Effect of combined multiple self-check parameters on management of patients with chronic heart failure
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摘要: 目的 联合采用体重、6分钟步行试验(6-MWT)、静息心率(RHR)以及血浆脑钠肽(BNP)多项自检参数对慢性心力衰竭(CHF)患者进行管理,评价其对心功能状况、再住院和预后的影响及各项自检参数之间的相关性。 方法 选择2015年2月-2016年4月在上海市浦东医院心内科住院的207例纽约心脏病学会(NYHA)心功能分级Ⅱ~Ⅳ级的CHF患者,经治疗病情缓解后出院,按出院日期随机分为随访管理组和对照组。连续随访12个月。测量患者体重、血压[收缩压(SBP)、舒张压(DBP)]、外周血白细胞(WBC)、血红蛋白(HB)、血小板(PLT)计数、空腹血糖(FPG)、谷丙转氨酶(ALT)、总胆红素(TBIL)、血清肌酐(SCr)、钾(K+)、钠(Na+)、氯(Cl-)、血浆BNP水平,评估 NYHA心功能分级、左室射血分数(LVEF)、6-MWT、夜间睡眠心率(SHR)、清晨RHR。 结果 ①随访一年后管理组患者体重、BNP、SHR及RHR低于对照组,LVEF和6-MWT高于对照组(均P<0.05),SCr、K+、Na+、CL-、NYHA分级差异无统计学意义(均P>0.05)。②随访一年管理组和对照组患者再入院、平均住院天数、死亡差异有统计学意义(均P<0.05)。③各项自检参数体重、6-MWT、SHR、RHR、BNP、LVEF间有良好的相关性(均P<0.05)。 结论 联合采用多项自检参数对CHF患者全程干预管理,可以显著改善CHF患者心功能状况,减少再住院和住院天数,降低死亡率,有效减少医资源的消耗,具有显著的医疗效应和社会效应。Abstract: Objective To manage the patients with chronic heart failure (CHF) through combining the multiple self-check parameters of body weight, 6-minute walk test (6-MWT), resting heart rate (RHR), plasma brain natriuretic peptide (BNP), evaluate the effect of combined multiple self-check parameters on cardiac function status, re-hospitalization, the prognosis of patients, and discuss the correlations between the parameters. Methods Total 207 patients with CHF of New York Heart Association (NYHA) cardiac function grade Ⅱ-Ⅳ in Pudong hospital from February, 2015 to April, 2016 were recruited. The patients were randomly divided into the special messenger follow-up management group (manage group) and routine follow-up visit group (control group) according to the date of discharged from hospital after the patient's state was improved by treatment. All patients were followed up for 12 months. The body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral white blood cell (WBC), hemoglobin (HB), platelet (PLT) count, fasting plasma glucose (FPG), alanine transaminase (ALT), total bilirubin (TBIL), serum creatinine (SCr), potassium (K+), natrium (Na+), chlorine (Cl-), BNP, NYHA cardiac function grade, left ventricular ejection fraction (LVEF), 6-MWT, sleep heart rate (SHR) and morning RHR were recorded. Results ① After one year follow-up, the body weight, BNP, SHR and RHR of the manage group patients were significantly lower than those in the control, the LVEF and 6-MWT were significantly higher than those in the control (P<0.05), the SCr, K+, Na+, Cl- and NYHA cardiac function grade were not different statistically between the two groups (P>0.05). ② The re-hospitalization, mean hospitalization day and death after one year follow-up between the groups were different statistically (P<0.05). ③ There were good correlations between the multiple self-check parameters of body weight, 6-MWT, RHR, BNP and LVEF (P<0.05). Conclusion The program of combining multiple self-check parameters to manage the patients with chronic heart failure all-the-way can improve the patient's cardiac function status, reduce hospital readmission and hospitalization day, decrease mortality, reduce the consumption of medical resources effectively, and had significantly medical and social effects.
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