慢性心衰病诊疗方案推广验证及社区管理模式研究

Study on Promotion and Verification of Diagnosis and Treatment of Chronic Heart Failure and Community-based Management Mode

目的:将慢性心衰病诊疗方案在社区进行推广验证,探索建立基于社区的心衰病管理模式。方法:入选心衰病人,不设对照组。在常规西医治疗基础上,按中医心衰病诊疗方案予对症治疗,疗程为2～4周。以中医症状改善为主要疗效指标,心功能改善、6min步行试验、生存质量、急性发作程度和次数等为补充指标进行临床治疗方案的验证,比较治疗前后疗效差异。同时通过阶段培训、规范管理等建立心衰病信息化管理网络。结果:将心衰病诊疗方案在社区进行了推广验证,初步建立了基于社区的心衰病管理模式。结论:基于社区的心衰病管理模式是心衰病的有效防治方案。

Objective ： To promote and verify the diagnosis treatment project of chronic heart failure in community and explore the establishment of community - based heart failure disease management mode. Methods ： Selecte patients with heart failure with no control group. On the basis of conventional Western medicine treatment, according to traditional Chi- nese medicine treatment program for patients with heart failure symptomatic treatment, the total treatment time was 2 -4 weeks. The improvement rate of TCM symptoms was the primary effective value,improvement of cardiac function,6 -mi- nute walk test, quality of life, the extent and frequency of acute attacks were the additional indicators for the clinical treat- ment plan verification. Observe the index changes at different time points. At the same time, through the stage of train- ing ,the standard heart failure disease management was initially established. Result ：The diagnosis and treatment of heart failure were promoted and verified in the community, and community -based heart failure disease management mode was initially established. Conclusion ：Community -based heart failure disease management model is an effective disease pre- vention and treatment of heart failure program.