衰竭患者的社区管理研究[J].中华心血管病杂志,2012,40(11):939-944.
[10]上海市心力衰竭调查协作组.上海市1980、1990、2000年心力衰竭住院患者流行病学及治疗现状调查[J].中华心血管病杂志,2002,30(1):24-27.
[11]Bocchi EA,Cruz F,Guimares G,et al.Long-term prospective,randomized,controlled study using repetitive education at six-month intervals and monitoring for adherence in heart failure outpatients:the REMADHE trial[J].Circ Heart Fail,2008,1(2):115-124.

备注/Memo

备注/Memo:
收稿日期：2013-06-07.基金项目：普陀区卫生系统自主创新科研项目资助(普KW090) 通讯作者：金惠根，教授，主要从事心血管疾病介入治疗研究 Email：jhg1953@126.com 作者简介：张文全，住院医师，硕士 Email：wenquan2264@sina.com
更新日期/Last Update: 2014-01-20