老年慢性心力衰竭患者自我容量管理方案的构建及应用  

Construction and application of self-volume management programs for elderly patients with chronic heart failure

作　　者：果迪 孙超[2] 王蕾[2] 胡慧秀[2] 赵雅洁 张军[1] 蔺亚婷 GUO Di;SUN Chao;WANG Lei;HU Huixiu;ZHAO Yajie;ZHANG Jun;LIN Yating(Cardiology Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing,100730,China)

机构地区：[1]北京医院心内科/国家老年医学中心/中国医学科学院老年医学研究院,北京市100730 [2]北京医院心内科/国家老年医学中心/中国医学科学院老年医学研究院护理部,北京市100730

出　　处：《中国护理管理》2024年第7期967-972,共6页Chinese Nursing Management

基　　金：辽宁省“揭榜挂帅”科技项目课题(2022JH1/10800072);中央高水平医院临床科研业务费(BJ-2021-215);中央高水平医院临床科研业务费(BJ-2023-212);中央高水平医院临床科研业务费(BJ-2023-137)。

摘　　要：目的:构建老年慢性心力衰竭患者自我容量管理方案并评价其临床应用效果,以期提高老年慢性心力衰竭患者的自我护理能力。方法:基于计划行为理论,运用德尔菲法构建老年慢性心力衰竭患者自我容量管理方案,方案包括行为态度、主观规范、知觉行为控制、行为意向到行为产生4个维度。便利选取北京市某三级甲等医院2022年6月至2023年1月入院的老年慢性心力衰竭患者为研究对象,以2022年6月—9月的47例患者为对照组,采用常规护理方法;以2022年10月至2023年1月的44例患者为干预组,采用常规护理结合自我容量管理方案的方法。3个月后,比较两组患者的自我护理能力、容量相关指标、心血管不良事件发生率。结果:3个月后,干预组患者的自我护理能力得分低于对照组(P<0.001),脑钠肽水平和体质量降低幅度大于对照组(P<0.001);干预组患者的左室舒张末内径缩小,对照组患者左室舒张末内径扩大,两组变化趋势不同(P=0.036);两组患者心血管不良事件发生率比较,差异无统计学意义(P=0.138)。结论:本研究构建的老年慢性心力衰竭患者自我容量管理方案的应用可以提高患者的自我管理能力和容量管理效果,可为老年慢性心力衰竭的自我容量管理提供参考。Objective:To construct a self-volume management program in elderly patients with chronic heart failure and and evaluate its application effectiveness,so as to improve their self-care ability.Methods:Based on the Theory of Planned Behavior,the program of self-volume management for elderly patients with chronic heart failure was constructed with Delphi method,including behavioral attitude,subjective norms,perceived behavioral control,behavioral intention to generation.Elderly patients with chronic heart failure admitted to a tertiary grade A hospital in Beijing from June 2022 to January 2023 was selected by convenient sampling.Those were admitted from June to September 2022 were set as the control group(n=47),and they were with routine nursing care.Those were admitted from October 2022 to January 2023 were set as the intervention group(n=44),and they were with routine nursing care combined with self-volume management.Self-care ability,volumerelated indicators,and the incidence of adverse cardiovascular events were compared between the two groups after 3 months.Results:After 3 months,the self-care ability score of the patients in intervention group was lower than that of the control group(P<0.001),and the decrease in brain natriuretic peptide levels and weight loss was greater than that of the control group(P<0.001).The left ventricular end diastolic diameter of the the patients in intervention group decreased,while the control group expanded,the trend of changes in the two groups was statistically different(P=0.036).There was no statistically significant difference in the incidence of cardiovascular adverse events between the two groups(P=0.138).Conclusion:The self-volume management programs constructed in this study are benefit to improve the self-management ability and volume management effects of elderly patients with chronic heart failure,and can provide a reference for self-volume management in this population.

关 键 词：老年 慢性心力衰竭 容量管理 自我管理 计划行为理论 方案构建 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]