照顾者视角下慢性心力衰竭患者居家液体管理影响因素的质性研究

doi:10.3761/j.issn.0254-1769.2026.10.011

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (10): 1379-1385.DOI: 10.3761/j.issn.0254-1769.2026.10.011

照顾者视角下慢性心力衰竭患者居家液体管理影响因素的质性研究

鲁欢欢¹(), 顾则娟¹(), 杨静², 徐苏梦¹, 王蔚云³, 张新月⁴, 徐冬梅⁴

¹ 南京医科大学护理学院南京市 211166
² 南京中医药大学护理学院南京市 210023
³ 南京医科大学第一附属医院大血管外科南京市 210029
⁴ 南京医科大学第一附属医院心血管内科南京市 210029

收稿日期:2025-10-28 出版日期:2026-05-20 发布日期:2026-05-09
*通讯作者: 顾则娟，E-mail：jassicagu@163.com
作者简介:鲁欢欢：女，本科（硕士在读），E-mail：13595413834@163.com
第一联系人：作者贡献声明
鲁欢欢：研究设计及实施、资料收集及分析、论文撰写及修改；顾则娟、徐冬梅：研究指导、论文审阅与修改、基金支持；杨静、徐苏梦、王蔚云、张新月：资料整理与分析
基金资助:
江苏高校优势学科建设工程四期项目“护理学”（苏教研函〔2023〕11号）

A qualitative study on the influencing factors of home fluid management in patients with chronic heart failure from the perspective of caregivers

LU Huanhuan¹(), GU Zejuan¹(), YANG Jing², XU Sumeng¹, WANG Weiyun³, ZHANG Xinyue⁴, XU Dongmei⁴

¹ School of Nursing， Nanjing Medical University， Nanjing 211166， China
² School of Nursing， Nanjing University of Chinese Medicine， Nanjing 210023， China
³ Department of Macrovascular Surgery， the First Affiliated Hospital of Nanjing Medical University， Nanjing 210029， China
⁴ Department of Cardiovascular Medicine， the First Affiliated Hospital of Nanjing Medical University， Nanjing 210029， China.

Received:2025-10-28 Online:2026-05-20 Published:2026-05-09
* Corresponding author: GU Zejuan，E-mail：jassicagu@163.com
Funding program:
Project of “Nursing Science” Funded by the 4th Priority Discipline Development Program of Jiangsu Higher Education Institutions(Jiangsu Education Department〔2023〕11)

摘要/Abstract

摘要：

目的从家庭照顾者及护士的角度探讨慢性心力衰竭患者居家实施液体摄入管理的促进与障碍因素，为制订液体摄入管理居家实施策略提供依据。方法采用最大差异抽样法，于2024年12月至2025年3月，选取江苏省某三级甲等综合医院13名慢性心力衰竭患者的家庭照顾者及11名心血管内科护士进行半结构式访谈，并采用内容分析法对资料进行分析。结果共提炼8个促进因素（具备一定证据基础、创新相对优势较好、医院管理外部支持、知识获取环境良好、操作兼容性较强、感知居家液体管理益处、疾病康复需求强烈、团队力量协作共进）及6个障碍因素（居家实施步骤复杂、居家可用性受限、指导与实践交互性不足、居家液体管理知识技能不足、照护抵抗行为应对不佳、长期实施监督作用弱化）。结论将液体摄入管理从医院延续至居家，为心力衰竭患者及家庭照顾者提供了切实可行的疾病管理新策略。通过将院内措施转化为居家可操作实施策略，并借助“学习—实践—反馈”的互动指导与移动医疗平台的动态监测，可有效促进患者居家实施，改善预后。

关键词: 心力衰竭, 容量管理, 居家, 家庭照顾者, 护士

Abstract:

