院外管理提高慢性心力衰竭患者的康复效果

Effects of Extramural Hospital Management in Improving Rehabilitation Effect for Patients with Chronic Heart Failure

目的探讨院外管理对慢性心力衰竭患者症状困扰、日常活动能力及再次住院率的影响。方法便利选取2012年5月至2013年3月慢性心力衰竭患者84例,按住院号的奇偶性分为对照组43例和试验组41例,对照组给予常规的出院指导及电话随访,试验组在此基础上实施院外管理,即在出院后第1周及第1、2、3个月给予院外指导、症状评估、自我护理实施情况评估。于出院前、出院后3个月对研究对象进行症状困扰测评及6min步行试验,并比较两组患者出院后3个月内因心力衰竭急诊或再次住院的相关数据。结果出院3个月后,试验组患者呼吸困难、疲劳、心悸、胸闷以及水肿困扰程度较对照组明显减轻,6min步行距离较对照组明显增加(P<0.05或P<0.01);试验组患者因心力衰竭急诊和再次住院的比例均低于对照组,差异有统计学意义(P<0.05)。结论有效的院外管理能够减轻心力衰竭患者的症状困扰,改善运动功能状态,降低急诊就诊率和再次住院率。

Objective To explore the effects of extramural hospital management on symptom distress （SD）,daily activities ability and readmission rate for patients with chronic heart failure.Methods From May 2012 to March 2013,totally 84 chronic heart failure patients were randomly divided into control group （n =43） and study group（n =41） according to the admission number.Patients in both groups were given routine discharge guidance and telephone follow-up,while patients in the study group were given additional extramural hospital management first week,one month,2 months,and 3 months after discharge,including discharge guidance,symptom assessment nursing implementation situation.Symptom distress questionnaire（SDQ）and 6-minute walk test （SMWT） were performed in both groups on discharge and 3 months after discharge.Data about hospital and emergency readmissions during the 3 months were collected and compared at the same time.Results Compared with control group,symptom distress score was significantly lower in study group and results of 6-minute walk test were significantly increased （P＜0.05 or P＜0.01）.Hospital readmission and emergency department visits rates were significantly lower in study group （P＜0.05）.Conclusion Extramural hospital management for patients with heart failure may reduce symptom distress and contribute to increasing exercise capacity and decreasing hospital readmission and emergency department visits rates.