慢性病轨迹模式对射血分数保留型心力衰竭患者预后的影响  

Effects of chronic illness trajectory model management on outcome of patients with heart failure with preserved ejection fraction

作　　者：孙云[1] 万进东 王丹[2,3] 杨怡 夏思维 王沛坚[2,3] SUN Yun;WAN Jin-dong;WANG Dan;YANG Yi;XIA Si-wei;WANG Pei-jian(Party Secretary Office,The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China;Department of Cardiology,The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China;Key Laboratory of Aging and Vascular Homeostasis, Sichuan Provincial Universities, Chengdu 610500, China)

机构地区：[1]成都医学院第一附属医院党委书记办公室,四川省成都市610500 [2]成都医学院第一附属医院心血管内科,四川省成都市610500 [3]成都医学院第一附属医院衰老与血管稳态四川省高校重点实验室,四川省成都市610500

出　　处：《中国心血管病研究》2019年第8期704-708,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金项目(81400289);四川省杰出青年学术技术带头人资助计划(2016JQ0032);四川省护理科研项目(H18005);四川省教育厅科研创新团队项目(18TD0030);四川省医学会科研项目(S15022);四川省老年医学临床医学研究中心专项科研基金项目(SCLNZX1808):成都医学院科研创新团队项目(CYTD16-01);成都医学院科研基金项目(CYZ14-017).

摘　　要：目的探讨慢性病轨迹模式(CITM)管理在射血分数保留型心力衰竭(HFpEF)患者中的应用效果.方法本研究共纳入458例HFpEF患者,按随机数字表法分为两组:CITM组226例(给予以指南为导向的CITM管理)和对照组232例(给予常规诊疗和随访管理).随访12个月,比较两组患者干预前后的自我管理量表(SCHFI)、生活质量量表(KCCQ)、负性情绪评分以及再住院率和病死率情况.结果干预前,两组患者的SCHFI、KCCQ以及负性情绪评分均无明显差异(P>0.05).干预后,两组患者的SCHFI及KCCQ评分明显提高,负性情绪评分均明显降低,且与对照组比较,CITM组改善更加显著(P<0.05).随访12个月,CITM组和对照组分别有36例(15.9%)和83例(35.8%)患者因心力衰竭而再次住院(P<0.05).Cox模型分析结果显示,CITM组患者心力衰竭再住院率较对照组显著降低[风险比(HR)=0.448,95%可信区间(CI)0.322~0.661,P=0.003].结论CITM可以显著提升HFpEF患者的疾病管理质量,明显降低HFpEF再住院率,是一种切实可用的管理模式.Objective To investigate the effectiveness of chronic illness trajectory model (CITM ) management for patients with heart failure with preserved ejection fraction (HFpEF). Methods A total of 458 patients with HFpEF were enrolled in the study. According to the random number generator results, patients were divided into CITM group (giving guidance-oriented CITM management, n=226) and control group (giving routine care and follow-up management,/i=232). After 12 months of follow-up, the self-administration scale (SCHFI), quality o f life scale ( KCCQ) score, negative emotion scores, rehospitalization rate and mortality were compared between the two groups. Results There was no significant difference in SCHFI scores, KCCQ scores and negative emotion scores between the two groups before intervention( P >0.05). After the intervention, the SCHFI score and KCCQ score of both groups were significantly improved, and negative emotion scores were significantly reduced. Compared with the control group, the CITM group improved more significantly(P <0.05). During the follow-up o f 12 months, 3 6 ( 15.9%) and 83(35.8%) of the CITM group and the control group were hospitalized again due to heart failure (P <0.05). Cox model analysis showed that the rate of heart failure rehospitalization was significantly lower in the CITM group [/zaza/Y/ razio (///?)=0.448,95%狀e i.men;a/(C7) 0.322-0.661,P =0.003]. Conclusion CITM can greatly improve the quality of disease management in patients with HFpEF and significantly reduce the rate of HFpEF rehospitalization. It is a practical management model.

关 键 词：慢性病轨迹模式 射血分数保留型心力衰竭 疾病管理 再住院率 生活质量 

分 类 号：R541.6[医药卫生—心血管疾病]