Objective To explore the decision（facilitation/barrier） factors of fluid intake management in patients with chronic heart failure（CHF） at home from the perspective of family caregivers and nurses，and to provide the basis for formulating strategies of fluid intake management at home.Methods From December 2024 to March 2025，13 family caregivers of patients with chronic heart failure and 11 nurses of cardiovascular department in a tertiary A general hospital in Jiangsu Province were selected by maximum difference sampling method to conduct semi-structured interviews，and the data were analyzed by content analysis.Results A total of 8 facilitation factors were extracted（with a certain evidence base，good relative advantages of innovation，external support for hospital management，good knowledge acquisition environment，strong operational compatibility，perceived benefits of home liquid management，strong demand for disease rehabilitation，and support of team cooperation force） and 6 barrier factors（complex home implementation steps，limited home availability，insufficient interaction between guidance and practice，inadequate knowledge and skills of home fluid management，poor response to care resistance behavior，and weak long-term implementation supervision）.Conclusion Extending fluid intake management from hospital to home provides a feasible new strategy for heart failure patients and their caregivers. By transforming hospital measures into home operational implementation strategies，and using the interactive guidance of “learning-practice-feedback”and the dynamic monitoring of mobile medical platform，the home implementation of patients can be effectively promoted，thereby improving the prognosis of patients.

Key words: Heart Failure, Fluid Management, Home Care, Family Caregivers, Nurses

鲁欢欢, 顾则娟, 杨静, 徐苏梦, 王蔚云, 张新月, 徐冬梅. 照顾者视角下慢性心力衰竭患者居家液体管理影响因素的质性研究[J]. 中华护理杂志, 2026, 61(10): 1379-1385.

LU Huanhuan, GU Zejuan, YANG Jing, XU Sumeng, WANG Weiyun, ZHANG Xinyue, XU Dongmei. A qualitative study on the influencing factors of home fluid management in patients with chronic heart failure from the perspective of caregivers[J]. Chinese Journal of Nursing, 2026, 61(10): 1379-1385.

