常规社区管理联合中医健康管理对慢性心力衰竭患者短期预后的改善效果研究

Study on the improvement effect of routine community management combined with TCM health management on short-term prognosis of patients with chronic heart failure

目的 研究常规社区管理联合中医健康管理对慢性心力衰竭(CHF)患者短期预后的改善效果。方法 选取上海市两家综合性医院和两家中医医院2019年1-12月出院且居住在医院周边3公里内的CHF患者139例,以及按80%比例抽取2019年1-12月于上述医院周边3公里内的4所社区卫生服务中心就诊且被三级医院明确诊断的CHF患者141例。共计纳入280例CHF患者,其中排除14例,失访脱落7例,最终259例CHF患者纳入分析。采用实用性临床试验法,将CHF患者根据距离中医医院的远近及个人意愿分入干预组和对照组,于2021年6-12月进行常规社区管理或联合中医健康管理干预。通过调查问卷法,确定常规社区管理联合中医健康管理对患者短期预后和心功能改善效果。结果 259例CHF患者平均年龄为(74±8)岁。经倾向性评分匹配后,共90对患者匹配成功。再入院在基层医疗机构水平上不存在聚集性,干预组患者6个月再入院率低于对照组(χ^(2)=10.414,P=0.001),干预组美国纽约心脏病协会(NYHA)分级总体下降明显,生活质量量表评分和N末端B型利钠肽原(NT-proBNP)水平改善效果明显优于对照组,差异有统计学意义(P<0.05)。结论 常规社区管理联合中医健康管理能改善CHF患者短期预后,为基层提供有效的健康管理策略。

Objective To study the effect of routine community management combined with traditional Chinese medicine(TCM)health management on the short-term prognosis of patients with chronic heart failure(CHF).Methods A total of 139 patients with CHF who were discharged from two general hospitals and two traditional Chinese medicine hospitals in Shanghai from January to December 2019 and lived within 3 km around the hospital were selected,and 141 patients with CHF who were admitted to four community health service centers within 3 km around the above hospitals from January to December 2019 and clearly diagnosed in tertiary hospitals were selected according to 80%proportion.A total of 280 patients with CHF were included in this study,including 14 cases excluded,seven cases lost to follow-up,and finally 259 patients with CHF were included in the analysis.Using the practical clinical trial method,CHF patients were divided into the intervention group and control group according to the distance from the hospital of traditional Chinese medicine or personal wishes,and routine community management alone or combined with traditional Chinese medicine health management intervention was carried out.Through the questionnaire method,it was determined whether the conventional community management combined with traditional Chinese medicine health management had more advantages in the short-term prognosis and cardiac function improvement of patients.Results The mean age of 259 patients with CHF was(74±8)years.After propensity score matching,a total of 90 pairs of patients were successfully matched.There was no aggregation of readmission at the level of primary medical institutions.The 6-month readmission rate of the intervention group was lower than that of the control group(χ^(2)=10.414,P=0.001).The Ne w York Heart Association(NYHA)classification of the intervention group decreased significantly,and the quality of life scale score and N-terminal B-type natriuretic peptide(NT-proBNP)level were significantly better than those of the control group,the difference was statistically significant(P<0.05).Conclusion Conventional community management combined with traditional Chinese medicine health management can improve the short-term prognosis of CHF patients and provide effective health management strategies for the grassroots.