社区化管理模式在慢性左室射血分数下降的心力衰竭患者出院后随访管理中的应用价值  

Effects of community management on outpatients of heart failure with reduced left ventricular ejection fraction

作　　者：刘翀[1] 韦铁民[1] 吕玲春[1] 赵瑞英[1] 向贻佳[1] 吴晓燕[1] 林莉[1] 曾春来[1] LIU Chong WEI Tie-min LV Ling-chun ZHAO Rui-ying XIANG Yi-jia WU Xiao-yan LIN Li ZENG Chun-lai(Department of Cardiology, Lishui City Central Hospital, Lishui, Zhejiang Province 323000, Chin)

机构地区：[1]浙江省丽水市中心医院心内科,浙江省丽水323000

出　　处：《中国慢性病预防与控制》2016年第12期885-889,共5页Chinese Journal of Prevention and Control of Chronic Diseases

摘　　要：目的评价社区化管理模式在慢性左室射血分数下降的心力衰竭患者出院后管理中的应用效果,为慢性心血衰竭患者的治疗提供依据。方法对2012年1月至2014年12月期间在丽水市中心医院心内科住院治疗的纽约心脏病协会（NYHA）心功能分级为Ⅲ~Ⅳ级的1 273例丽水市莲都区户籍慢性心力衰竭患者进行超声心动图检查,采用改良的辛普森（Simpson）法测量左室射血分数（LVEF）,发现LVEF〈40%的患者共459例,从中选取405例慢性左室射血分数下降的心力衰竭住院患者为研究对象,并将其随机分为3组,A组为社区化管理组（134例）,B组为电话随访组（136例）,C组为自我管理组（135例）。所有患者均接受正规抗心力衰竭治疗。3组患者在出院后3个月、6个月及12个月各进行1次随访,用SPSS 23.0软件包对数据进行t检验和多组间比较的单因素方差分析。结果 A、B两组β受体阻滞剂与血管紧张素转化酶抑制剂或血管紧张素受体抑制剂（ACEI或ARB）类药物的用量均显著大于C组,且剂量逐渐递增,其中A组用量较B组更大,而C组却出现了β受体阻滞剂减量、ACEI或ARB类药物不再加量的现象。3组患者在治疗1年后血压及心率均较治疗前下降,6 min步行距离显著增高,血浆B型利钠肽（BNP）浓度显著下降,但只有A组患者治疗后LVEF水平较入组时明显升高（分别为32.18%±6.93%、31.45%±7.89%）,差异有统计学意义（P〈0.01）,其余两组治疗后LVEF水平较入组时无显著改变。A组患者的血压、心率控制更满意,心功能改善最明显,1年内再住院率（9.92%）及病死率（7.44%）最低。C组患者的血压、心率控制最不满意,心功能改善最不明显,1年内再住院率（23.14%）及病死率（13.22%）最高。B组情况介于A、C两组之间。结论社区化管理模式和电话随访管理模式较患者自我管理模式能更好地提高患者服药的依从性,取得更好的疗�Objective To assess the effects of community management on outpatients of heart failure with reduced left ventricular ejection fraction, and to provide the basis for treating chronic heart failure. Methods From January of 2012 to December of 2014,405 outpatients of heart failure with reduced left ventricular ejection fraction served as the subjects, the subjects were divided into three groups： Group A（134 cases with the follow-up of community management）, Group B（136 cases with telephone follow-up）and Group C（135 cases with the follow-up of self-management）. All patients received the anti-heart-failure treatments. In 3, 6and 12 months after treatment, the follows-up were performed, respectively for all subjects. The t test and ANOVA were used to analyze the data with SPSS 23.0 software. Results As compared with group C, the usage of β-blockers, angiotensin converting enzyme inhibitors（ACEI）and angiotensin receptor blockers（ARB）in group A and B increased significantly. The usage of β-blockers, ACEI and ARB in group A was higher than that in group B. Also the usage of β-blockers decreased and the usage of ACEI and ARB did not increase in group C. In 12 months after treatment, the blood pressure and heart rate reduced, 6-minute walk increased significantly, the plasma BNP concentrations decreased for all subjects. Only LVEF level in group A increased significantly（P〈0.01）. In group A, the control of blood pressure and heart rate was satisfied, the improvement of heart function was significant, the re-hospitalization rate（9.92%）and case fatality rate（7.44%）were the lowest. In group C, the control of blood pressure and heart rate was not satisfied, the improvement of heart function was not significant, the re-hospitalization rate（23.14%）and case fatality rate（13.22%）were the highest. Conclusion The models of community management and telephone follow-up are better than the model of self-management for increasing the medication compliance and curative effect of patients.The

关 键 词：心力衰竭 随访 社区化管理 

分 类 号：R541.6[医药卫生—心血管疾病]