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|本期目录/Table of Contents|

对慢性心力衰竭患者进行院外干预的依从性及其效果

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第3期
页码:
313-316
栏目:
临床研究
出版日期:
2014-03-20

文章信息/Info

Title:
Impact of out-of-hospital multifactorial intensive intervention on patients with chronic heart failure
作者:
罗礼云1; 李 铁2; 彭 虹3
(中山大学附属第五医院：1.心内科，
2.老年病科，
3.预防保健科，广东 珠海 519000)
Author(s):
LUO Li yun;  LI Tie;  PENG Hong
(Department of Cardiology, Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, Guangdong, China)
关键词:
心力衰竭; 慢性; 干预研究
Keywords:
chronic heart failure;  intervention
分类号:
R541.61
DOI:
-
文献标识码:
A
摘要:
目的:观察对慢性心力衰竭(CHF)患者进行院外干预的效果。方法:通过前瞻性随机对照方法，将215名出院的心力衰竭（HF）患者随机分为普通随访组和强化干预组，通过1年的随访观察，最终完成随访的患者共计205例。普通随访组仅进行常规的门诊随访，强化干预组患者接受电话咨询、专门的心力衰竭门诊随诊及定期健康宣教。结果:强化干预组和普通组相比较，限水限钠达标率和坚持每天监测体质量的比例大幅度增加（P<0.01）,强化干预组利尿剂的使用率明显高于普通组（P<0.01），血管紧张素转换酶抑制剂（ACEI）/血管紧张素II受体拮抗剂（ARB）类药物、β受体阻滞剂的靶剂量达标率方面明显高于普通组（P<0.01），强化干预组左室射血分数高于普通随访组；与普通随访组相比，强化干预组氨基端脑钠肽前体（NT-pro-BNP）降低更明显（P<0.05），且6分钟步行试验优于普通组（P<0.05）。两组再次入院和总心血管事件发生率有显著差异（3% vs. 11%，P<0.05）,强化干预措施显著降低了死亡和再住院联合终点事件的发生率。结论: 对CHF患者进行院外强化干预，可以提高患者的自我管理能力，提高抗HF治疗药物的使用比例及二级预防药物的靶剂量达标率，降低再住院率和心血管事件发生率。
Abstract:
AIM:To observe the efficacy of out-of-hospital multifactorial intensive intervention on patients with chronic heart failure. METHODS: A prospective study was conducted in 215 patients with chronic heart failure. Patients were discharged from hospital and randomized into conventional follow-up group and intensive intervention group. The 215 patients were followed for 12 months and 205 of the patients completed the follow-up. Conventional follow-up group received only routine follow-up examination, whereas the intensive intervention group, in addition to the routine follow-up examination, received telephone counseling, specialized follow-up from heart failure clinics, and regular health education. RESULTS: The percentages of patients limiting water and salt intake and measuring body weight in intensive intervention group were markedly increased (P<0.01). The percentages of using diuretics and achieving target dose rate of ACEI/ARB/beta blockers were higher in intensive intervention group. The percentages of left ventricular ejection fraction and completing the 6-minute walking test were also higher in intensive intervention group, whereas the level of NT-pro-BNP was lower in intensive intervention group. Compared with those in the conventional follow-up group, the rehospitalization rate and incidence of cardiovascular events were lower in the intensive intervention group. CONCLUSION: Out-of-hospital multifactorial intensive intervention is helpful in improving the clinical outcome for patients with chronic heart failure.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2013-07-24.
作者简介：罗礼云，主治医师，博士生 Email: 510331873@qq.com
更新日期/Last Update: 2014-03-21