冠心病合并慢性心力衰竭患者院外规范化管理的疗效探讨  

Curative effects on standardized management of community patients with coronary heart disease complicated with chronic heart failure

作　　者：孙丽娜[1] 王宁夫[1] 钟益刚[1] 李虹[1] 郭士遵[1] 周占林[1] 童国新[1] 林坚[2] 盛国安 汪一波 徐鹏[1] 刘宇[4] 邹建伟[5] 

机构地区：[1]南京医科大学附属杭州医院杭州市第一人民医院心内科,310006 [2]杭州市上城区人民医院 [3]浙江省临安市人民医院 [4]常州市第二人民医院 [5]江苏省江阴市人民医院

出　　处：《中华医学杂志》2013年第30期2341-2344,共4页National Medical Journal of China

基　　金：基金项目：浙江省科技厅计划（2012C33127）;杭州市科技局重点项目（20080333Q03）

摘　　要：目的观察院外管理对冠心病合并慢性心力衰竭患者疗效的影响。方法2002年1月-2005年12月，杭州市第一人民医院心内科出院的冠心病合并慢性心力衰竭患者823例，其中同意随访者734例，将其按照计算机随机分组方法分为管理组440例与非管理组294例，对管理组患者进行规范化院外管理，即定期健康教育、电话及门诊随访等。结果与非管理组相比，管理组患者全因死亡、心源性死亡、心血管事件再入院等一级终点事件的发生率分别下降约26．5％、32．2％、57．0％。管理组患者第1年至第4年的生存率分别为92％、85％、83％、82％，非管理组患者分别为95％、89％、82％、75％。非管理组患者利尿剂、地高辛的使用依从性明显低于管理组患者。结论对冠心病合并慢性心力衰竭患者进行规范化的院外管理可以使患者在全因死亡、心源性死亡、心血管事件再人院等终点事件方面获益，提高患者的生存率及药物使用依从性。Objective To explore the effects on the standardized management of patients with coronary atherosclerotic heart disease complicated with chronic heart failure. Methods A total of 823 patients discharged from our department were randomly enrolled. Among 734 patients with follow-up consents, they were divided into management and control groups （ n = 440, 294）. The management group received standardized out-of-hospital management, regular health education and follow-ups of telephone and outpatient visits. Results Compared with the control group, the management group had lower rates of all- cause mortality, cardiac death and readmission due to cardiovascular events （CVE） declining by 26. 5% , 32. 2% and 57.0% respectively. Over a 4-year period, the annular survival rate of management group was 92% , 85% , 83% and 82% while that of control group 95% , 89% , 82% and 75% respectively. Patient compliance of digoxin and diureticum in the control group was inferior to that in the management group. Conclusion Through standardized out-of-hospital management, the patients with coronary atherosclerotic heart disease plus chronic heart failure may achieve significant benefits through reducing the rates of all- cause mortality, cardiac death and readmission due to CVE and improving survival rate.

关 键 词：冠状动脉疾病 心力衰竭 充血性 疾病管理 

分 类 号：R541.4[医药卫生—心血管疾病] R541.6[医药卫生—内科学]