数字健康技术在心力衰竭患者居家容量管理中的应用进展

doi:10.3761/j.issn.0254-1769.2024.21.017

摘要/Abstract

摘要：

钠水潴留是导致心力衰竭患者发病和死亡风险增加的关键且可控制的危险因素，长期、连续、有效的容量管理是帮助患者达到个体化最佳容量平衡状态的重要策略，但心力衰竭患者在院外难以获得及时、有效的容量管理指导。数字健康技术在心血管疾病领域的逐步应用，为心力衰竭患者的院外容量管理提供了新的可能。该文综述了数字健康技术在心力衰竭患者容量状态评估、容量管理、容量风险预警、健康教育与随访中的应用，并分析了存在的问题与对策，为院外心力衰竭患者进行数字化容量管理提供参考。

关键词: 心力衰竭, 容量管理, 数字健康, 护理, 综述

Abstract:

Sodium and water retention are key and controllable risk factors that contribute to the increased risk of morbidity and mortality in patients with heart failure，and long-term continuous and effective volume management is an important strategy to help patients achieve an individualized state of optimal volume balance. The gradual application of digital health technology in the field of cardiovascular disease has provided new possibilities for volume management in patients with heart failure，while the relevant domestic studies and reports remain fewer. This article reviews the application of digital health technology in the assessment of volume status，management of volume status，volume risk warning，health education and follow-up in patients with heart failure，and analyzes the existing problems and countermeasures，to provide a reference for digital volume management in out-of-hospital heart failure patients.

Key words: Heart Failure, Volume Management, Digital Health, Nursing Care, Review

张艳, 彭希, 陈华丽, 彭超, 孙思琪, 陈婷. 数字健康技术在心力衰竭患者居家容量管理中的应用进展[J]. 中华护理杂志, 2024, 59(21): 2672-2677.

ZHANG Yan, PENG Xi, CHEN Huali, PENG Chao, SUN Siqi, CHEN Ting. Application progress of digital health technology in home-based volume management of heart failure patients[J]. Chinese Journal of Nursing, 2024, 59(21): 2672-2677.

