慢性心力衰竭患者个体化液体摄入管理方案的构建与应用研究

Construction and application of an individualized management scheme of fluid intake for patients with chronic heart failure

目的构建慢性心力衰竭(chronic heart failure,CHF)患者个体化液体摄入管理方案,并分析其应用效果。方法基于前期研究结果,结合入组时体内水分过多(overhydration,OH)值,制订CHF患者个体化液体摄入管理方案。2020年5月—10月通过便利抽样法,选择江苏省某三级甲等医院住院CHF患者278例,随机分为试验组和对照组各139例。试验组采用个体化液体摄入管理方案,对照组采用指南推荐的液体摄入量,分析两组应用效果。结果试验组OH值、估计血浆容量、临床淤血评分、口渴痛苦感、明尼苏达心力衰竭生活质量、出院后3个月和6个月再入院率均低于对照组,差异具有统计学意义(P<0.05);试验组出院后3个月和6个月心源性死亡率较对照组低,但差异无统计学意义(P>0.05)。结论个体化液体摄入管理方案能改善CHF患者的容量状态、缓解口渴痛苦感、提升生活质量、降低再入院率,可为CHF患者的液体摄入管理提供依据。

Objective To construct an individualized management scheme of fluid intake for patients with chronic heart failure(CHF)and discuss its application effect.Methods Based on the previous results of“maximum cumulative fluid balance and number of days for CHF patients with safe volume load”and overhydration(OH)value at the time of entry,an individualized management scheme of fluid intake for patients with CHF was developed.Using the convenience sampling method,278 patients with CHF admitted to a tertiary first-class hospital in Jiangsu Province from May to October 2020 were selected.By the random number table method,the patients were randomly divided into an experimental group(139 cases)and a control group(139 cases).The experimental group adopts an individualized management scheme of fluid intake,and the control group adopts the department’s routine fluid management strategies and we evaluated the effect of the intervention.Results After the intervention,OH value,estimated plasma volume status,Clinical Congestion Scale,Thirst Distress Scale-Heart Failure,the Minnesota Living with Heart Failure Questionnaire,3-and 6-month post-discharge readmission rates in the experimental group were lower than those in the control group(P<0.05).There was no significant difference between 2 groups in 3-and 6-month post-discharge cardiac mortality(P>0.05).Conclusion The individualized management scheme of fluid intake for patients with CHF can improve volume status and quality of life,providing a basis for management of fluid intake for patients with CHF.