家庭医生遵循《中国心力衰竭诊断和治疗指南》管理慢性心力衰竭的效果评价

Family physicians follow “Chinese Guidelines for the Diagnosis and Treatment of Heart Failure”: effect evaluation on their practice for chronic heart failure

【目的】探讨在家庭医生模式下依照《中国心力衰竭诊断和治疗指南》管理慢性心力衰竭的效果。【方法】2016年9月—2017年9月,将在上海市虹口区凉城新村街道社区卫生服务中心就诊的慢性心力衰竭患者51例,随机分为管理组(26例)和对照组(25例)。管理组给予家庭医生模式的跟踪随访,强化应用肾素-血管紧张素-醛固酮系统拮抗剂、β受体阻滞剂;对照组予常规门诊随访。观察两组患者12个月后N末端脑利钠肽前体水平、左室射血分数、生活质量评分的差异。【结果】两组基线特征差异无统计学意义。经过12个月干预后,两组之间N末端脑利钠肽前体水平[(717.15±196.78)和(851.88±182.33)ng/L,P<0.05]、生活质量评分[36条简明健康问卷(82.54±7.00与78.08±5.92,P<0.05)以及明尼苏达心衰生活质量量表得分(40.50±6.35与44.00±5.42,P<0.05)]差异均有统计学意义。【结论】家庭医生严格按照循证指南对慢性心力衰竭患者进行规范化管理,是一种行之有效的管理模式。

[Objective]To evaluate the efficacy of management of patients with chronic heart failure by family physician,who followed Chinese Guidelines for the Diagnosis and Treatment of Heart Failure.[Methods]A total of 51 patients with chronic heart failure visiting Shanghai Hongkou District Liangcheng New Village Community Health Service Center from September 2016 to September 2017 were investigated.All the patients were randomly divided into two groups:management group(n=26)and control group(n=25).In the management group,the patients received follow-up,health education and exercise diet guidance by family physicians.They took RAAS antagonist andβ-blocker,gradually increasing the dosage until the target dose was reached.In the control group,the patients received regular outpatient follow-up.NT-proBNP,LVEF,quality of life score of patients in the two groups before and after treatment were compared in the study.[Results]No significant differences were observed between the two groups at baseline.But significant differences were found between the two groups after 12-month follow-up(management group vs.control group):NT-proBNP[(717.15±196.78)pg/mL vs.(851.88±182.33)pg/mL,P<0.05];quality of life score[SF-36,(82.54±7.00 vs.78.08±5.92,P<0.05),MLHFQ(40.50±6.35 vs.44.00±5.42,P<0.05)].[Conclusion]Combination of evidence-based medicine and family physician mode management for patients with chronic heart failure is feasible and effective.