探究居家慢性心力衰竭患者出入量监测纵向情况与预后的关系

To explore the relationship between longitudinal condition of the intake and output monitoring and prognosis in patients with chronic heart failure at home

目的分析慢性心力衰竭(chronic heart failure,CHF)患者入院至出院居家不同时期出入量监测现况,探究其与疾病预后的关系。方法采用方便抽样,纳入2021年6月-2022年6月某三级甲等医院收治的128例CHF患者为研究对象。对患者和照顾者开展规范化住院健康教育、居家出入量监测指导、出院电话与门诊随访等。于患者入院时、出院时、出院后1个月、3个月、6个月纵向收集患者不同时期出入量监测情况与预后相关指标,并进行相关性分析。结果(1)从入院到出院后6个月,CHF患者的出入量居家监测合格率分别为入院时14.2%,出院时79.7%,随访1个月、3个月、6个月时分别为60.9%、50%、40.6%,呈现下降趋势。(2)重复测量方差分析结果显示:不同时期患者预后相关症状发生率(呼吸困难、水肿)、心功能指标(NT-proBNP)、再住院率随出院时间延长,呈现风险升高趋势(P<0.05)。(3)出院后1个月、3个月、6个月,居家出入量监测不合格患者症状发生率、NT-proBNP高于监测合格患者。出院后3个月、6个月监测不合格患者再住院率显著高于合格者,差异有统计学意义(P<0.05)。结论CHF患者落实出入量监测是容量管理的重要内容。目前患者居家出入量监测状况不容乐观。不同时期监测情况与CHF居家疾病预后有显著相关性,建议结合随访期患者需求优化方案,着重提升出院后3个月与6个月患者的出入量监测能力,改善预后。

Objective To analyze the status of the intake and output monitoring of chronic heart failure(CHF)patients in different periods from admission to home,and to explore its relationship with the prognosis of disease.Methods A total of 128 CHF patients admitted to a tertiary A hospital from June 2021 to June 2022 were selected as the study objects by convenience sampling.The monitoring of patients'intake and output and prognostic related indicators was longitudinally collected at the time of admission,discharge,and 1 month,3 month,6 month after discharge,and the correlation between the qualified rates and prognosis were analyzed.Results(1)From admission to 6 months after discharge,the qualified rate of home monitoring of CHF patients was 14.2%at admission,79.7%at discharge,and 60.9%,50%,and 40.6%at 1 month,3 month,and 6 month of follow-up,respectively,while with a decreasing trend.(2)The results of repeated measurement ANOVA showed that the incidence of prognostic related symptoms(dyspnea,edema),cardiac function index(NT-proBNP),and the readmission rate of patients in different periods increased with the time of discharge,showing an increasing risk trend(P<0.05).(3)The incidence of symptoms and NT-proBNP in patients with unqualified monitoring status were higher than those in qualified monitoring patients at 1 month,3 month,and 6 month after discharge.The re-hospitalization rate of unqualified patients was significantly higher than that of qualified patients at 3 month and 6 month after discharge,with statistical significance(P<0.05).Conclusions Monitoring the volume of CHF patients is an important part of volume management.At present,the monitoring status of patients'intake and output is not optimistic.There is a significant correlation between the monitoring status at different periods and the prognosis of CHF at home.It is suggested to optimize the home management plan combined with patients'needs during the follow-up period,and focus on improving patients'monitoring ability at 3 month and 6 month after discharge to improve the prognosis.