家庭自我监测在慢性心力衰竭患者管理中的应用价值

Effect of family self-monitoring in patients with chronic heart failure

慢性心力衰竭（CHF）是各种心脏疾病发展的严重阶段,具有高发病率、高致残率、高病死率和再入院率高的特点,严重影响患者生活质量,同时极大消耗医疗卫生资源。国外多个临床研究及荟萃分析提示,对CHF患者进行自我管理可有效降低再住院率、病死率及医疗费用,提高患者生活质量。本研究结合我科自2010年以来开展的CHF患者随访情况，对接受家庭自我临洲和常规治疗的患者进行比较，初步探讨通过出院前培训、强化随访、电话指导等方式加强CHF患析的家庭自我监测，从而达到疾病管理的可行性及有救性。

A total of 130 patients with CHF were divided into self-monitoring group and routine group randomly.All patients were followed for 10-12 months.At the end of follow-up,the proportions of self-monitoring of weight,blood pressure,pulse rate and urine volume in the self-monitoring group were remarkably higher than those in routine group（58.7% vs 30.0%,46.0% vs 18.3%,79.4% vs 23.3%,19.0% vs 5.0%,all P 0.05）.There were 37patients（58.7%）in self-monitoring group while only 11 patients（18.3%）in routine group whose NYHA functional class improved at least 1degree.There was significant difference in the LVEF between the two groups[（41±10）%vs（31±6）%,P0.05].Readmission rate and cardiovascular events rate were significantly lower in self-monitoring group than those in routine group（27.0% vs 53.3%,31.7% vs 65.0%,P 0.05）,but there was no significant difference in mortality.The percentage of patients taking beta-adrenergic receptor blocker was higher in self-monitoring group（69.8% vs 41.7%,P0.05）.In addition,25.4%in selfmonitoring group and 10.0%in routine group achieved the target dose of beta-blocker（P0.05）.