多学科团队合作干预对老年慢性心力衰竭患者自我管理及液体潴留的影响

Effect of multidisciplinary cooperative intervention on self-management and fluid retention in elderly patients with chronic heart failure

目的:探讨多学科团队(MDT)合作干预提升老年慢性心力衰竭(CHF)患者自我管理及改善液体潴留的临床效果。方法:采用基于医院的便利抽样法,选择桂林医学院附属医院2018年1—12月收治的老年慢性心力衰竭患者130例为研究对象,采用随机数字表法分为对照组和观察组各65例。对照组实施常规护理指导和电话随访,观察组在对照组的基础上通过多学科团队指导患者进行自我管理,干预3个月后比较2组患者自我管理及液体潴留情况。结果:干预3个月后,观察组患者在药物管理、饮食管理、心理和社会适应管理、症状管理4个维度的得分及总分分别为(19.43±0.71)、(11.51±0.59)、(19.07±0.65)、(25.24±1.31)、(72.65±7.16)分,对照组分别为(11.09±3.40)、(6.05±1.71)、(12.73±2.49)、(15.72±4.18)、(46.35±7.83)分,观察组在4个维度的得分及总分情况均优于对照组(t值为4.835~13.727,均P<0.05);干预3个月后观察组患者重度水肿、中度水肿、轻度水肿占比分别为4.61%(3/65)、13.85%(9/65)、81.54%(53/65),对照组分别为38.46%(25/65)、52.31%(34/65)、9.23%(6/65),观察组液体潴留程度优于对照组(Z值为-2.373,均P<0.05)。结论:多学科团队合作干预可提升老年慢性心力衰竭患者自我管理及改善液体潴留。

Objective To explore the clinical effect of multidisciplinary cooperative intervention in improving self-management and improving fluid retention in the elderly patients with chronic heart failure.Methods Totally 130 cases of the elderly patients with chronic heart failure from January to December 2018 were enrolled and were divided into control group and observation group with 65 cases randomly.The control group received routine nursing instruction and telephone follow-up.The observation group was given multidisciplinary team guidance to patients self-management in addition to routine nursing instruction and telephone follow-up.After 3 months,the self-management and fluid retention of the two groups were compared.Results After 3 months of intervention,the scores and total scores of the observation group in the four dimensions of drug management,diet management,psychological and social adaptation management,symptom management were 19.43±0.71,11.51±0.59,19.07±0.65,25.24±1.31,72.65±7.16,the control group was 11.09±3.40,6.05±1.71,12.73±2.49,15.72±4.18,46.35±7.83.The scores and total scores of the observation group were better than those of the control group(t value was 4.835-13.727,all P<0.05).After intervention for 3 months,the proportion of severe edema,moderate edema and mild edema in the observation group was 4.61%(3/65),13.85%(9/65),81.54%(53/65),respectively,and the control group was 38.46%(25/65),52.31%(34/65)and 9.23%(6/65)respectively.The degree of fluid retention in the observation group was better than that in the control group(Z value was-2.373,all P<0.05).Conclusion Multidisciplinary cooperative intervention can improve self-management and improve fluid retention in elderly patients with chronic heart failure.