心力衰竭患者易损期液体管理方案的构建及应用

doi:10.3761/j.issn.0254-1769.2022.13.001

摘要/Abstract

摘要：

目的构建基于信息-知识-信念-行为（information-knowledge-attitude-practice,IKAP）理论的液体管理方案并探讨其在易损期心力衰竭患者中的应用效果。方法采用专家小组讨论法,构建基于IKAP理论液体管理方案四大流程及架构内容;采用方便抽样方法,选取南昌市某三级甲等医院心内科2021年5月—10月心力衰竭患者94例作为试验组,选取2020年5月—10月心力衰竭患者94例作为对照组。试验组实施基于IKAP理论液体管理方案,对照组给予常规护理,比较两组干预效果。结果试验组最终收集94例,对照组最终收集92例。两组干预后自我护理能力、体重管理能力、B型利钠肽水平、患者干体质量达标率及再入院率比较,差异均具有统计学意义（P<0.05）。结论基于IKAP理论液体管理方案能够提高易损期心力衰竭患者自我护理能力、体重管理能力及干体质量达标率,降低B型利钠肽水平及再入院率。

关键词: 心力衰竭, 液体管理, 易损期, 护理

Abstract:

Objective To construct a volume management program based on Information-Knowledge-Attitude-Practice（IKAP） theory and to discuss its application effect for patients with heart failure in vulnerable phase. Methods The 4 process and capacity management architecture based on IKAP theory were constructed by the expert group discussion method. Using the convenience sampling method,94 patients with heart failure from May to October 2021 were selected as the experimental group,and the same number of patients from May to October 2020 were selected as the control group,both of whom were admitted to a tertiary first-class hospital in the city of Nanchang. The experimental group received the volume management program based on IKAP theory,and the control group received the routine care of the department. Finally,we evaluated the effect of the intervention. Results 94 patients in the experimental group and 92 patients in the control group were finally collected. There were statistically significant differences in self-care ability,weight management ability,B-type natriuretic peptide level,dry body mass compliance rate and readmission rate between 2 groups after the intervention（P<0.05）. Conclusion The volume management program based on IKAP theory can improve self-care ability,weight management ability and dry body mass compliance rate of vulnerable patients with heart failure,and reduce B-type natriuretic peptide level and readmission rate in vulnerable phase.

Key words: Heart Failure, Volume Management, Vulnerable Phase, Nursing Care

陈华, 熊晓云, 孙兴兰, 肖丹, 涂惠, 易凤仪, 魏文婷, 刘佳文, 宋玉洁. 心力衰竭患者易损期液体管理方案的构建及应用[J]. 中华护理杂志, 2022, 57(13): 1541-1547.

CHEN Hua, XIONG Xiaoyun, SUN Xinglan, XIAO Dan, TU Hui, YI Fengyi, WEI Wenting, LIU Jiawen, SONG Yujie. Construction and application of a volume management program in vulnerable phase for patients with heart failure[J]. Chinese Journal of Nursing, 2022, 57(13): 1541-1547.

图/表 4

图1 心力衰竭患者易损期液体管理方案四大流程及架构内容

Figure 1 The volume management program of the 4 major processes and structure content

表1 两组一般资料比较

Table 1 Comparison of general information between 2 groups

表2 两组自我护理能力及体重管理能力比较（分,$\bar{x}$±s）

Table 2 Comparison of self-care and weight management ability between 2 groups （scores,$\bar{x}$±s）

表3 两组B型利钠肽水平比较（pg/ml,$\bar{x}$±s）

Table 3 Comparison of B-type natriuretic peptide between 2 groups（pg/ml,$\bar{x}$±s）