参考文献 44

[1]	王蔚云, 刘长红, 孙国珍, 等. 累积液体平衡量对心力衰竭患者容量状态影响的研究[J]. 中华护理杂志, 2024, 59(14):1691-1698.
	Wang WY, Liu CH, Sun GZ, et al. The influence of cumulative fluid balance on volume status in patients with heart failure[J]. Chin J Nurs, 2024, 59(14):1691-1698.
[2]	陈华, 熊晓云, 孙兴兰, 等. 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. DOI
	Chen H, Xiong XY, Sun XL, et al. Construction and application of a volume management program in vulnerable phase for patients with heart failure[J]. Chin J Nurs, 2022, 57(13):1541-1547. DOI
[3]	邱小芩, 黄彩献, 傅桂芬, 等. 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. DOI
	Qiu XQ, Huang CX, Fu GF, et al. Construction and application of APP in out-of-hospital health management for patients with chronic heart failure[J]. Chin J Nurs, 2022, 57(4):401-407. DOI
[4]	Farwati M, Riaz H, Tang WHW. Digital health applications in heart failure:a critical appraisal of literature[J]. Curr Treat Options Cardiovasc Med, 2021, 23(2):12. DOI PMID
[5]	World Health Organization. Global strategy on digital health 2020-2025[EB/OL].[2024-03-01]. https://iris.who.int/bitstream/handle/10665/344249/9789240020924-eng.pdf?sequence=1.
[6]	What is digital health?[EB/OL].[2024-03-01]. https://www.fda.gov/medical-devices/digital-health-center-excellence/what-digital-health.
[7]	姚自强, 秦宁, 石双姣, 等. 数字健康技术在高血压患者药物管理中的应用进展[J]. 中华护理杂志, 2023, 58(11):1403-1409. DOI
	Yao ZQ, Qin N, Shi SJ, et al. Application progress of digital health technology in the medication management of hyperten-sive patients[J]. Chin J Nurs, 2023, 58(11):1403-1409.
[8]	Bombard Y, Ginsburg GS, Sturm AC, et al. Digital health-ena-bled genomics:opportunities and challenges[J]. Am J Hum Genet, 2022, 109(7):1190-1198. DOI PMID
[9]	薛鹏, 白安颖, 江宇, 等. WHO数字健康全球战略及对中国的启示[J]. 中华预防医学杂志, 2022, 56(2):218-221. PMID
	Xue P, Bai AY, Jiang Y, et al. WHO global strategy on digital health and its implications to China[J]. Chin J Prev Med, 2022, 56(2):218-221. DOI PMID
[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 Docter Association,Editorial Board of Chinese Journal of Heart Failure and Cardiomyopathy. China expert’s suggestion on capacity management of heart failure[J]. Chin J Heart Fail Cardiomyopathy, 2018, 2(1):8-16.
[11]	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. DOI
	Wang WY, Liu CH, Huang YL, et al. Construction and appli-cation of an individualized management scheme of fluid intake for patients with chronic heart failure[J]. Chin J Nurs, 2021, 56(12):1772-1778.
[12]	Shavelle DM, Desai AS, Abraham WT, et al. Lower rates of heart failure and all-cause hospitalizations during pulmonary artery pressure-guided therapy for ambulatory heart failure:one-year outcomes from the CardioMEMS post-approval study[J]. Circ Heart Fail, 2020, 13(8):e006863.
[13]	Deora S, Choudhary R, Kaushik A, et al. Noninvasive assess-ment of pulmonary congestion in heart failure:need of the hour[J]. Indian Heart J, 2023, 75(4):224-228.
[14]	Amir O, Ben-Gal T, Weinstein JM, et al. Evaluation of remote dielectric sensing(ReDS) technology-guided therapy for de-creasing heart failure re-hospitalizations[J]. Int J Cardiol, 2017, 240:279-284.
[15]	Castro-Gutiérrez V, Rada G. Is fluid restriction needed in heart failure?[J]. Medwave, 2017, 17(Suppl 1):e6817.
[16]	Borofsky MS, Dauw CA, York N, et al. Accuracy of daily fluid intake measurements using a “smart” water bottle[J]. Uroli-thiasis, 2018, 46(4):343-348.
[17]	Böhm M, Drexler H, Oswald H, et al. Fluid status telemedicine alerts for heart failure:a randomized controlled trial[J]. Eur Heart J, 2016, 37(41):3154-3163.
[18]	Rohde LE, Rover MM, Hoffmann Filho CR, et al. Multifaceted strategy based on automated text messaging after a recent heart failure admission:the MESSAGE-HF randomized clinical trial[J]. JAMA Cardiol, 2024, 9(2):105-113. DOI PMID
[19]	Koehler F, Koehler K, Deckwart O, et al. Efficacy of teleme-dical interventional management in patients with heart failure(TIM-HF2):a randomised,controlled,parallel-group,unmasked trial[J]. Lancet, 2018, 392(10152):1047-1057.
[20]	黄兰青, 邱小芩, 黄彩献, 等. 移动健康干预在慢性心力衰竭患者居家容量管理中的应用[J]. 护理学杂志, 2023, 38(16):111-114.
	Huang LQ, Qiu XQ, Huang CX, et al. Application of mHealth intervention in volume management of home-dwelling patients with chronic heart failure[J]. J Nurs Sci, 2023, 38(16):111-114.
[21]	Jaarsma T, Hill L, Bayes-Genis A, et al. Self-care of heart failure patients:practical management recommendations from the Heart Failure Association of the European Society of Cardiology[J]. Eur J Heart Fail, 2021, 23(1):157-174.
[22]	中华医学会心血管病学分会, 中国医师协会心血管内科医师分会, 中国医师协会心力衰竭专业委员会, 等. 中国心力衰竭诊断和治疗指南2024[J]. 中华心血管病杂志, 2024, 52(3):235-275.
	Chinese Society of Cardiology,Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese Heart Failure Association of Chinese Medical Doctor Association, et al. Chinese guidelines for the diagnosis and treatment of heart failure 2024[J]. Chin J Cardiol, 2024, 52(3):235-275.
