重症心衰患者发生房颤的危险因素及E-Coach管理模式干预的有效性  

Risk factors of atrial fibrillation in severe HF patients and effectiveness of E-Coach management mode intervention

作　　者：王丽 杜叶平[2] 李倩[1] 贾素红[3] 胡雪 许艳[1] WANG Li;DU Ye-ping;LI Qian;JIA Su-hong;HU Xue;XU Yan(Department of Emergency,Second People's Hospital of Huaian City,Huaian,Jiangsu,223001,China)

机构地区：[1]淮安市第二人民医院急诊科,江苏淮安223001 [2]淮安市第二人民医院急诊与重症医学部,江苏淮安223001 [3]淮安市第二人民医院ICU,江苏淮安223001 [4]淮安市第二人民医院神经内科,江苏淮安223001

出　　处：《心血管康复医学杂志》2022年第5期538-542,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：江苏省卫生计生委医学科研课题(2018-148)。

摘　　要：目的:探讨重症心力衰竭(HF)患者发生房颤的危险因素及E-Coach管理模式干预的有效性。方法:选择我院收治的120例重症HF合并房颤患者(心衰合并房颤组),120例同期未发生房颤的重症HF患者(心衰无房颤组),分析重症HF患者发生房颤的危险因素。心衰合并房颤组又随机分为常规干预组和E-Coach组(给予E-Coach管理模式干预),各60例。干预治疗出院6个月后,比较两组治疗前后心功能、自我管理评分。结果:二元Logistic回归分析显示,高血压、冠心病、糖尿病、风湿性心脏病、房颤家族史、BNP水平升高均是重症HF患者发生房颤的独立危险因素(OR=3.831~4.654,P均<0.01)。干预6个月后,与常规干预组比较,E-Coach组每搏输出量[(60.48±16.44)ml比(71.61±17.21)ml]、心输出量[(4.47±1.16)L/min比(6.62±1.81)L/min]、自我管理的治疗管理、躯体活动管理、社会心理管理维度评分及总评分[(60.50±5.01)分比(76.58±5.30)分]均显著增加(P均=0.001)。结论:BNP水平升高,以及合并高血压、冠心病、糖尿病、风湿性心脏病及房颤家族史的重症HF患者发生房颤风险增加,E-Coach管理模式可显著改善重症HF合并房颤患者预后。Objective:To explore risk factors of atrial fibrillation(AF)in patients with severe heart failure(HF)and the effectiveness of E-Coach management mode intervention.Methods:A total of 120 severe HF patients with AF treated in our hospital were enrolled as HF+AF group,another 120 severe HF patients not suffering from AF were simultaneously enrolled as HF without AF group.Risk factors for AF in severe HF patients were analyzed.HF+AF group was randomly and equally divided into routine intervention group and E-Coach group(received E-Coach management mode intervention).Heart function and score of self-management were compared between two groups before intervention and six months after discharge.Results:Binary Logistic regression analysis indicated that hypertension,coronary heart disease(CHD),diabetes mellitus(DM),rheumatic heart disease(RHD),AF family history and elevated BNP level were independent risk factors for AF in severe HF patients(OR=3.831~4.654,P<0.01 all).After six-month intervention,compared with routine intervention group,there were significant rise in stroke volume[(60.48±16.44)ml vs.(71.61±17.21)ml],cardiac output[(4.47±1.16)L/min vs.(6.62±1.81)L/min],dimension scores of treatment management,body activity management,social psychologic management and total score of self-management[(60.50±5.01)scores vs.(76.58±5.30)scores]in E-Coach group,P=0.001 all.Conclusion:Elevated BNP level,complicated hypertension,coronary heart disease,diabetes mellitus,rheumatic heart disease and AF family history can lead to increased AF risk in severe HF patients,E-Coach management mode can significantly improve prognosis of severe HF+AF patients.

关 键 词：心力衰竭 心房颤动 危险因素 

分 类 号：R541.6109[医药卫生—心血管疾病]