参考文献 27

[1]	Chun S, Tu JV, Wijeysundera HC, et al. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure[J]. Circ Heart Fail, 2012, 5(4):414-421. DOI URL
[2]	Solomon SD, Dobson J, Pocock S, et al. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure[J]. Circulation, 2007, 116(13):1482-1487. DOI PMID
[3]	Greene SJ, Fonarow GC, Vaduganathan M, et al. The vulnerable phase after hospitalization for heart failure[J]. Nat Rev Cardiol, 2015, 12(4):220-229. DOI URL
[4]	中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会,中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
	Heart Failure Group of Cardiovascular Branch of Chinese Medical Association,Heart Failure Professional Committee of Chinese Medical Doctor Association,Editorial Board of Chinese Journal of Heart Failure and Cardiomyopathy. 2018 Chinese guidelines for the diagnosis and treatment of heart failure[J]. Chin J Cardiol, 2018, 46(10):760-789.
[5]	Gracia E, Hamid A, Butler J. Timely management of new-onset heart failure[J]. Circulation, 2019, 140(8):621-623. DOI PMID
[6]	周京敏, 徐亚妹. 心力衰竭易损期的心率管理:概念与策略[J]. 心电与循环, 2018, 37(2):80-82.
	Zhou JM, Xu YM. Heart rate management during vulnerability to heart failure:concepts and strategies[J]. J Electrocardiol Circ, 2018, 37(2):80-82.
[7]	赵旭, 王伟, 赵小静, 等. 慢性心力衰竭患者出入量管理的最佳证据总结[J]. 中华护理杂志, 2020, 55(3):456-461. DOI
	Zhao X, Wang W, Zhao XJ, et al. Best evidence summary for management of output and input in chronic heart failure patients[J]. Chin J Nurs, 2020, 55(3):456-461.
[8]	王蔚云, 刘长红, 黄艳玲, 等. 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[J]. 中华护理杂志, 2021, 56(12):1772-1778.
	Wang WY, Liu CH, Huang YL, et al. Construction and application of an individualized management scheme of fluid intake for patients with chronic heart failure[J]. Chin J Nurs, 2021, 56(12):1772-1778.
[9]	罗桢蓝, 龚静欢, 朱凌燕. 心力衰竭患者液体管理的研究进展[J]. 中华护理杂志, 2021, 56(3):473-477. DOI
	Luo ZL, Gong JH, Zhu LY. Research progress of fluid management strategies in patients with heart failure[J]. Chin J Nurs, 2021, 56(3):473-477.
[10]	中国医师协会心力衰竭专业委员会, 中华心力衰竭和心肌病杂志编辑委员会. 心力衰竭容量管理中国专家建议[J]. 中华心力衰竭和心肌病杂志(中英文), 2018, 2(1):8-16.
	Heart Failure Professional Committee of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Heart Failure and Cardiomyopathy. Chinese expert consensus on volume management of heart failure[J]. Chin J Heart Fail & Cardiomyopathy, 2018, 2(1):8-16.
[11]	Hoover JD, Wong WW, Adachi I, et al. Energy intake and expenditure in children with heart failure[J]. Pediatr Crit Care Med, 2018, 19(11):e627-e630.
[12]	Prescher S, Schoebel C, Koehler K, et al. Prognostic value of serial six-minute walk tests using tele-accelerometry in patients with chronic heart failure:a pre-specified sub-study of the TIM-HF-Trial[J]. Eur J Prev Cardiol, 2016, 23(2 suppl):21-26. PMID
[13]	荆璇, 薛平, 袁丽荣. IKAP模式在慢性病管理中的应用研究进展[J]. 护理研究, 2021, 35(8):1441-1446.
	Jing X, Xue P, Yuan LR. Application research progress of IKAP model in the management of chronic diseases[J]. Chin Nurs Res, 2021, 35(8):1441-1446.
[14]	吴惠, 符秀梅, 王德仙, 等. IKAP管理模式在老年高血压患者中的应用[J]. 中国老年学杂志, 2019, 39(6):1458-1460.
	Wu H, Fu XM, Wang DX, et al. Application of IKAP management model in elderly hypertensive patients[J]. Chin J Gerontol, 2019, 39(6):1458-1460.
