自我管理项目对慢性心力衰竭患者预后影响的研究
摘要
目的本研究旨在探讨规范化自我管理项目对慢性心力衰竭患者综合预后的影响。
方法选取符合条件的慢性心衰患者62例,随机分为干预组和对照组,其中对照组只采取常规护理措施和一般随访治疗;干预组除此之外,还实施规范化的自我管理项目,它包括住院期间系统健康教育、出院健康指导以及电话和家庭随访。干预时间为10个月,排除基线干扰后比较两组患者的心功能变化情况(LVEF值、NYHA分级,BNP值)、自我管理能力与生存质量情况以及病死率、再入院率和再入院患者的平均住院日。
结果干预前两组患者的各项指标比较无统计学差异,具有可比性(P>0.05)。10个月后随访,干预组的BNP值、LVEF值、NYHA分级、生存质量得分、自我管理得分等各项指标变化与对照组相比较,差异均有统计学意义(P值均<0.01);干预组的再住院率以及平均住院天数较对照组明显下降,差异有统计学意义(P<0.05);干预组病死率低于对照组,但差异无统计学意义(P >0.05)。
结论规范化的自我管理项目能改善慢性心力衰竭患者的预后。
Objective: To investigate the effect of the self-management programme on the prognosis in patients with chronic heart failure.
Methods: 62 patients with chronic heart failure, New York Heart Association Functional Class III orⅣ, were randomly divided into the intervention and control group. The control group were only given routine therapy and usual follow-up; the intervention group were given self-management programme which was based on the model of the self-management theory and included systematic health education about CHF during hospitalization and health guidence, telephone- or home- based interventions after discharge. Before and 10 months after intervention, (1) cardiac function index (BNP、LVEF、NYHA), (2)self-management capacity, health related quality of life , (3)the mortality,rehospitalization rate, average length of stay of the two patient groups were recorded.
Results: Cardiac function index (BNP, LVEF, NYHA), self-management capacity, health related quality of life , rehospitalization rate, average length of stay of intervention group were markedly improved. The difference had a statistical significance(P<0.01), the mortality of the intervention group was lower than that of the control group, which did not have a statistical significance(P >0.05).
Conclusion: Standard self-management programme for patients with chronic heart failure improved the clinic prognosis of the patients with chronic heart failure.
方法选取符合条件的慢性心衰患者62例,随机分为干预组和对照组,其中对照组只采取常规护理措施和一般随访治疗;干预组除此之外,还实施规范化的自我管理项目,它包括住院期间系统健康教育、出院健康指导以及电话和家庭随访。干预时间为10个月,排除基线干扰后比较两组患者的心功能变化情况(LVEF值、NYHA分级,BNP值)、自我管理能力与生存质量情况以及病死率、再入院率和再入院患者的平均住院日。
结果干预前两组患者的各项指标比较无统计学差异,具有可比性(P>0.05)。10个月后随访,干预组的BNP值、LVEF值、NYHA分级、生存质量得分、自我管理得分等各项指标变化与对照组相比较,差异均有统计学意义(P值均<0.01);干预组的再住院率以及平均住院天数较对照组明显下降,差异有统计学意义(P<0.05);干预组病死率低于对照组,但差异无统计学意义(P >0.05)。
结论规范化的自我管理项目能改善慢性心力衰竭患者的预后。
Objective: To investigate the effect of the self-management programme on the prognosis in patients with chronic heart failure.
Methods: 62 patients with chronic heart failure, New York Heart Association Functional Class III orⅣ, were randomly divided into the intervention and control group. The control group were only given routine therapy and usual follow-up; the intervention group were given self-management programme which was based on the model of the self-management theory and included systematic health education about CHF during hospitalization and health guidence, telephone- or home- based interventions after discharge. Before and 10 months after intervention, (1) cardiac function index (BNP、LVEF、NYHA), (2)self-management capacity, health related quality of life , (3)the mortality,rehospitalization rate, average length of stay of the two patient groups were recorded.
Results: Cardiac function index (BNP, LVEF, NYHA), self-management capacity, health related quality of life , rehospitalization rate, average length of stay of intervention group were markedly improved. The difference had a statistical significance(P<0.01), the mortality of the intervention group was lower than that of the control group, which did not have a statistical significance(P >0.05).
Conclusion: Standard self-management programme for patients with chronic heart failure improved the clinic prognosis of the patients with chronic heart failure.
引文
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[6]叶任高,陆再英.内科学[M].6版.北京人民卫生出版社,2004:169.
[7]朱燕波,折笠秀树,郑洁.慢性心功能不全患者的生活质量[J].中国临床康复,2004,8(15):2928-2929.
[8] Opasich C, Rapezzi C, et al. Precipitating factors and decision making processes of short term worsening heart failure despite optimal for all treatment (from the in CHF registry)[J]. Am J Cardiol,2001,88(4):382-387.
[9] Artinian NT,Magnan M, Sloan M, et al. Self-care behaviors among patients with heart failure [J]. Heart Lung,2002,31(3):161-172.
[10] Riegel B, Driscoll A, Suwanno J, et al. Heart Failure Self-care in Developed andDeveloping Countries[J]. Journal of Cardiac Failure,2009,15(6):508-516.
[11] Ditewig JB, Blok H, Havers J, et al. Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: A systematic review[J]. Patient Educ Couns,2010,78(3)297-315.
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