慢性心力衰竭患者自我管理快速决策轮的设计及应用

doi:10.3761/j.issn.0254-1769.2023.12.009

摘要/Abstract

摘要：

目的研制并探讨自我管理快速决策轮在慢性心力衰竭患者中的应用效果。方法在文献回顾及患者访谈基础上，研制适用于各知识层次的慢性心力衰竭患者自我管理快速决策轮。选取2021年7月—2022年6月入住浙江省某三级甲等医院符合标准的慢性心力衰竭患者作为应用对象，其中2022年1月—6月的80例作为试验组，2021年7月—12月的85例作为对照组。试验组在传统管理的基础上配套使用决策轮进行自我管理，对照组实施传统管理。比较两组出院后1、3个月的自我护理能力、二氧化碳通气当量斜率、心血管不良事件发生率及再住院率的差异。结果共脱落3例，最终试验组78例，对照组84例。重复测量方差分析结果显示，不同时间点两组自我护理能力、二氧化碳通气当量斜率的时间效应、组间效应及交互效应均具有统计学意义（P<0.05），且试验组均优于对照组。出院3个月后，试验组心血管不良事件发生率及再入院率均低于对照组（均P<0.001）。结论该研究构建的自我管理快速决策轮具有较好的科学性和实用性，能有效提升慢性心力衰竭患者自我护理能力、改善患者预后、降低再住院率。

关键词: 心力衰竭, 自我管理, 生活质量, 延续护理

Abstract:

Objective To develop and explore the application effect of the self-management decision wheel in patients with chronic heart failure（CHF）. Methods Based on literature review and patient interviews，a self-management decision wheel for CHF patients at all levels of knowledge was developed. Patients with CHF who were admitted to a tertiary A hospital in Zhejiang province from July 2021 to June 2022 were selected as the research subjects，among which 80 patients from January to June 2022 were taken as the intervention group，and 85 patients from July to December 2021 were selected as the control group. The intervention group used the decision wheel for self-management on the basis of the traditional management，and the control group was managed according to the traditional method. Self-care ability，carbon dioxide ventilation equivalent slope（VE/VCO₂ slope），major adverse cardiac events，and re-hospitalization rates were compared at 1th and 3th after intervention between the 2 groups. Results A total of 3 cases were dropped，and 78 cases in the final experimental group and 84 cases in the control group. The results of repeated measurement analysis of variance showed that at different time points the self-care ability， time effect of VE/VCO₂ slope，inter group effect，and interaction effect of the two groups were statistically significant（P<0.05），and the experimental group was superior to the control group. The incidence of cardiovascular adverse events and the re-hospitalization rate in the experimental group were lower than those in the control group at 3 months（P<0.001）. Conclusion The self-management decision tool constructed in this study is more scientific and practical，and it can effectively improve the self-care ability of patients with CHF，improve the patient prognosis，and reduce the rate of re-hospitalization.

Key words: Heart Failure, Self-Management, Quality of Life, Continuing Nursing

祝海香, 庄一渝, 韩小雪, 杨帆, 吴缘, 许启锦. 慢性心力衰竭患者自我管理快速决策轮的设计及应用[J]. 中华护理杂志, 2023, 58(12): 1469-1475.

ZHU Haixiang, ZHUANG Yiyu, HAN Xiaoxue, YANG Fan, WU Yuan, XU Qijin. Design and application of a self-management tool in patients with chronic heart failure[J]. Chinese Journal of Nursing, 2023, 58(12): 1469-1475.

图/表 7

图1 慢性心力衰竭患者自我管理决策轮内容

Figure 1 Content of the self-management tool for CHF patients

图2 决策轮正面

Figure 2 Front face of the decision wheel

图3 决策轮背面

Figure 3 Back side of the decision wheel

表1 两组一般资料比较

Table 1 Comparison of general data between the 2 groups

表2 两组不同时间点自我护理能力、二氧化碳通气当量斜率比较（$\bar{x}\pm s$）

Table 2 Comparison of self-care behavior and VE/VCO2 slope in 2 groups（$\bar{x}\pm s$）

表3 两组心血管不良事件及再入院情况的比较[例（百分率，%）]

Table 3 Comparison of cardiovascular adverse events and readmissions in the 2 groups[cases（percentages，%）]

表4 两组不同时间点最大摄氧量、左心室射血分数的比较

Table 4 Comparison of maximum oxygen uptake and left ventricular ejection fraction between 2 groups at different time points

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