图/表 3

参考文献 19

[1]	Beezer J, Al Hatrushi M, Husband A, et al. Polypharmacy defi-nition and prevalence in heart failure:a systematic review[J]. Heart Fail Rev, 2022, 27(2):465-492. DOI
[2]	唐荣欣, 刘新灿, 李明, 等. 慢性心力衰竭病人容量管理行为决定要素的质性研究[J]. 护理研究, 2025, 39(20):3468-3473.
	Tang RX, Liu XC, Li M, et al. Qualitative study on behavioral determinants in capacity management of chronic heart failure patients[J]. Chin Nurs Res, 2025, 39(20):3468-3473.
[3]	闫琳, 张辰, 刘周周, 等. 心力衰竭患者出入量记录的实践现况及影响因素分析[J]. 中华护理杂志, 2025, 60(16):1941-1948. DOI
	Yan L, Zhang C, Liu ZZ, et al. Analysis of current practice status and influencing factors of intake and output recording in patients with heart failure[J]. Chin J Nurs, 2025, 60(16):1941-1948. DOI
[4]	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 Society of Cardiovascu-lar Physicians, Chinese Society of Cardiovascu-lar Physicians, Chinese Medical Doctor Association,Chinese Society of Heart Failure, et al. Chinese guidelines for the diag-nosis and treatment of heart failure 2024[J]. Chin J Cardiol, 2024, 52(3):235-275.
[5]	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 applica-tion of an individualized management scheme of fluid intake for patients with chronic heart failure[J]. Chin J Nurs, 2021, 56(12):1772-1778.
[6]	徐佳忆, 张慧超, 孙兴, 等. 基于德尔菲法构建慢性心力衰竭病人居家容量管理行为偏差评估工具[J]. 护理研究, 2024, 38(13): 2281-2287.
	Xu JY, Zhang HC, Sun X, et al. Construction of assessment tool for capacity management behavioral discrepancy at home in patients with chronic heart failure based on Delphi method[J]. Chin Nurs Res, 2024, 38(13):2281-2287.
[7]	Borgstedt J, Clark RA, Morran JL, et al. Pre-admission and post-hospital management of heart failure in patients not enrolled in specialist programs[J]. Pharmacy Practice And Res, 2009, 39(3):186-191. DOI URL
[8]	孙立信, 宫恩莹, 刘逸舒, 等. 实施科学理论、模型与框架概述[J]. 协和医学杂志, 2025, 16(5):1332-1343.
	Sun LX, Gong EY, Liu YS, et al. Introduction to implementation science theories,models,and frameworks[J]. Med J Peking Union Med Coll Hosp, 2025, 16(5):1332-1343.
[9]	陈辰, 郑晶, 刘旭, 等. 基于健康信念模式的血液透析患者液体管理影响因素的关系模型研究[J]. 中华护理杂志, 2023, 58(24):2996-3003. DOI
	Chen C, Zheng J, Liu X, et al. Relational model of factors in-fluencing fluid management in hemodialysis patients based on the health belief model[J]. Chin J Nurs, 2023, 58(24):2996-3003.
[10]	王超群, 俞梦盈, 刘畅, 等. 老年慢性心力衰竭患者照顾者准备度现状及影响因素分析[J]. 中华护理杂志, 2024, 59(14):1706-1712.
	Wang CQ, Yu MY, Liu C, et al. The status of caregiver rea-diness of elderly patients with chronic heart failure and its influencing factors[J]. Chin J Nurs, 2024, 59(14):1706-1712.
[11]	王宇, 何梦雨, 祁明昊, 等. 慢性心力衰竭患者照顾者家庭护理准备方案的构建及应用研究[J]. 中华护理杂志, 2025, 60(16):1925-1932. DOI
	Wang Y, He MY, Qi MH, et al. Construction and application of a home care readiness program for caregivers of patients with chronic heart failure[J]. Chin J Nurs, 2025, 60(16):1925-1932. DOI
[12]	Lyons KS, Lee CS. The theory of dyadic illness management[J]. J Fam Nurs, 2018, 24(1):8-28. DOI PMID
[13]	丁春戈, 梅永霞, 林蓓蕾, 等. 二元应对在慢性病患者及其配偶中的应用进展[J]. 中华护理杂志, 2018, 53(5):626-630.
	Ding CG, Mei YX, Lin BL, et al. The application of dyadic coping in patients with chronic diseases and their spouses[J]. Chin J Nurs, 2018, 53(5):626-630.
[14]	Gure TR, Kabeto MU, Blaum CS, et al. Degree of disability and patterns of caregiving among older Americans with congestive heart failure[J]. J Gen Intern Med, 2008, 23(1):70-76. DOI PMID
[15]	范文海, 刘悦, 李春霞, 等. 慢性心力衰竭患者照护者居家照护体验质性研究的Meta整合[J]. 中华护理杂志, 2022, 57(4):424-431. DOI
	Fan WH, Liu Y, Li CX, et al. The experience of informal caregivers caring for patients with chronic heart failure at home:a meta-synthesis of qualitative studies[J]. Chin J Nurs, 2022, 57(4):424-431.
[16]	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 cumu-lative fluid balance on volume status in patients with heart failure[J]. Chin J Nurs, 2024, 59(14):1691-1698.
[17]	Aliti GB, Rabelo ER, Clausell N, et al. Aggressive fluid and sodium restriction in acute decompensated heart failure:a randomized clinical trial[J]. JAMA Intern Med, 2013, 173(12):1058-1064. DOI URL
[18]	Albert NM, Nutter B, Forney J, et al. A randomized controlled pilot study of outcomes of strict allowance of fluid therapy in hyponatremic heart failure(SALT-HF)[J]. J Card Fail, 2013, 19(1):1-9. DOI PMID
[19]	Pandolfi MM, Wang Y, Spenard A, et al. Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction,heart failure and pneumonia at the healthcare community level in the United States[J]. Int J Older People Nurs, 2017, 12(4).

