基于格林模式的健康管理对老年慢性心力衰竭患者营养状况及预后的影响

Impact of Health Management Based on Green's Model on Nutritional Status and Prognosis of Elderly Patients with Chronic Heart Failure

背景老年慢性心力衰竭(CHF)患者常因胃肠道消化、吸收功能障碍而导致营养不良,而营养不良可使患者1年病死率升高至11%。目前改变老年CHF患者既有的思维和行为是护理的难点。格林模式是基于多学科视角的主要重视个体行为转变和信念维持的干预方式,有利于改善其营养状态及预后。目的探讨基于格林模式的健康管理对老年CHF患者营养状况及预后的影响。方法选取2018年2月—2019年6月扬州大学附属医院西院区收治的老年CHF患者49例为观察组,另选取同期本院东院区收治的老年CHF患者49例为对照组。两组患者均给予常规健康宣教及院后随访,同时观察组患者给予基于格林模式的健康管理。比较两组患者干预前后心力衰竭患者微型营养表(MNA-HF)评分、血清白蛋白及血脂水平、心力衰竭生活质量调查问卷(MLHFQ)评分、自我管理能力评分、6 min步行距离(6MWD)及1年再住院率。结果两组患者干预前MNA-HF评分,血清白蛋白、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,MLHFQ、自我管理能力评分,6MWD和干预后血清HDL-C、LDL-C水平及1年再住院率比较,差异无统计学意义(P>0.05)。观察组患者干预后MNA-HF评分、血清白蛋白水平、自我管理能力评分高于对照组,血清TC、TG水平及MLHFQ评分低于对照组,6MWD长于对照组(P<0.05)。对照组、观察组患者干预后MNA-HF评分、血清白蛋白水平、自我管理能力评分分别高于本组干预前,血清TC、TG水平及MLHFQ评分分别低于本组干预前(P<0.05)。结论基于格林模式的健康管理可有效改善老年CHF患者的营养状况及心功能,降低外源性血脂水平,提高自我管理能力。

Background Elderly patients with chronic heart failure(CHF)are often accompanied with digestion and absorption dysfunction,resulting in malnutrition,and malnutrition can increase the 1-year mortality rate to 11%.Changing the existed thinking and behavior of elderly patients with CHF is a problematic point in nursing care.Green's model is based on a multi-disciplinary perspective and emphasizes individual behavior changes and belief maintenance,in order to improve the patients'nutritional status and prognosis.Objective To explore the impact of health management based on Green's model on the nutritional status and prognosis of elderly patients with CHF.Methods From February 2018 to June 2019,49 cases of elderly patients with CHF hospitalized in the West Branch of Affiliated Hospital of Yangzhou University were selected as the observation group,49 cases of elderly patients with CHF hospitalized in the East Branch of the hospital were chosen as the control group.All patients were given regular health education and follow-up after the hospital,and patients in the observation group were given health management based on Green's model.Mini-Nutrition Assessment Special for Heart Failure(MNAHF)scores,serum albumin level and blood lipid level,Minnesota Living with Heart Failure Quality(MLHFQ)score,self-management ability score,6 minute walking distance(6MWD)before and after intervention,and rehospitalization rate within one year were compared between the two groups.Results There was no statistically significant difference in MNA-HF score,serum levels of albumin,total cholesterol(TC),triglycerides(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C),scores of MLHFQ and self-management ability,6MWD before intervention,serum levels of HDL-C and LDL-C after intervention,rehospitalization rate within one year between the two groups(P>0.05).Compared with those in the control group,the observation group showed higher MNA-HF score,serum level of albumin and self-management ability score,lower serum levels of TC,TG and MLHFQ score,longer 6MWD after intervention(P<0.05).After intervention,the MNA-HF score,serum level of albumin,and self-management ability score of the two groups were higher than those before intervention,serum levels of TC,TG,and MLHFQ score were lower than those before intervention,respectively(P<0.05).Conclusion Health management based on Green's model can effectively improve the nutritional status and heart function of elderly patients with CHF,reduce exogenous blood lipid levels,and increase self-management ability.