慢性心力衰竭患者疾病管理后心血管事件及生活质量评价

Health care follow-up after chronic heart failture can reduce cardiovascular events and improve quality of life

目的 评价慢性心力衰竭患者疾病管理对心血管事件的发生和生活质量的影响.方法 观察2007年2月至2008年12月在我院住院被确诊为慢性心力衰竭患者166例,在常规治疗心力衰竭的前提下,按出院顺序分为管理组65例和对照组101例,随访5年对全因死亡、心力衰竭再入院、生活质量的影响.结果 两组患者基线资料差异均无统计学意义,两组具有可比性.管理组在随访期间全因死亡8例,全因死亡率为12.30％（8/65）,对照组全因死亡15例,全因死亡率为14.85％（15/101）,两组比较差异无统计学意义（x2=0.22,P＞0.05）.管理组因心力衰竭再入院率12.30％（9/65）,对照组组因心力衰竭再入院率35.64％（36/101）,二组间差异有统计学意义（x2=9.51,P＜0.05）.管理组患者3年、5年SF-36生活质量调查总得分分别为（114.11±2.76）分,（116.07±15.43）分,均较管理前总得分（91.37 ±2.62）分明显提高,其差异有统计学意义（x2=102.39,P=0.00）,对照组患者出院前,出院后3年、5年SF-36生活质量调查表的总得分分别为（92.65±3.65）分,（90.09±5.12）分,（89.08±5.71）分,评分下降,两组比较差异有统计学意义（x2=102.39,P=0.00）.结论 对心力衰竭患者进行随访管理不能显著降低全因死亡率,但通过随访管理可明显降低心力衰竭再入院率并改善生活质量.

Objective To observe the impatcts of health care follow-up after chronic heart faihure on cardiovascular events and qualigy of life. Methods One hundred and sixty-six patients who were confirmed to have chronic heart failture in our hospital during February 2007 and December 2008 were enrolled in this investigation. The patients were then assigned to the health management group （n=65） or the non-health management group （n=101） and followed up for 5 years. All-cause mortality, readmission for heart faihure and quality of life （SF-36 score） were evaluated. Results There was no significant difference of all-cause mortality between the two groups （health management group： 12.30% （8/65）; non-health management group： 14.85% （15/101; X2=0.22, P〉0.05）, although a statistically significant difference of readmission rate was found between the two groups （health management group： 12.30% （9/65）; non-health management group： 35.64% （36/101; X2=9.51, P〈0.05）. In health management group, the scores of SF-36 were significantly increased at 3 （114.11 ± 2.76） or 5 years （116.07 ± 15.43） when compared with baseline （91.37± 2.62） （X2 =102.39, P〈0.05）. For the non-health management group, the scores of SF-36 were significantly decreased from 92.65±3.65 at baseline to 90.09±5.12 at 3 years or 89.08±5.71 at 5 years （X2= 102.39, P〈0.05）. Conclusion Health care follow-up after chronic heart failture may not decrease all-cause mortality, although can decrease readmission rate and improve quality of life of the patients.