慢性心力衰竭患者重点随访对改善心功能的效果观察

徐悦 杨妙珍 王一尘

（上海市彭江医院 上海 200070）

摘 要目的：探讨慢性心力衰竭患者重点随访对改善心功能的效果。方法：采用随机、对照研究方法，将2010 年7月-2014年7月我院诊断明确的慢性心力衰竭患者100例，按随机数字表法分为干预组50例，对照组50例。干预组患者每周随访2次，根据心功能和临床症状进行干预，包括调整规范治疗方案，指导患者正确使用药物。对照组不做任何干预。在6个月和12个月时采用6 min步行试验(6 MWT)及超声心动图检查，对患者的心功能状况评价。结果：6个月、12个月时干预组6 MWT分别为（345±124）m、（369±122）m，明显高于对照组的（283±95）m、（260±86）m，差异有统计学意义（P<0.05）。12个月时，干预组的左心室射血分数显著高于对照组(P<0.05)。结论： 对慢性心力衰竭患者进行重点随访干预可以改善其心功能。

关键词慢性心力衰竭 重点随访 心功能

The effect of the focus on follow-up on the improvement of the cardiac function in patients with chronic heart failure

XU Yue, YANG Miaozhen, WANG Yichen

(Shanghai Penjiang Hospital, Shanghai 200070, China)

ABSTRACTObjective: To explore the effect of the focus on follow-up on the improvement of cardiac function in patients with chronic heart failure. Methods: One hundred cases of the patients with chronic heart failure who were diagnosed in our hospital between July, 2010 and July, 2014 were randomized into an intervention group and a control group by random number tables with 50 cases each. The patients in the intervention group were followed up twice each week and were intervened based on their cardiac function and clinical symptoms, in which to adjust the standard treatment program and guide them to correct medication were included, while no intervention was performed in the control group. The cardiac function was evaluated by 6-minute walking test (6 MWT) and echocardiography. Results: The results of 6 MWT were (345±124) m and (369±122) at the sixth and twelfth month in the intervention group, which were significantly higher than those [(283±95) m and (260±86) m] in the control group (t values were 3.407 and 5.488, P < 0.05. Left ventricular ejection fraction (LVEF) was significantly higher in the intervention group than in the control group at the 12th month (P < 0.05). Conclusion: The focus on follow-up to the patients with chronic heart failure can improve their heart function.

KEY WORDSfocus on follow-up; chronic heart failure; cardiac function

慢性心力衰竭(chronic heart failure, CHF)是各种心脏病的严重阶段，具有高致残率、高发病率、高再入院率和病死率的特点。目前以药物治疗为主，除了病情较重住院外，大部分慢性心力衰竭患者均采取门诊治疗的方式。由于种种原因，很多门诊随访患者的治疗依从性较差，缺乏自我护理能力和自我防护意识、不能定期复查、按时服药、受凉后导致肺部感染加重病情而入院。本文总结我院对CHF患者进行院外重点随访，以心功能改善为观察指标，探讨这一措施的临床价值。

1 资料与方法

1.1 一般资料

研究对象为2010年7月-2014年7月我院门诊或住院明确诊断的CHF患者100例，按随机数字表法分为干预组50例，对照组50例。干预组年龄34～78岁，平均（63.0±10.4）岁。对照组34～79岁，平均（62.4±11.4）岁。两组患者的年龄、心功能分级、CHF原发疾病比较差异无统计学意义（P＞0.05，表1）。……