照顾者视角下慢性心力衰竭患者居家液体管理影响因素的质性研究

A qualitative study on the influencing factors of home fluid management in patients with chronic heart failure from the perspective of caregivers

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 19

相关文章 15

编辑推荐

Metrics

[1]	王丹丹, 吕会力, 李付华, 李慧, 张侠, 史小艳, 张苇. 三级医院硕士学历护士工作重塑的影响因素及路径分析[J]. 中华护理杂志, 2026, 61(7): 973-978.
[2]	赵浩, 赵颖, 杨艳珍. 慢性心力衰竭患者家庭照顾者照护技能干预方案的构建及应用研究[J]. 中华护理杂志, 2026, 61(6): 775-782.
[3]	中华护理学会人文护理专业委员会, 中华护理学会急诊护理专业委员会, （执笔：刘义兰, 汪唯, 甘秀妮, 朱陈萍, 杨霞, 熊莉娟, 朱丽辉, 徐翠荣, 郭舒婕, 张洁, 金晓燕, 李君, 李丽, 黄素芳, 王晓洁, 周晨曦, 李映兰. 对急诊科护士的人文关怀策略专家共识[J]. 中华护理杂志, 2026, 61(5): 612-615.
[4]	周敏, 王林娟, 黄雀兰, 付勤, 李贾贾, 付坤会, 董琪, 孟令雨. 15所三级医院儿科ICU护士对外周动脉导管管理的知信行现状调查[J]. 中华护理杂志, 2026, 61(5): 682-688.
[5]	卢露, 朱林, 周晓, 李哲, 卢芳燕. 1例行双心室辅助装置植入术患者的围手术期护理[J]. 中华护理杂志, 2026, 61(5): 702-706.
[6]	陈玲, 宋秀琪, 任伟, 余丽华, 全红梅, 杨亚妮, 蔡文智. 美国家庭开业护士的发展现状及启示[J]. 中华护理杂志, 2026, 61(5): 715-720.
[7]	关锐, 赵亚莎, 张士变, 李巧丽, 郭清洁, 李亚楠, 韩箫笛. 姿势调节训练在ICU肌肉骨骼损伤护士中的应用研究[J]. 中华护理杂志, 2026, 61(4): 543-548.
[8]	芦凤娟, 解子惠, 关银银, 裴晓莉, 房玉霞. 骨科护士疼痛共情的现状及影响因素研究[J]. 中华护理杂志, 2026, 61(4): 549-556.
[9]	李修平, 梁娇娇, 王玲玲, 付琴, 侯铭, 李萍. 中老年脑卒中患者及家庭照顾者家庭弹性、护理能力与衰弱间的关系研究[J]. 中华护理杂志, 2026, 61(3): 361-367.
[10]	祝海香, 李艳, 许启锦, 陈瑾萱, 韩小雪, 吴缘. 慢性心力衰竭患者分级分类症状识别工具的研制及应用研究[J]. 中华护理杂志, 2026, 61(2): 149-156.
[11]	王蔚云, 顾则娟, 汤一帆, 苏子雯, 刘长红. 心力衰竭患者的液体平衡阈值研究及护理对策[J]. 中华护理杂志, 2026, 61(2): 157-165.
[12]	陶娟, 尹永田, 秦玉婷, 王诗源, 韩榕, 张瀚丹. 左心室辅助装置植入患者照顾者居家照护体验的Meta整合[J]. 中华护理杂志, 2026, 61(2): 182-189.
[13]	兰星, 刘婷, 李勍, 柯稳, 李鑫, 张转运, 翟洁, 刘佳佳. 700所医疗机构麻醉科专科护士工作及管理现状的调查研究[J]. 中华护理杂志, 2026, 61(2): 237-243.
[14]	王飞霞, 李卫珍, 陈海燕. 伤口患者“互联网+”护理服务使用现状分析及护理策略[J]. 中华护理杂志, 2026, 61(10): 1310-1317.
[15]	李奎, 潘爱红, 徐佩丽, 许采颉, 任汝南, 王春. 维持性血液透析患者容量管理行为潜在剖面分析及影响因素研究[J]. 中华护理杂志, 2026, 61(1): 113-120.