慢性心力衰竭院外容量管理的有效性及安全性分析

    Study on the effectiveness and safety of out-of-hospital volume management of chronic heart failure

    • 摘要:
      目的: 评估院外容量管理模式对慢性心力衰竭(CHF)病人的心功能指标、运动耐量、再入院率和急性心力衰竭(AHF)发作次数的影响。
      方法: 选择2023年1—5月心内科收住的120例NYHA心功能分级为Ⅱ ~ Ⅳ级的CHF病人,随机分为对照组与干预组。其中,对照组定期门诊随访常规治疗,干预组则在对照组常规治疗方案基础之上加用院外容量管理方式,评估2组CHF病人出院前一天和6个月后的NYHA心功能分级、电解质水平、脑钠肽(BNP)、血脂水平、左室射血分数(LVEF)、6 min步行试验(6-MWT)、明尼苏达心力衰竭生活质量调查表(MLHFQ)、AHF发作次数和再入院次数。
      结果: 出院前一天,2组各指标差异无统计学意义(P > 0.05)。随访6个月后,干预组病人的BNP、血脂水平及MLHFQ均低于对照组,6-MWT、LVEF水平均高于对照组(P < 0.05)。2组NYHA分级差异有统计学意义(P < 0.05~P < 0.01)。随访6个月内,2组AHF发作次数和再入院次数差异有统计学意义(P < 0.01和P < 0.05)。
      结论: 院外容量管理有望提高CHF病人的心功能水平和改善生活质量,降低AHF发作次数和再入院次数。

       

      Abstract:
      Objective To evaluate the effects of out-of-hospital volume management on cardiac function indicators, exercise tolerance, readmission rate and acute heart failure (AHF) episodes in patients with chronic heart failure (CHF).
      Methods From January to May 2023, 120 CHF patients with NYHA grade Ⅱ to Ⅳ from the department of cardiology were randomly divided into the control group and intervention group. The control group was given the regular outpatient follow-up and routine treatment, and the intervention group was given the out-of-hospital volume management on the basis of the conventional treatment. The NYHA cardiac function rating, electrolyte levels, brain natriuretic peptide (BNP), lipid levels, left ventricular ejection fraction (LVEF), 6-min walk test (6-MWT), Minnesota living with heart failure questionnaire (MLHFQ), AHF episodes, and readmission were evaluated in two groups before discharge and 6 months later.
      Results On the day before discharge, there was no statistical significance in all indexes between two groups (P > 0.05). After 6 months of follow-up, the levels of BNP, lipid and MLHFQ in the intervention group were lower than those in control group, and the levels of 6-MWT and LVEF were higher than those in control group (P < 0.05 to P < 0.01). The difference of the NYHA classification was statistically significant between two groups (P < 0.05). Within 6 months of follow-up, the differences of number of AHF episodes and readmissions were statistically significant between two groups (P < 0.01 and P < 0.05).
      Conclusions The out-of-hospital volume management is expected to improve the cardiac function and quality of life of CHF patients, and reduce the frequency of AHF attacks and readmission.

       

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