摘要
目的慢性心力衰竭(chronic heart failure,CHF)是多种心血管疾病的终末阶段,对CHF患者给予积极治疗和良好社区管理可避免心力衰竭加重。本研究探讨社区全科医生管理CHF患者的效果。方法选择上饶市人民医院和北门社区2009-09-01-2015-09-01就诊和管理的186例CHF患者为研究对象,根据组间基本特征匹配的原则分为干预组和对照组,每组93例。干预组由医院高年资全科医生对社区医生进行规范化心力衰竭诊疗培训,医生参与干预组随访管理;对照组进行常规门诊随访,仅记录相关资料。干预24个月后,观察两组心功能、心脏事件、再次住院率和平均住院天数。结果共179例患者完成干预,干预组90例,对照组89例。管理后干预组左心室射血分数为(56.4±3.5)%,优于对照组的(45.7±6.8)%,t=3.791,P<0.001。干预组心功能Ⅰ~Ⅱ级患者48例,多于对照组的36例,χ2=3.242,P=0.035。干预组生活质量评分为(97.8±19.2)分,高于对照组的(89.2±17.6)分,t=-3.848,P<0.001。干预组N端脑钠肽前体水平为(756.15±187.74)ng/L,低于对照组的(890.27±218.23)ng/L,t=-3.010,P=0.012。干预组心功能Ⅲ~Ⅳ级患者42例,少于对照组53例,χ2=4.123,P=0.024。干预组再次住院率为37.8%,低于对照组的60.7%,χ2=5.214,P=0.021。干预组平均住院天数为(8.6±2.6)d,低于对照组的(12.5±3.1)d,t=3.257,P=0.023。干预组和对照组心脏事件发生率分别为5.6%和6.7%,差异无统计学意义,P=0.841。结论社区全科医生对CHF患者进行规范化防治管理可改善心功能、降低再次住院率和缩短住院天数。
OBJECTIVE Chronic heart failure(CHF)is the terminal stage of a variety of cardiovascular diseases.Active treatment and good community management for CHF patients can prevent heart failure from getting worse.This study explored the effect of community general practitioners in the management of CHF patients.METHODS A total of186 patients with CHF who were treated and managed in Shangrao People’s Hospital and Beimen Community from September 1,2009 to September 1,2015 were selected as the research objects.According to the principle of matching basic characteristics between groups,they were divided into intervention group and control group,93 cases in each group.In the intervention group,senior general practitioners in the hospital provided standardized heart failure diagnosis and treatment training to community doctors,and doctors participated in the follow-up management of the intervention group;the control group received regular outpatient follow-up and only recorded relevant information.After 24 months of intervention,the cardiac function,cardiac events,readmission rate and average length of hospital stay were observed in the two groups.RESULTS A total of 179 patients completed the intervention,90 cases in the intervention group and 89 cases in the control group.After management,the left ventricular ejection fraction of the intervention group was(56.4±3.5)%,which was better than that of the control group(45.7±6.8)%,t=3.791,P<0.001.In the intervention group,there were48 patients with cardiac function gradeⅠtoⅡ,more than 36 in the control group,χ2=3.242,P=0.035.The quality of life score of the intervention group was 97.8±19.2,which was higher than that of the control group 89.2±17.6,t=-3.848,P<0.001.The N-terminal pro-brain natriuretic peptide level in the intervention group was(756.15±187.74)ng/L,which was lower than that of the control group(890.27±218.23)ng/L,t=-3.010,P=0.012.In the intervention group,there were 42 patients with heart function gradeⅢtoⅣ,which was less than the control group(53 cases),χ2=4.123,P=0.024.The rehospitalization rate in the intervention group was 37.8%,which was lower than that of the control group(60.7%,χ2=5.214,P=0.021).The average length of stay in the intervention group was(8.6±2.6)d,which was lower than that of the control group(12.5±3.1)d,t=3.257,P=0.023.The incidence of cardiac events in the intervention group and the control group were 5.6%and 6.7%,and the difference was not statistically significant,P=0.841.CONCLUSIONS The standardized prevention and management of CHF patients by community general practitioners can improve the heart function of patients,reduce the rate of re-hospitalization and shorten the length of hospital stay.
作者
郑文
廖玲
张元亚
付星祥
吴成辉
陶明华
郑宜蕾
ZHENG Wen;LIAO Ling;ZHANG Yuan-ya;FU Xing-xiang;WU Cheng-hui;TAO Ming-hua;ZHENG Yi-lei(Department of General Practice,Renmin Hospital of Shangrao,Shangrao 334000,P.R.China)
出处
《社区医学杂志》
CAS
2020年第24期1664-1667,共4页
Journal Of Community Medicine
基金
江西省普通科技计划(20181572)
关键词
慢性心力衰竭
社区综合管理
全科医学
心功能
chronic heart failure
community integrated management
general practice
community medicine
