The community management research in chronic heart failure by united teamwork model on specialist medicine and general family medicine
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摘要: 目的 观察专科-全科联合团队模式对社区慢性心力衰竭患者的管理效果,摸索建立一个行之有效的慢性心力衰竭社区管理模式。 方法 选取明确诊断为慢性心力衰竭的患者90例,用随机数字法随机分成管理组40例和对照组50例,管理组由联合团队按照多学科管理模式进行综合管理,对照组由不参与本研究的全科团队按照常规慢病管理模式进行随访治疗及健康指导,并及时做好各种量表及随访记录。随访1年后分别对2组患者的左室射血分数(EF值)、N末端B型利钠肽原(NT-proBNP)、6分钟步行距离(6MWT)、明尼苏达心力衰竭生存质量问卷(MLHFQ评分)、慢性心力衰竭标准化药物的使用率、病死率、住院率进行比较。 结果 2组患者在年龄、心功能分级、心衰标准化用药的比率以及各项观察指标方面差异均无统计学意义(P>0.05)。管理实施后2组的EF值比较差异无统计学意义(t=1.392,P=0.166)。2组的6MWT (t=2.660,P=0.009)、NT-ProBNP (z=-3.380,P=0.033)、MLHFQ总分(z=-2.375,P=0.018)、躯体领域评分(z=-3.460,P=0.037)和情绪领域评分(z=-7.750,P<0.001)比较差异均有统计学意义。实施后2组螺内酯使用率比较差异无统计学意义(χ2=0.058,P=0.809),ACEI/ARB和β-受体阻滞剂的使用率比较差异均有统计学意义(P<0.01)。实施管理后2组病死率比较差异无统计学意义(χ2=0.775,P=0.456),但在住院率的比较上差异具有统计学意义(χ2=4.220,P=0.040)。 结论 组成专科-全科联合团队能明显提高原有全科团队慢性心力衰竭的管理效果,可有效提高患者的生存质量,值得推广。Abstract: Objective Watch specialist-general joint team mode of community patients with chronic heart failure management effect,grope for establishing an effective pattern of the community management of chronic heart failure. Methods We researched 90 patients having chronic heart failure.With methods of random grouping,the patients were divided into management group and control group.The management group was managed by united teamwork,meanwhile the control group was managed by the GPs who didn't take part in this research.We collected the data on follow-up,health guidance,scales and laboratory indexes.After a year,we analyzed two group data on EF value,NT-proBNP,MLHFQ score,standard drug-taking rates on CHF,mortality and hospitalization rate. Results Compared with the baseline,there was no statistical significance on these two groups about age,cardiac function classification,drug-taking rates and other observation indexes(P>0.05).After managing,there was statistical significance among 6MWT(t=2.660,P=0.009),NT-proBNP(z=-3.380,P=0.033),MLHFQ score(z=-2.375,P=0.018) and physical(z=-3.460,P=0.037) and emotion score(z=-7.750,P<0.001).There was statistical significance among the drug-taking rates on ACEI/ARB(χ2=12.823,P<0.001)and β-blocker(χ2=11.390,P<0.001).There was statistical significance on hospitalization rate between management group and control group(χ2=4.220,P=0.040). Conclusion Compared with the general practice team model,the united teamwork model on specialist medicine and general family medicine can improve the management effect and life quality,and it is worth popularizing.
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Key words:
- Chronic heart failure /
- Community medicine /
- Disease management
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