联动社区对老年心力衰竭患者液体管理的效果评价  

Study on the effect of liquid management in the elderly patients with heart failure by the linkage between tertiary hospitals and community hospitals

作　　者：崔希增[1] 曹秋梅[2] Cui Xi-zeng;Cao Qiu-mei(Department of Emergency,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院急诊科,北京100730 [2]首都医科大学附属北京同仁医院急诊科全科医疗科,北京100730

出　　处：《中国急救医学》2021年第11期943-949,共7页Chinese Journal of Critical Care Medicine

基　　金：首都全科医学研究专项课题(17QK16)。

摘　　要：目的评价三级医院与社区医院联动对老年心力衰竭患者液体管理在改善患者预后中的效果,以及定期监测N端B型利钠肽原(NT-pro BNP)对老年心力衰竭患者发生因心血管病再住院的预测价值。方法将符合研究标准的老年心力衰竭患者共300例随机分为常规管理组和团队管理组,按照不同的策略进行液体管理,比较两组患者因心血管病再住院率和全因病死率;定期监测患者的NT-pro BNP较基线NT-pro BNP的增加值(△NT-pro BNP),比较无事件患者和因心血管病再住院患者间△NT-pro BNP。结果团队管理组3个月内、6个月内和9个月内因心血管病再住院率均较常规管理组呈轻度下降(分别为13.4%vs.17.4%,24.6%vs.32.6%和34.5%vs.45.7%),团队管理组12个月内再住院率较常规管理组显著下降(43.1%vs.55.8%);团队管理组与常规管理组间3个月内、6个月内、9个月内和12个月内全因病死率差异均无统计学意义(P>0.05);≥80岁患者无事件组和再住院组间△NT-pro BNP差异有统计学意义,其中LVEF<40%以△NT-pro BNP 4154.0 pg/m L为切点,LVEF≥40%以△NT-pro BNP 8795.5 pg/m L为切点,对患者因心血管病再住院有预测价值。结论三级医院与社区医院联动管理老年心力衰竭患者液体可有效降低患者12个月内因心血管病再住院率,但未能降低其12个月内全因病死率;△NT-pro BNP≥4154.0 pg/m L(LVEF<40%)或≥8795.5 pg/m L(LVEF≥40%),对≥80岁的心力衰竭患者发生因心血管病再住院有临床预测价值。Objective To evaluate the effect of liquid management in the elderly patients with heart failure by the linkage between tertiary hospitals and community hospitals in improving the patients’prognosis,and to examine the value of monitoring N-terminal pro-B-type natriuretic peptide(NT-pro BNP)as a predictor of readmission related to cardiovascular disease(CVD)in the elderly patients with heart failure.Methods A total of 300 elderly patients with heart failure were randomly divided into usual management(UM)group and team management(TM)group.Liquid management was carried out according to different strategies separately.Readmission rates related to CVD and all-cause mortality rates between the two groups were compared.The elevation of NT-pro BNP than the baseline,namely△NT-pro BNP,of all the patients were regularly measured.△NT-pro BNP between the event-free patients and the re-hospitalized patients related to CVD were compared as well.Results 3-month,6-month and 9-month readmission rates related to CVD in the TM group were slightly lower(13.4%vs.17.4%,24.6%vs.32.6%and 34.5%vs.45.7%,respectively),while 12-month readmission rates related to CVD was significantly lower(43.1%vs.55.8%)compared with the UM group.There were no significant differences in 3-month,6-month,9-month and 12-month all-cause mortality rates between the TM group and the UM group.In the patients≥80 years,significant difference in△NT-pro BNP was seen between the event-free patients and the re-hospitalized patients related to CVD,and△NT-pro BNP may predict readmission due to CVD when it was over 4154.0 pg/m L in the patients with LVEF<40%,or over 8795.5 pg/m L with LVEF≥40%.Conclusions Liquid management in the elderly patients with heart failure by the linkage between tertiary hospitals and community hospitals can effectively reduce 12-month readmission rate related to CVD,but not 12-month all-cause mortality rate.△NT-pro BNP≥4154.0 pg/m L(LVEF<40%)or≥8795.5 pg/m L(LVEF≥40%)can be a predictor of readmission related to CVD in the pat

关 键 词：心力衰竭 液体管理 NT-PROBNP 

分 类 号：R541.6[医药卫生—心血管疾病]