对慢性心力衰竭患者进行院外多因素强化护理干预的研究

Impact of multifactor intensive nursing intervention on chronic heart failure patients with outside hospital treatment

目的探讨院外多因素素强化护理干预对慢性心力衰竭患者自我管理能力及相关临床指标的影响。方法采用前瞻性随机对照方法，将215例出院的心力衰竭患者随机分为普通随访组和强化护理干预组，通过1年的随访观察，最终完成随访的患者共计205例。普通随访组98例仅进行常规的门诊随访，强化护理干预组患者107例接受电话咨询、专门的心力衰竭门诊随诊及定期健康宣教、心理护理。比较干预后2组的自我管理能力及相关的临床指标水平。结果强化护理干预组和普通组相比较，限水限钠达标率和坚持每天监测体质量的比例大幅度增加，强化护理干预组左室射血分数高于普通组；与普通组相比，强化护理干预组NT—pro—BNP降低更明显，且6min步行试验优于普通组。2组再次入院和总心血管事件发生率比较差异有统计学意义，强化护理干预措施显著降低了死亡和再住院联合终点事件的发生率。结论对慢性心力衰竭的患者进行院外强化护理干预，可以提高患者的自我管理能力、改善心功能、降低再住院率和心血管事件发生率。

Objective To observe the efficacy of multifactor intensive nursing intervention on chronic heart failure patients with outside hospital treatment, including self-management ability and related clinical indicators. Methods By application of prospective study, a total of 215 patients with chronic heart failure discharged from hospital were randomized into the usual care group （105 cases） and the intensive nursing intervention group （110 cases）. Patients were followed up for 12 months,and 205 patients completed the follow-up. The usual care group only received conventional outpatient follow-up, the intensive intervention group patients received telephone counseling, more detailed clinical follow-up and regular health education. The intervention effect was compared between two groups. Results Compared with the usual care group, the passing rate of sodium/water limit and daily monitoring of weight was higher in the intensive intervention group. Left ventricular ejection fraction and six-minute walking test were better in the intensive intervention group,while the level of NT-pro-BNP was lower in the intensive intervention group. Compared with the usual care group, re-hospitalization rate and incidence of cardiovascular events were lower in the intensive intervention group. Conclusions Muhifactor intensive nursing intervention is helpful on improving self-management ability, alleviate cardiac function, reduce re-hospitalization rate and incidence of cardiovascular events for chronic heart failure patients.