慢型克山病患者自我管理家庭治疗效果的长期随访与评价

Long-term follow-up and evaluation of the treatment effect of self-administered family therapy of patients with chronic Keshan disease

目的分析评价自我管理家庭治疗(简称家庭治疗)干预方法对慢型克山病患者治疗的长期效果,为提高患者生存率和生活质量提供指导依据。方法采用回顾性分析方法,收集2008-2018年山东省邹城市连续2年以上参加家庭治疗干预项目的慢型克山病患者病例资料,根据患者治疗前后的一般情况、临床体征、心电图、心脏彩超及心功能分级等变化情况综合评价治疗效果和转归。结果共收集74例慢型克山病患者,其中,男33例、女41例,平均年龄为47.63岁;在家庭治疗末次调查时,患者治疗总有效率为78.38%(58/74)。经Fisher确切概率法检验,环境因素对慢型克山病患者的疗效影响显著(P<0.05),表明离开本地区可以影响患者疗效;而患者性别、年龄、职业、心理因素及经济状况对疗效无显著影响(P均>0.05)。家庭治疗前后,患者心胸比率、心功能分级的分布情况有显著差异,且对患者心室高电压情况有显著改善(P均<0.05);患者在家庭治疗前的心功能分级和末次家庭治疗的效果对最后转归情况有显著影响(P均<0.05)。结论开展长期连续的家庭治疗干预对慢型克山病现症患者的疗效有显著影响,能够更好地提升患者的转归。家庭治疗是一项需要长期坚持的科学干预方法。

Objective To analyze and evaluate the long-term effects of self-administered family therapy(family therapy) interventions on patients with chronic Keshan disease, and provide guidance for improving patient survival and quality of life. Methods A retrospective analysis method was used to collect case data of patients with chronic Keshan disease who participated in family therapy intervention projects for 2 consecutive years or more in Zoucheng City, Shandong Province from 2008 to 2018. According to the general conditions, clinical signs, the changes of electrocardiogram, cardiac color ultrasound, cardiac function grading, the therapeutic effect and prognosis were evaluated. Results A total of 74 patients with chronic Keshan disease were studied, including 33 males and 41 females, with an average age of 47.63 years old. At the last survey of family therapy, the total effective rate was 78.38%(58/74). Fisher′s exact probability test showed that environmental factors had a significant effect on the efficacy of patients with chronic Keshan disease (P < 0.05), indicating that leaving the local epidemic area could affect the patient′s efficacy;and the patient′s gender, age, occupation, psychological factors and economic status had no significant effect on the efficacy (P > 0.05). Before and after the family therapy, the distribution of cardiothoracic ratio and cardiac function grading were significantly different, and the ventricular high voltage condition was significantly improved (P < 0.05);the patient′s cardiac function grading before family therapy and the effect of the last family therapy had a significant effect on the final outcomes (P < 0.05). Conclusions The long-term continuous family therapy intervention has a significant effect on the curative effect of patients with chronic Keshan disease, and can improve the prognosis even better. Family therapy is a scientific intervention that requires long-term adherence.