2019 年第 4 期 第 14 卷

三级医院-社区医院一体化管理在高原慢性心力衰竭患者治疗中的应用

Application of integrated management of tertiary hospitals and community hospitals in treatment of patients with chronic heart failure in plateau area

作者：李江刘文娴赵晗次仁仲嘎康云鹏任燕龙

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科（李江、刘文娴、赵晗、康云鹏、任燕龙）；850000拉萨市人民医院心内科（次仁仲嘎）

英文单位：

关键词：慢性心力衰竭；一体化管理；高原；依从性；再入院率；死亡率

英文关键词：

• 摘要：

• 【摘要】目的    评价三级医院-社区医院慢性心力衰竭（CHF）一体化管理（简称一体化管理）在高原CHF患者治疗中的作用。方法    于2017年4—6月在拉萨市人民医院辖区5个社区医院登记的CHF档案库中用抽签法随机抽取300例CHF患者，经筛选符合试验标准且同意参加试验的患者265例，将这265例患者用随机数字法随机分为观察组（133例）及对照组（132例）。对照组给予传统心力衰竭治疗及管理，患者根据自身情况到医院就诊或复诊；观察组则在常规心力衰竭治疗基础上增加一体化管理。治疗观察12个月，主要观察患者心力衰竭治疗药物使用率；并观察患者总死亡、心源性死亡及因心力衰竭再入院等心血管不良事件发生率。结果    治疗12个月后，观察组β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂和醛固酮受体拮抗剂（螺内酯）使用率均明显高于对照组［78.2%（93/119）比40.0%（42/105）、82.4%（98/119）比47.6%（50/105）、81.5%（97/119）比41.0%（43/105）］（均P<0.05），其他利尿剂使用率及洋地黄类强心药使用率2组差异无统计学意义（P>0.05）；干预12个月内，观察组因心力衰竭再入院率、死亡率明显低于对照组（P<0.05）。结论    一体化管理较传统心力衰竭管理能提高高原CHF患者的依从性并改善患者预后。

• 【Abstract】Objective    To evaluate the effect of integrated management of tertiary hospitals and community hospitals on patients with chronic heart failure（CHF） in plateau area. Methods    A total of 300 CHF patients were randomly selected from the database of 5 community hospitals attached to Lhasa People′s Hospital from April to June 2017. Finally 265 patients who met the inclusion criteria and agreed to participate in the experiment were included. The 265 subjects were randomly divided into observation group(n=133) and control group(n=132). The control group was treated with conventional intervention. The observation group was treated with integrated management on the basis of conventional treatment. The experiment last for 12 months. Drug use rate, cardiovascular adverse events such as total mortality, cardiogenic death and readmission due to heart failure were analyzed. Results    After 12 months of treatment, use rates of β-receptor blockers, angiotensin converting enzyme inhibitors/angiotensin receptor inhibitors and aldosterone receptor antagonist(spirolactone) in observation group were significantly higher than those in control group［78.2%（93/119） vs 40.0%（42/105）, 82.4%（98/119） vs 47.6%（50/105）, 81.5%（97/119） vs 41.0%（43/105）］(P<0.05). There was no significant difference of use rates of other diuretics and digitalis cardiotonic agents between groups（P>0.05）. During 12 months of treatment, readmission rate and mortality rate in observation group were significantly lower than those in control group (P<0.05). Conclusion    Integrated management can improve the compliance and prognosis of patients with CHF in plateau area.