[15]	朱艳霞, 王路, 乔丹, 等. 基于IKAP模式的延续性护理在冠心病患者中的应用[J]. 中华现代护理杂志, 2021, 27(21):2888-2891.
	Zhu YX, Wang L, Qiao D, et al. Application of continuing care based on IKAP model in patients with coronary heart disease[J]. Chin J Mod Nurs, 2021, 27(21):2888-2891.
[16]	刘连弟, 邹有娣, 冯文利, 等. 基于信息知识信念行为模式的健康教育对胃癌围术期患者负面情绪及生活质量的影响[J]. 护理实践与研究, 2016, 13(22):86-88.
	Liu LD, Zou YD, Feng WL, et al. Effect of health education based on information,knowledge,attitude and practice pattern on negative emotion and quality of life of patients with gastric cancer during perioperative period[J]. Nurs Pract Res, 2016, 13(22):86-88.
[17]	符蝶, 陈虹, 黄丹, 等. IKAP管理模式在糖尿病患者诊疗中的应用[J]. 中国老年学杂志, 2018, 38(14):3342-3344.
	Fu D, Chen H, Huang D, et al. Application of IKAP management model in the diagnosis and treatment of diabetic patients[J]. Chin J Gerontol, 2018, 38(14):3342-3344.
[18]	涂惠, 郭婷, 孙兴兰, 等. 慢性心力衰竭患者容量管理方案的制订与实践[J]. 中国护理管理, 2021, 21(4):570-575.
	Tu H, Guo T, Sun XL, et al. Development and evaluation of volume management program for patients with chronic heart failure[J]. Chin Nurs Manag, 2021, 21(4):570-575.
[19]	Artinian NT, Magnan M, Sloan M, et al. Self-care behaviors among patients with heart failure[J]. Heart Lung, 2002, 31(3):161-172. PMID
[20]	邵欣. 慢性心力衰竭患者自我护理行为及影响因素的研究[D]. 北京: 中国协和医科大学, 2009.
	Shao X. Research on the self-care behaviors and the influential factors of chronic heart failure patients[D]. Beijing: Peking Union Medical College, 2009.
[21]	Wang XH, Qiu JB, Pang JH, et al. Establishment of a weight management scale for patients with congestive heart failure[J]. Acta Cardiol Sin, 2014, 30(1):74-81.
[22]	张宇辉, 张真路, 王运红. 基层医院心力衰竭临床诊疗中B型利钠肽和N末端B型利钠肽原的应用中国专家建议[J]. 中华全科医师杂志, 2017, 16(3):169-173.
	Zhang YH, Zhang ZL, Wang YH. Chinese expert consensus on the application of B-type natriuretic peptide/N-terminal pro B-type natriuretic peptide in diagnosis and treatment of heart failure in primary hospitals[J]. Chin J Gen Pract, 2017, 16(3):169-173.
[23]	Costanzo MR, Ronco C, Abraham WT, et al. Extracorporeal ultrafiltration for fluid overload in heart failure:current status and prospects for further research[J]. J Am Coll Cardiol, 2017, 69(19):2428-2445. DOI PMID
[24]	王子迎, 米冬花, 王水莲, 等. 老年慢性心力衰竭患者的自我管理现状及其影响因素研究[J]. 中华护理杂志, 2017, 52(4):431-435.
	Wang ZY, Mi DH, Wang SL, et al. Self-management and its influencing factors of elderly patients with chronic heart failure[J]. Chin J Nurs, 2017, 52(4):431-435.
[25]	胡慧秀, 孙超, 张洁, 等. 老年慢性心力衰竭患者出院准备服务的循证实践[J]. 中华护理杂志, 2021, 56(12):1765-1771.
	Hu HX, Sun C, Zhang J, et al. Evidence-based practice of discharge preparation for elderly patients with chronic heart failure[J]. Chin J Nurs, 2021, 56(12):1765-1771.
[26]	杨婷, 王书蕊, 王瑞瑞, 等. 基于生物-心理-社会医学模式的老年人压力源评估指标体系的构建[J]. 中华现代护理杂志, 2021, 27(33):4505-4511.
	Yang T, Wang SR, Wang RR, et al. Construction of an evaluation index system for stressors in the elderly based on bio-psycho-social medicine model[J]. Chin J Mod Nurs, 2021, 27(33):4505-4511.
[27]	龚静欢, 朱凌燕, 胡三莲, 等. 心力衰竭患者症状管理质性研究的系统评价[J]. 护理学杂志, 2021, 36(5):10-15.
	Gong JH, Zhu LY, Hu SL, et al. Symptom management in patients with heart failure:a systematic review of qualitative studies[J]. J Nurs Sci, 2021, 36(5):10-15.