三甲医院指导下社区慢性心力衰竭患者按分期管理的效果分析  

Effect analysis of community chronic heart failure patients managed by stages under the guidance of third-class hospitals

作　　者：黄宇理[1] 姚慧强 张先林[1] 徐琼[1] 周彤[1] 王冬梅[1] 缪安琦 HUANG Yuli;YAO Huiqiang;ZHANG Xianlin;XU Qiong;ZHOU Tong;WANG Dongmei;MIAO Anqi(Department of Cardiology,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院心内科,安徽蚌埠233004

出　　处：《中华全科医学》2023年第6期977-980,1007,共5页Chinese Journal of General Practice

基　　金：安徽省高校人文社会科学研究重点项目(SK2020A0351)。

摘　　要：目的社区医护在三甲医院心力衰竭(简称心衰)中心团队指导下对社区慢性心衰患者实施分期目标管理,分析管理前后目标效果的变化。方法2021年6—12月共入选760例30~92岁蚌埠市4家社区卫生服务中心的慢性心衰患者。由蚌埠医学院第一附属医院心衰中心医生指导社区医院按慢性心衰分期随访管理1年。主要观察指标包括管理前后患者对心衰的知晓率、标准化药物使用率、标准化药物达标率、生活质量评分、年住院率。结果患者对心衰的知晓率上升(55.45%vs.97.63%,χ^(2)=178.031,P=0.002);心衰患者β受体阻滞剂使用率上升(22.75%vs.92.89%,χ^(2)=296.121,P=0.001),血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)/沙库巴曲缬沙坦(ARNI)使用率上升(46.21%vs.90.28%,χ^(2)=186.173,P=0.002),螺内酯使用率上升(63.27%vs.91.70%,χ^(2)=120.312,P=0.003);β受体阻滞剂达标率上升(5.92%vs.83.65%,χ^(2)=328.231,P=0.001),ACEI/ARB/ARNI达标率上升(12.56%vs.82.70%,χ^(2)=296.224,P=0.001),螺内酯达标率上升(43.36%vs.85.55%,χ^(2)=178.321,P=0.002);生活质量评分改善(t=95.311,P=0.003),年住院率下降(45.50%vs.24.41%,χ^(2)=85.252,P=0.004)。结论三甲医院指导下社区慢性心衰患者按分期规范化管理模式,提高了心衰患者控制率和生活质量,减少再住院,也提高了社区医生心衰防治水平,从而推进分级诊疗政策持续实施。Objective Under the guidance of the team of the heart failure center of the third-class hospital,community doctors and nurses implemented target management for community patients with chronic heart failure by stages,and analyzed the target effect of management.Methods A total of 760 chronic heart failure patients aged 30-92 from four community health service centers in Bengbu City were selected from June to December in 2021.Community hospitals were guided by doctors from the Heart Failure Center of the First Affiliated Hospital of Bengbu Medical College to follow up and manage chronic heart failure in stages for one year.The main observation indicators included patient awareness of heart failure,standardized drug usage rate,standardized drug compliance rate,quality of life score,and annual hospitalization rate before and after management.Results The awareness rate of heart failure among patients increased(55.45%vs.97.63%,χ^(2)=178.031,P=0.002).The usage rate ofβreceptor blockers increased in heart failure patients(22.75%vs.92.89%,χ^(2)=296.121,P=0.001),the usage rate of angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)/angiotensin receptor and neprilysin inhibitor(ARNI)increased(46.21%vs.90.28%,χ^(2)=186.173,P=0.002),and the usage rate of spironolactone increased(63.27%vs.91.70%,χ^(2)=120.312,P=0.003).The compliance rate ofβreceptor blockers increased(5.92%vs.83.65%,χ^(2)=328.231,P=0.001),the compliance rate of ACEI/ARB/ARNI increased(12.56%vs.82.70%,χ^(2)=296.224,P=0.001),and the compliance rate of spironolactone increased(43.36%vs.85.55%,χ^(2)=178.321,P=0.002).The quality of life score improved(t=95.311,P=0.003),and the annual hospitalization rate decreased(45.50%vs.24.41%,χ^(2)=85.252,P=0.004).Conclusion Under the guidance of tertiary hospitals,the standardized management by stages for community chronic heart failure patients has improved the control rate and quality of life of heart failure patients,reduced readmission,and improved the level of heart failure prevention

关 键 词：慢性心力衰竭 分期管理 社区卫生服务 

分 类 号：R541.6[医药卫生—心血管疾病] R197.61[医药卫生—内科学]