慢性心力衰竭患者院外健康管理程序的构建及应用

doi:10.3761/j.issn.0254-1769.2022.04.003

摘要/Abstract

摘要：

目的构建慢性心力衰竭（chronic heart failure,CHF）患者院外健康管理的应用程序,并验证其应用价值。方法构建由患者版手机端、医护版手机端和电脑版管理端组成的“心管家”应用程序,应用于2017年4月—2018年4月广西壮族自治区某三级甲等医院出院的150例CHF患者的院外健康管理。将出院的150例CHF患者按随机数字表法分为试验组和对照组,各75例。试验组在常规院外健康管理的基础上,实施基于“心管家”应用程序的院外健康管理,对照组采用常规院外健康管理。比较两组患者干预前及干预3个月、6个月和1年后的自我管理能力、生活质量、6 min步行距离、1年后的主要心脏不良事件发生率及无事件存活率。结果两组患者自我管理能力、生活质量和6 min步行距离的时间效应、组间效应及交互效应均有统计学意义（P<0.05）,两组除干预3个月后生活质量无显著差异外,其余时间点各指标比较,试验组均优于对照组（P<0.001）。试验组因心力衰竭再次入院率低于对照组（χ²=4.298,P=0.038）,无事件存活率高于对照组（χ²=8.912,P=0.003）。结论 “心管家”应用程序能为CHF患者提供科学、高效的延续护理,实现智能化的院外健康管理,有效提高CHF患者自我管理能力,降低心脏不良事件发生率,改善生活质量。

关键词: 慢性心力衰竭, 院外健康管理, 应用程序, 自我管理, 生活质量, 延续护理

Abstract:

Objective To build an APP of out-of-hospital health management for patients with chronic heart failure（CHF）,and to verify its value. Methods A“heart management” system,consisting of patient version mobile terminal,medical version mobile terminal and computer version management terminal,was constructed for the out-of-hospital health management of 150 CHF patients discharged from a tertiary A hospital in Guangxi from April 2017 to April 2018. 150 discharged CHF patients were divided into an intervention group and a control group by random number table method,with 75 cases in each group. The control group adopted routine out-of-hospital health management,and the intervention group implemented out-of-hospital health management based on the“heart management” system on the basis of the control group. The self-management ability,quality of life,6 min walking results,the incidence of major adverse cardiac events and event-free survival were compared between the 2 groups before intervention,3 months,6 months and 1 year after intervention. Results The self-management ability,quality of life and 6 min walking results of the 2 groups were statistically significant（P<0.005）. At the same time,there was no significant difference in quality of life between the 2 groups except after 3 months of intervention. At the other time points,the indexes of the intervention group were significantly better than those of the control group. The rate of re-admission of the patients in the intervention group was lower than that of the control group（χ²=4.298,P=0.038）. The event-free survival rate was higher in the intervention group than it in the control group（χ²=8.912,P=0.003）. Conclusion The“heart management” system provides scientific and efficient means of continuous care for CHF patients,and realizes intelligent out-of-hospital health management,which helps to effectively improve CHF patients’ self-management ability,reduce the incidence of adverse cardiac events,and improve quality of life.

Key words: Chronic Heart Failure, Out-of-Hospital Health Management, Application Development, Self-Management, Quality of Life, Continuing Nursing

邱小芩, 黄彩献, 傅桂芬, 蓝春晗, 卢志红, 施莹. 慢性心力衰竭患者院外健康管理程序的构建及应用[J]. 中华护理杂志, 2022, 57(4): 401-407.

QIU Xiaoqin, HUANG Caixian, FU Guifen, LAN Chunhan, LU Zhihong, SHI Ying. Construction and application of APP in out-of-hospital health management for patients with chronic heart failure[J]. Chinese Journal of Nursing, 2022, 57(4): 401-407.

图/表 3

表1 两组一般资料的比较[例（百分比,%）]

Table 1 Comparison of general data between the two groups[case（percent,%）]

表2 两组患者不同时间点各项指标比较（$\bar{x}\pm s$）

Table 2 Comparison of indicators at different time points between the two groups（$\bar{x}\pm s$）

图1 两组无时间生存曲线

Figure 1 The two groups had no event survival curves

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