31例80岁以上高龄老年房颤合并心力衰竭患者院外临床路径管理初探  

Study on outside-hospital clinical pathway management for 31 cases of over 80-year-old sufferers with senile atrial fibrillation and heart failure

作　　者：纪鹏[1] 卢杰[1] 王建国[1] 汪春晖[1] 

机构地区：[1]解放军第82医院急诊与重症医学科,223001

出　　处：《中国疗养医学》2017年第3期231-233,共3页Chinese Journal of Convalescent Medicine

基　　金：江苏省医学人文社会科学基金(JSYRKJ2014-B-06);江苏省淮安市科技专项基金(HAP201575)

摘　　要：目的探讨高龄老年房颤合并心力衰竭患者院外管理的方法与路径。方法对解放军第82医院急诊与重症医学科2013-01-01—2015-12-31治疗出院的患者中,年龄≥80岁,永久性房颤合并心力衰竭,改善心功能达Ⅰ或者Ⅱ级,共31例患者,院外进行路径管理,包括:基本处方及随访管理、病因及危险分层管理、心率、节律和生活质量管理。结果通过电话及门诊随访,31例患者无1例失访。前3个月管理路径判定效果标准均为满意,无死亡或急诊再住院治疗。随后随访期间,1例超高龄患者第7个月在家死亡,病因不明;11例患者出现"红旗"症状,再住院期治疗,其中死亡4例,1例死于顽固性心力衰竭,2例死于大面积脑梗死,1例死于大量脑出血。结论应用院外临床路径管理能够提高医护人员对房颤合并心衰治疗的规范性,有益于改善患者生存率及生活质量,是值得探索的疾病管理方法之一。Objective To discuss the outside-hospital management method and pathway for aged sufferers with se- nile atrial fibrillation and heart failure.Methods 31 sufferers over 80 years old with permanent atrial fibrillation and heart failure treated and discharged from Emergency and ICU Department of No.80 PLA Hospital from January 1,2013 to December 31,2015, with improved cardiac function of grade Ⅰ or Ⅱ,were given outside-hospital path- way management, including basic prescription and follow-up management, pathogenesis and risk stratification manage- ment, and heart rate, rhythm and living quality management. Results There was no patient lost to follow-up through. Within the first 3 months, the pathway management effects of all patients were satisfactory after standardized evalua- tion, and there was no death or emergency readmission in that period.In the subsequent follow-up, 1 over-aged suffer- er died home in the 7th month without clear pathogenesis. 11 sufferers developed ＂red flag＂ symptoms and readmitted to hospital. There were 4 cases of deaths, including 1 from refractory heart failure, 2 from large area cerebral infraction and 1 from massive cerebral hemorrhage.Conclusion Outside-hospital clinical pathway management can improve the normativity of medical staff for atrial fibrillation and heart failure, help with survival rate and living quality of suffer- ers, which is a disease management method worth further exploration.

关 键 词：高龄 房颤合并心力衰竭 路径管理 生存率 生活质量 

分 类 号：R541[医药卫生—心血管疾病]