慢性心力衰竭患者医院-家庭过渡期容量管理^*

Capacity Management During the Hospital-to-Home Transition Period for Patients With Chronic Heart Failure

摘要

目的 探讨医院-家庭过渡期容量管理方案在慢性心力衰竭患者中的应用效果。方法 选取2022年12月–2024年8月住院的慢性心力衰竭患者为研究对象，随机分为对照组和观察组各96例。对照组采用常规护理方案，观察组采用医院-家庭过渡期容量管理方案。比较两组患者的主要结局指标（出院后2个月的干体重达标率）、次要结局指标（自我护理能力）及其他结局指标（6 min步行距离、再入院率）。结果 出院后2个月，观察组干体重达标率高于对照组（P<0.05），观察组6 min步行距离大于对照组（P<0.05），观察组自我护理维持、自我护理管理和自我护理信心得分均高于对照组（P<0.05），观察组再入院率低于对照组（P<0.05）。结论 医院-家庭过渡期容量管理方案可有效提高慢性心力衰竭患者自我容量管理能力，稳定容量负荷状态，可为慢性心力衰竭患者自我容量管理提供参考。

Abstract

Objective Exploring the effects of the hospital-to-home transitional capacity management plan in patients with chronic heart failure. Methods Patients with chronic heart failure who were hospitalized from December 2022 to August 2024 were selected as research subjects and randomly assigned to either a control group or an observation group, with 96 cases in each group. The control group received the conventional nursing plan, while the observation group received the hospital-to-home transitional volume management plan. The main outcome indicator was the rate of achieving dry weight targets two months after discharge. Secondary outcome indicators included self-care ability, and other outcome indicators included 6-minute walking distance and readmission rate. These outcomes were compared between the two groups. Results Two months after discharge, the rate of achieving normal body weight in the observation group was higher than in the control group (P < 0.05), The 6-minute walking distance in the observation group was greater than in the control group ( P < 0.05), The scores for self-care maintenance, self-care management, and self-care confidence in the observation group were all higher than those in the control group ( P < 0.05), and the readmission rate in the observation group was lower than that in the control group ( P < 0.05). Conclusion The hospital-family transitional volume management program enhance the self-capacity management ability of patients with chronic heart failure, stabilize the volume load status, and provide a reference for self-capacity management of patients with chronic heart failure.

关键词

慢性心力衰竭 / 容量管理 / 自我管理 / 医院-家庭过渡期

Key words

Chronic heart failure / Volume management / Self management / Hospital-family transition period

参考文献

[1] BOZKURT B, COATS A, TSUTSUI H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail, 2021, 23(3): 352-380. doi: 10.1002/ejhf.2115.

[2] GREENE S J, FONAROW G C, VADUGANATHAN M, et al. The vulnerable phase after hospitalization for heart failure. Nat Rev Cardiol, 2015, 12(4): 220-229. doi: 10.1038/nrcardio.2015.14.

[3] De La ESPRIELLA R, COBO M, SANTAS E, et al. Assessment of filling pressures and fluid overload in heart failure: an updated perspective. Rev Esp Cardiol (Engl Ed), 2023, 76(1): 47-57. doi: 10.1016/j.rec.2022.07.009.

[4] BONIOS M J, KYRZOPOULOS S, TSIAPRAS D, et al. Ultrasound guidance for volume management in patients with heart failure. Heart Fail Rev, 2020, 25(6): 927-935. doi: 10.1007/s10741-019-09863-5.

[5] 陈亚亚, 丁劲, 葸英博, 等. 慢性心力衰竭患者容量管理的最佳证据总结. 护理学杂志, 2022, 37(21): 42-46. doi: 10.3870/j.issn.1001-4152.2022.21.042.

[6] CHEN Y Y, DING J, XI Y B, et al. Evidence summary: fluid management in chronic heart failure. Iournal of Nursing Science, 2022, 37(21): 42-46. doi: 10.3870/j.issn.1001-4152.2022.21.042.

[7] 刘允. 医院-家庭过渡期护理模式在慢性心衰患者自我管理中的应用. 开封: 河南大学, 2023. doi: 10.27114/d.cnki.ghnau.2023.000576.

[8] LIU Y. Application of hospital-home transitional nursing model in self-management of patients with chronic heart failure. Kaifeng: Henan University. 2023. doi: 10.27114/d.cnki.ghnau.2023.000576.

[9] 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. 中华心血管病杂志, 2024, 52(3): 235-275. doi: 10.3760/cma.j.cn112148-20231101-00405.

[10] 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. Chin J Cardiol, 2024, 52(3): 235-275. doi: 10.3760/cma.j.cn112148-20231101-00405.

[11] 傅咏华, 李志强, 徐玉凤, 等. 个性化容量管理对慢性心力衰竭患者的影响. 复旦学报(医学版), 2022, 49(5): 726-732. doi: 10.3969/j.issn.1672-8467.2022.05.013.

[12] FU Y H, LI Z Q, XU Y F, et al. Effect of individualized volume management for patients with chronic heart failure. Fudan University Journal of Medical Sciences, 2022, 49(5): 726-732. doi: 10.3969/j.issn.1672-8467.2022.05.013.

