基于无缝管理理念的MDT模式对CHF患者的临床疗效及其H-FABP、cTnI水平与心功能的关系研究  

Clinical efficacy of MDT mode based on seamless management concept on CHF patients and the association of H-FABP,cTnI levels with cardiac function

作　　者：张峰 田亚男 张晓敏 王静[1] ZHANG Feng;TIAN Ya-nan;ZHANG Xiao-min;WANG Jing(Department of Cardiology,First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei,075000,China)

机构地区：[1]河北北方学院附属第一医院心内科,河北张家口075000

出　　处：《心血管康复医学杂志》2024年第4期439-445,共7页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨无缝管理理念下的多学科协作(MDT)模式对慢性心力衰竭(CHF)患者的临床疗效,并分析心型脂肪酸结合蛋白(H-FABP)、心肌肌钙蛋白I(cTnI)水平与心功能指标的相关性。方法:纳入2020年11月-2021年11月本院收治的222例CHF患者,根据随机数字表法分为对照组(111例,采用MDT模式干预)和实验组(111例,采用无缝管理理念联合MDT模式干预)。干预一个月后,采用心力衰竭自我管理量表评价两组患者临床疗效,并比较两组干预前后明尼苏达心力衰竭生活质量问卷(MLHFQ)评分、H-FABP、cTnI水平及心功能指标,采用Pearson相关分析法分析H-FABP、cTnI水平与心功能指标的相关性。结果:干预一个月后,与对照组比较,实验组心力衰竭自我管理量表得分[(50.04±6.08)分比(72.07±5.65)分]、左室射血分数(LVEF)[(36.23±3.68)%比(43.42±3.36)%]、6min步行距离(6MWD)[(228.35±28.78)m比(337.29±32.31)m]均显著增加,MLHFQ评分[(40.14±3.25)分比(33.05±4.61)分]、H-FABP[(5.97±0.57)ng/ml比(2.77±0.59)ng/ml]、cTnI[(3.34±0.33)ng/ml比(2.45±0.61)ng/ml]水平均显著降低(P均<0.001)。CHF患者H-FABP、cTnI水平随心功能分级提升呈显著上升趋势(P均<0.001)。Pearson相关分析显示,H-FABP、cTnI与LVEF、6MWD呈显著负相关(r=-0.745~-0.676,P均<0.001),与BNP水平呈显著正相关(r=0.705、0.668,P均<0.001)。结论:无缝管理理念的MDT模式应用于CHF的临床治疗,能显著改善患者生活质量及心功能,联合H-FABP、cTnI检测对指导CHF患者预后评估及心功能监测具有重要临床意义。Objective:To explore the clinical efficacy of the multidisciplinary team(MDT)mode under the seamless management concept on patients with chronic heart failure(CHF),and analyze the correlation among levels of heart-type fatty acid binding protein(H-FABP),cardiac troponin I(cTnI)and cardiac function indexes.Methods:A total of 222 CHF patients treated in our hospital from November 2020 to November 2021 were enrolled and divided into control group(n=111,MDT mode intervention)and experimental group(n=111,seamless management concept combined MDT mode intervention)according to random number table.After 1-month intervention,heart failure self-management scale was used to assess clinical efficacy of two groups,score of Minnesota Living with Heart Failure Questionnaire(MLHFQ),H-FABP and cTnI levels and cardiac function indexes were compared between two groups before and after intervention.Pearson correlation analysis was used to analyze the correlation among H-FABP,cTnI levels and cardiac function indexes.Results:After one month,compared with control group,there were significant rise in score of heart failure self-management scale[(50.04±6.08)points vs.(72.07±5.65)points],left ventricular ejection fraction(LVEF)[(36.23±3.68)%vs.(43.42±3.36)%],6min walking distance(6MWD)[(228.35±28.78)m vs.(337.29±32.31)m],and significant reductions in MLHFQ score[(40.14±3.25)points vs.(33.05±4.61)points],levels of H-FABP[(5.97±0.57)ng/ml vs.(2.77±0.59)ng/ml]and cTnI[(3.34±0.33)ng/ml vs.(2.45±0.61)ng/ml]in experimental group(P<0.001 all).H-FABP and cTnI levels significantly increased in CHF patients as cardiac function class increased(P<0.001 all).Pearson correlation analysis indicated that H-FABP and cTnI levels were significant inversely correlated with LVEF and 6MWD(r=-0.745~-0.676,P<0.001 all),and significant positively correlated with BNP level(r=0.705,0.668,P<0.001 both).Conclusion:Seamless management concept-based MDT mode can significantly improve the quality of life and cardiac function in CHF patients.Combined detectio

关 键 词：心力衰竭 病人医护管理 脂肪酸结合蛋白类 肌钙蛋白I 

分 类 号：R541.61[医药卫生—心血管疾病]