叶晓艳 梁崇单 吴芳

摘 要 目的：探索個案管理对社区老年冠心病患者健康行为和健康状况的影响。方法：选取上海芷江西路街道社区卫生服务中心内科病房2018年9月—2020年6月收治的60例老年冠心病患者，使用随机数字表法分为干预组和对照组，每组30例。对照组有男性15例，女性15例，平均年龄（73.17±5.21）岁。干预组有男性11例，女性19例，平均年龄（73.83±5.86）岁。对对照组患者进行常规护理、健康教育与出院随访。对干预组患者在常规护理和健康教育的基础上，进行以护士为主导的社区个案管理模式。比较两组在出院6个月时的健康状况（生存质量和心功能）和健康行为情况。结果：干预组患者在生存质量中的一般健康状况水平、生理功能水平、精力、精神健康水平、躯体疼痛程度等维度及健康行为的饮酒、食盐量、呼吸训练、睡眠、服药依从性方面优于对照组（P<0.05）；两组患者在左心室射血分数、6 min步行距离等心功能指标差异没有统计学意义（P>0.05）。结论：以护士为主导的社区个案管理模式可以改善社区老年冠心病患者的生存质量，促进患者的健康行为。

关键词 冠心病；社区个案管理模式；生存质量；健康行为

中图分类号：R54 文献标志码：A 文章编号：1006-1533（2021）16-0048-05

The influence of community case management mode on health behavior and health status of elderly patients with coronary heart disease

YE Xiaoyan， LIANG Chongdan， WU Fang

（Nursing Department of Zhijiangxilu Community Health Service Center of Jingan District， Shanghai 200070， China）

ABSTRACT Objective： To explore the influence of case management on health behavior and health status of elderly patients with coronary heart disease in the community. Methods： Sixty elderly patients with coronary heart disease were selected from the Internal Medicine Ward of Zhijiangxilu Community Health Service Center， Shanghai from September 2018 to June 2020， and using random number table method， divided into an intervention group and a control group with 30 cases in each group. There were 15 males and 15 females in the control group， with an average age of （73.17±5.21） years old. There were 11 males and 19 females in the intervention group， with an average age of （73.83±5.86） years old. Routine care， health education and discharge follow-up were given to the patients in the control group. On the basis of routine nursing and health education， a community case management mode led by nurses was implemented for patients in the intervention group. The health status（quality of life and cardiac function） and health behavior of the two groups at 6 months after discharge were compared. Results： The patients in the intervention group were better than the patients in the control group in terms of general health status， physiological function level， energy， mental health level， physical pain level and other dimensions of the quality of life， as well as health behaviors in terms of drinking， salt intake， breathing training， sleep， and medication compliance（P<0.05）； there was no statistically significant difference in the left ventricular ejection fraction and 6-minute walk distance between the two groups of the patients（P>0.05）. Conclusion： The community case management mode， which is dominated by nurses， can improve the quality of life of elderly patients with coronary heart disease and promote the health behavior of the patients.

KEY WORDS coronary heart disease； community case management mode； quality of life； healthy behavior

冠心病是冠状动脉粥样硬化导致的缺血性心脏病的简称。2019年的《中国心血管健康与疾病报告》指出，中国心血管病患病率及死亡率仍居高不下，估计心血管病的现患人数达3.3亿，其中冠心病为1 100万[1]。而老年人则是冠心病多发群体，在临床诊疗中临床特征呈现多样化，合并症现象多，在诊疗时难度加大[2]。目前，我国冠心病患者出院后的疾病管理主要以延续性护理和健康教育为主[3-5]，冠心病患者的自我管理行为水平和生存质量仍处较低水平[6]。……