[13] COSTANZO M R, RONCO C, ABRAHAM W T, et al. Extracorporeal ultrafiltration for fluid overload in heart failure: current status and prospects for further research. J Am Coll Cardiol, 2017, 69(19): 2428-2445. doi: 10.1016/j.jacc.2017.03.528.

[14] 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. 中华护理杂志, 2022, 57(13): 1541-1547. doi: 10.3761/j.issn.0254-1769.2022.13.001.

[15] CHEN H, XIONG X Y, SUN X L, et al. Construction and application of a volume management program in vulnerable phase for patients with heart failure. Chin J Nurs, 2022, 57(13): 1541-1547. doi: 10.3761/j.issn.0254-1769.2022.13.001.

[16] 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. 中国护理管理, 2021, 21(4): 570-575. doi: 10.3969/j.issn.1672-1756.2021.04.020.

[17] TU H, GUO T, SUN X L, et al. Development and evaluation of volume management program for patients with chronic heart failure. Chin Nurs Manag, 2021, 21(4): 570-575. doi: 10.3969/j.issn.1672-1756.2021.04.020.

[18] 郭金玉, 李峥, 康晓凤. 心力衰竭自我护理指数量表的汉化及信效度检测. 中华护理杂志, 2012, 47(7): 653-655. doi: 10.3761/j.issn.0254-1769.2012.07.028.

[19] GUO J Y, LI Z, KANG X F, et al. Chinese adaptation and validity and reliability testing of the heart failure self-care index. Chin J Nurs, 2012, 47(7): 653-655. doi: 10.3761/j.issn.0254-1769.2012.07.028.

[20] 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. 中华心力衰竭和心肌病杂志, 2018, 2(1): 8-16. doi: 10.3760/cma.j.issn.2096-3076.2018.03.004.

[21] Heart Failure Professional Committee of Chinese Medical Docter Association, Editorial Board of Chinses Jourol of Heart Failure and Cardiomyopathy. Expert recommendation on the voume control in heart failure management. Chinese Journal of Heart Failure and Cardiomyopathy, 2018, 2(1): 8-16. doi: 10.3760/cma.j.issn.2096-3076.2018.03.004.

[22] 郑慧萍, 张美素, 杨卫琴, 等. 体质量专案管理在慢性心力衰竭患者中的应用分析. 护理与康复, 2020, 19(10): 38-41. doi: 10.3969/j.issn.1671-9875.2020.10.012.

[23] ZHENG H P, ZHANG M S, YANG W Q, et al. An analysis of the application of body mass index-based case management in patients with chronic heart failure. Nursing and Rehabilitation Journal, 2020, 19(10): 38-41. doi: 10.3969/j.issn.1671-9875.2020.10.012.

[24] 黄淑燕. 基于标准化程序的容量管理对重症心力衰竭患者血压和心功能的影响. 心血管病防治知识, 2023, 13(3): 82-85. doi: 10.3969/j.issn.1672-3015(x).2023.03.025.

[25] HUANG S Y. The effects of standardized capacity management on blood pressure and cardiac function in patients with severe heart failure. Prevention and Treatment of Cardiovascular Disease, 2023, 13(3): 82-85. doi: 10.3969/j.issn.1672-3015(x).2023.03.025.

[26] HERBER O R, ATKINS L, STORK S, et al. Enhancing self-care adherence in patients with heart failure: a study protocol for developing a theory-based behaviour change intervention using the COM-B behaviour model (ACHIEVE study). BMJ Open, 2018, 8(9): e25907. doi: 10.1136/bmjopen-2018-025907.

[27] 李涤凡, 尹德荣, 黄文伶, 等. 老年慢性心力衰竭患者自我管理现况调查和影影响因素的研究. 中国护理管理, 2020, 20(3): 360-366. doi: 10.3969/j.issn.1672-1756.2020.03.010.

[28] LI D F, YIN D R, HUANG W L, et al. Investigation of self-management behaviors and its influencing factors inelderly patients with chronic heart failurel. Chin Nurs Manag, 2020, 20(3): 360-366. doi: 10.3969/j.issn.1672-1756.2020.03.010.

[29] 王芳芳, 文杰, 张慧颖, 等. 精细化容量管理对慢性心力衰竭急性加重患者的影响. 中国护理管理, 2024, 24(4): 588-592. doi: 10.3969/j.issn.1672-1756.2024.04.020.

[30] WANG F F, WEN J, ZHANG H Y, et al. Effects of the precise volume management on patients with acute exacerbation of chronic heart failure. Chin Nurs Manag, 2024, 24(4): 588-592. doi: 10.3969/j.issn.1672-1756.2024.04.020.

[31] LI M, LI Y, MENG Q, et al. Effects of nurse-led transitional care interventions for patients with heart failure on healthcare utilization: a meta-analysis of randomized controlled trials. PLoS One, 2021, 16(12): e261300. doi: 10.1371/journal.pone.0261300.

基金资助

*安徽省教育厅高校自然科学研究项目(KJ2021A0301)