[23]	Takada T, Imamoto M, Sasaki S, et al. Effects of self-monito-ring of daily salt intake estimated by a simple electrical device for salt reduction:a cluster randomized trial[J]. Hyper-tens Res, 2018, 41(7):524-530.
[24]	Jung CY, Kim Y, Kim HW, et al. Effectiveness of a smart-phone application for dietary sodium intake measurement[J]. Nutrients, 2023, 15(16):3590.
[25]	Thom SJM, Sivakumar B, Ayodele T, et al. Impact of mHealth interventions on supporting dietary adherence in cardiova-scular disease:a systematic review[J]. J Nutr Educ Behav, 2023, 55(6):419-436.
[26]	Kelders SM, Kok RN, Ossebaard HC, et al. Persuasive system design does matter:a systematic review of adherence to web-based interventions[J]. J Med Internet Res, 2012, 14(6):e152.
[27]	Komaki T, Miura SI, Arimura T, et al. The change in body weight during hospitalization predicts mortality in patients with acute decompensated heart failure[J]. J Clin Med Res, 2017, 9(3):200-206. DOI PMID
[28]	Kachur S, Lavie CJ, de Schutter A, et al. Obesity and cardio-vascular diseases[J]. Minerva Med, 2017, 108(3):212-228.
[29]	Lyngå P, Persson H, Hägg-Martinell A, et al. Weight monitor-ing in patients with severe heart failure(WISH). A randomi-zed controlled trial[J]. Eur J Heart Fail, 2012, 14(4):438-444.
[30]	王丽丽, 鞠阳, 张艳云, 等. 慢性心力衰竭患者体重监测依从性的影响因素分析[J]. 上海护理, 2017, 17(5):32-34.
	Wang LL, Ju Y, Zhang YY, et al. Influencing factors of weight monitoring compliance in patients with chronic congestive heart failure[J]. Shanghai Nurs, 2017, 17(5):32-34.
[31]	Haynes SC, Tancredi DJ, Tong K, et al. Association of adhere-nce to weight telemonitoring with health care use and death:a secondary analysis of a randomized clinical trial[J]. JAMA Netw Open, 2020, 3(7):e2010174.
[32]	Radhakrishnan K, Julien C, O’Hair M, et al. Usability testing of a sensor-controlled digital game to engage older adults with heart failure in physical activity and weight monitoring[J]. Appl Clin Inform, 2020, 11(5):873-881. DOI PMID
[33]	罗桢蓝, 胡三莲, 朱凌燕, 等. 慢性心力衰竭患者自我容量管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(7):880-886. DOI
	Luo ZL, Hu SL, Zhu LY, et al. Evidence summary for self volume-management in patients with chronic heart failure[J]. Chin J Nurs, 2022, 57(7):880-886. DOI
[34]	Kenig A, Kolben Y, Asleh R, et al. Improving diuretic response in heart failure by implementing a patient-tailored variability and chronotherapy-guided algorithm[J]. Front Cardiovasc Med, 2021, 8:695547.
[35]	Liu SR, Li JL, Wan DY, et al. Effectiveness of eHealth self-management interventions in patients with heart failure:systematic review and meta-analysis[J]. J Med Internet Res, 2022, 24(9):e38697.
[36]	Lourenço LB, Rodrigues RC, Ciol MA, et al. A randomized controlled trial of the effectiveness of planning strategies in the adherence to medication for coronary artery disease[J]. J Adv Nurs, 2014, 70(7):1616-1628. DOI PMID
[37]	Hale TM, Jethwani K, Kandola MS, et al. A remote medication monitoring system for chronic heart failure patients to reduce readmissions:a two-arm randomized pilot study[J]. J Med In-ternet Res, 2016, 18(5):e91.
[38]	杨浩杰, 胡宇乐, 周彦君, 等. 心力衰竭患者30天再住院现状及影响因素的研究进展[J]. 解放军护理杂志, 2022, 39(2):72-75.
	Yang HJ, Hu YL, Zhou YJ, et al. Research progress on the status quo and influencing factors of 30-day readmission of patients with heart failure[J]. Nurs J Chin PLA, 2022, 39(2):72-75.
[39]	Boehmer JP, Hariharan R, Devecchi FG, et al. A multisensor algorithm predicts heart failure events in patients with implanted devices:results from the MultiSENSE study[J]. JACC Heart Fail, 2017, 5(3):216-225.
[40]	Stehlik J, Schmalfuss C, Bozkurt B, et al. Continuous wearable monitoring analytics predict heart failure hospitalization:the LINK-HF multicenter study[J]. Circ Heart Fail, 2020, 13(3):e006513.
[41]	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. DOI
[42]	Choi EY, Park JS, Min D, et al. Heart Failure-Smart Life:a randomized controlled trial of a mobile app for self-mana-gement in patients with heart failure[J]. BMC Cardiovasc Disord, 2023, 23(1):7.
[43]	宋玉洁, 孙兴兰, 涂惠, 等. 基于“互联网+”医院家庭一体化模式在慢性心力衰竭患者容量管理中的应用[J]. 护理实践与研究, 2022, 19(15):2221-2225.
	Song YJ, Sun XL, Tu H, et al. Application of “Internet+” hospi-tal family integration model in capacity management of patients with chronic heart failure[J]. Nurs Pract Res, 2022, 19(15):2221-2225.
[44]	田焕, 张灵芳, 李姗, 等. 随访信息平台结合全程健康教育对慢性心力衰竭患者遵医行为及心脏功能的影响[J]. 中国实用护理杂志, 2020, 36(24):1907-1911.
	Tian H, Zhang LF, Li S, et al. Impact of follow-up information platform combined with health education on compliance behavior and cardiac function in patients with chronic heart failure[J]. Chin J Pract Nurs, 2020, 36(24):1907-1911.