Effect of Optimal Care + Volume Self-management on Quality of Life in Patients with Chronic Heart Failure
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摘要:
目的 探讨优护+容量自我管理模式对慢性心力衰竭患者心功能及生存质量的影响。 方法 将72例慢性心力衰竭患者随机数字表法分为对照组和观察组各36例。对照组给予常规健康宣教及电话随访；干预组开展优护+容量自我管理模式。分别于干预前、干预后3个月、干预后6个月评估2组患者的阶段性行为改变状况，评价2组患者的心功能及生存质量，对比2组患者出院30 d内再入院率。 结果 干预后3个月、6个月，干预组处于行为改变阶段的分别为44.4%和63.9%，且干预组处于行动维持阶段的人数明显多于对照组，差异有统计学意义（P < 0.05）；干预后3个月、6个月，干预组6MWT距离均高于对照组，差异有统计学意义（P < 0.05）；干预后6个月，2组的时间与组间交互效应，差异有统计学意义 (F = 5.928，P < 0.05)。与对照组相比，干预组6MWT距离随着干预时间的延长而呈缓慢上升的趋势；干预后6个月，干预组的生存质量总分、身体领域、情绪领域及其他领域均比同期对照组高，差异有统计学意义（P < 0.05）；干预组出院30 d内再入院率明显低于对照组，差异有统计学意义（P < 0.05）。 结论 开展优护+容量自我管理模式，能有效改善慢性心力衰竭患者心功能及生存质量，降低再次入院率，减轻心衰对世界卫生医疗系统及社会经济环境的压力，真正实现院外有效长期自我管理的目标。 Abstract:Objective To explore the effect of optimal care + volume self-management model on cardiac function and quality of life in patients with chronic heart failure. Method 72 patients with chronic heart failure were randomly divided into control group （n = 36） and observation group （n = 36）. The control group was given routine health education and telephone follow-up, and the intervention group received the model of optimal nursing + volume self-management. Before intervention, 3 months after intervention and 6 months after intervention, the stage behavior changes of patients in the 2 groups were evaluated, the cardiac function and quality of life of patients in the 2 groups were evaluated, and the readmission rate within 30 days after discharge was compared between the 2 groups. Results At 3 and 6 months after intervention, 44.4% and 63.9% of the intervention group were in the stage of behavior change, and the number of the intervention group in the stage of action maintenance was significantly higher than that of the control group, the difference was statistically significant （P < 0.05）. At 3 and 6 months after intervention, the 6MWT distance in the intervention group was higher than that in the control group, with statistical significance （P < 0.05）. 6 months after intervention, there was a significant difference in time and interaction between the two groups （F = 5.928, P < 0.05）. Compared with the control group, the 6MWT distance in the intervention group increased slowly with the extension of the intervention time. 6 months after intervention, the total score of quality of life, physical domain, emotional domain and other domains in the intervention group were higher than those in the control group, and the difference was statistically significant （P < 0.05）. The readmission rate within 30 days after discharge in the intervention group was significantly lower than that in the control group, with statistical significance （P < 0.05）. Conclusion The optimal care + capacity self-management model can effectively improve the cardiac function and quality of life of patients with chronic heart failure, reduce the readmission rate, reduce the pressure of heart failure on the world health care system and social and economic environment, and truly achieve the goal of effective long-term self-management outside the hospital. -
Key words:
- Chronic heart failure /
- Volume management /
- Information platform /
- Self-management /
- Extended nursing
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表 1 CHF患者及照顾者的路径式容量自我管理培训
Table 1. Path-based volumn self-management training program for CHF patients and caregivers
时间 项目 内容 住院第1天 自我评估 基础疾病评估：冠心病、高血压、心肌病等 心功能NYHA分级：I、II、III、IV 水肿分级：1级、2级、3级 住院第2天 饮食管理 低盐饮食 轻度：2～3 g/d 中重度：<2 g/d 液体摄入量 轻度水肿：1.5～2 L/d 中重度水肿：前1 d出量减500 mL（负平衡） 住院第3天 容量管理 尿量 准确的测量工具 正确的记录方法 体质量 晨起空腹、排空膀胱、同重量衣物、同测量工具 住院第4天 利尿剂管理 用药效果观察、不良反应鉴别、调整用量策略 住院第5天 体征管理 正确测量血压、脉搏、心率、血糖 住院第6天 康复管理 正确执行运动处方 住院第7～8天 出院准备 指导正确服用出院带药 出院前责任护士利用“优护+”手机APP端推送自制《CHF患者体重管理健康教育手册》及《CHF患者体重管理日记》，“一对一”加“面对面”对CHF患者进行出院前辅导，制定以体重为指导的个体化自我管理方案 
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表 2 2组患者基于“优护+”平台的行为改变阶段比较 [n（%）]
Table 2. Comparison of behavioral change stages between two groups based on preferential nursing+ platform [n（%）]
分组 干预前 干预后3个月 干预后6个月 改变前期 改变期 改变前期 改变期 改变前期 改变期 对照组 34（94.4） 2（6.7） 29（80.6） 7（19.4） 28（77.8） 8（22.2） 干预组 33（91.7） 3（8.3） 20（55.6） 16（44.4） 13（36.1） 23（63.9） χ2 0.215 5.175 12.746 P 0.643 0.023* 0.000* *P < 0.05。
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表 3 干预前后2组患者6MWT距离比较[（
$\bar x \pm s $ ），米]Table 3. Comparison of 6MWT distance between the two groups before and after intervention [（
$\bar x \pm s $ ），m]分组 干预前 干预后3个月 干预后6个月 F交互 P 对照组 369.86 ± 49.72 370.11 ± 32.27 370.22 ± 34.95 5.928 0.017* 干预组 371.75 ± 33.37 387.92 ± 33.95 390.94 ± 34.36 t −0.189 −2.281 −2.544 P 0.850 0.026* 0.013* *P < 0.05。
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表 4 干预前后2组生存质量得分比较[（
$\bar x \pm s $ ），分]Table 4. Comparison of quality of life scores between the two groups before and after intervention [（
$\bar x \pm s $ ），scores]指标 时点 对照组 干预组 t P 总分 干预前 91.31 ± 6.74 93.06 ± 6.89 −1.089 0.280 干预后6个月 80.22 ± 9.76 67.28 ± 5.34 6.978 0.000* 身体领域 干预前 57.81 ± 4.78 58.94 ± 5.14 −0.973 0.334 干预后6个月 52.08 ± 7.85 44.64 ± 3.18 5.273 0.000* 情绪领域 干预前 17.14 ± 1.71 17.08 ± 1.89 −0.114 0.909 干预后6个月 13.92 ± 3.34 10.83 ± 3.21 −3.970 0.000* 其他领域 干预前 16.36 ± 2.54 17.93 ± 1.87 −1.547 0.122 干预后6个月 15.17 ± 2.81 11.94 ± 2.33 −4.930 0.000* *P < 0.05。
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表 5 干预后2组出院30 d内再入院率比较[n（%）]
Table 5. Comparison of readmission rates within 30 days after discharge between the two groups after intervention [n（%）]
分组 n 干预后1个月 对照组 36 9（25%） 干预组 36 6（16.66%） χ2 4.229 P 0.047* *P < 0.05。
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