三甲医院-社区心衰管理模式对心功能的影响研究  

Changes of the cardiac function induced by the management mode assembling the third-grade class-A-hospital and community hospital in chronic heart failure

作　　者：余秀琼[1] 李锦[1] 戴玫[1] 蒋晖[1] 王引利[1] 巫文丽[1] 唐炯[1] 蔡琳[1] 

机构地区：[1]成都市第三人民医院心内科,四川成都610031

出　　处：《四川医学》2014年第1期11-13,共3页Sichuan Medical Journal

基　　金：2007年成都市"十一五"重大科技计划项目(编号:07YTYB957SF-020);2010年成都市科技局项目(编号:10GGYB932SF-182)

摘　　要：目的 评价三甲医院-社区心衰管理模式能否改善社区心衰患者的心功能、减少心血管事件.方法 入选200例NYHA心功能分级Ⅱ～Ⅳ级心力衰竭患者.随机分为管理组100例和对照组100例.对管理组患者进行三甲医院-社区心衰管理模式管理,对照组不进行任何管理.平均随访时间18.5±0.5个月.主要随访指标：NYHA心功能分级、6min步行试验、心脏彩超EF值、心血管事件.结果 管理组有效患者96例;对照组有效患者97例.通过三甲医院-社区心衰管理模式管理后,管理组患者较对照组在NYHA心功能分级、6分钟步行试验、心脏彩超EF值有明显改善（P〈0.05）,而III-IV心功患者（共61例,管理组30例;对照组31例）心血管事件发生率显著下降（管理组63.3%（19/30）;对照组90.3%（28/31）,P〈0.05）.结论 三甲医院-社区心衰管理模式能够改善社区心衰患者的心功能,并减少III-IV级心衰患者的心血管事件.Objective To observe the changes of the cardiac function induced by the management mode assembling the third-grade class-A-hospital and community hospital in chronic heart failure. Methods The heart failure patients （New York Heart Function II - IV） in two communities in Chengdu were divided into two groups by cluster randomization： the management group （ n = 100） and the control group （ n = 100）. The community hospital doctors were trained standardized guidelines for the evaluation and management of heart failure by third-grade class-A hospital doctors, and participated in the follow-up management for the management group patients. Meanwhile, the management group patients were received self-care education. Follow-up major contents： NYHA class, 6-minute walk test, echocardiography EF values and the incident of cardiovascular events. Results After 18.5 ±0. 5 months , 193 patients were included, 96 in the management group and 97 in the control group. After the management mode , the cardiac function of patients with＇ heart failure of the community were improved ,and their cardiovascular events were reduced in patients with New York Heart Function III-IV, the incident of cardiovascular events （63.3% （19/30） in management group vs 90.3% （28/31） in control group （P 〈 0.05）, Conclusion This management mode assembling the third-grade class-A-hospital and community hospital in Chengdu in chronic heart failure can improve the cardiac function of patients ,and reduce the cardiovascular events in patients of New York Heart Association III-IV.

关 键 词：社区 心衰 疾病管理 心功能 

分 类 号：R541.6[医药卫生—心血管疾病]