新型智慧化管理模式在心房颤动患者社区随访管理中的效果评价

闫珊; 沈慧; 顾智淳; 潘忙忙; 王新华; 叶奥星

doi:10.16766/j.cnki.issn.1674-4152.003555

新型智慧化管理模式在心房颤动患者社区随访管理中的效果评价

doi: 10.16766/j.cnki.issn.1674-4152.003555

上海市浦东新区花木社区卫生服务中心，上海 201204

基金项目:

上海市浦东新区科技发展基金科研课题 PKJ2022-Y69

详细信息

通讯作者:
叶奥星，E-mail: yeax65@126.com

中图分类号: R541.75R197.61
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- 文章访问数: 306
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出版历程
- 收稿日期: 2023-08-09
- 网络出版日期: 2024-07-22

Evaluation of the effect of a new intelligent management model in community follow-up management of patients with atrial fibrillation

Shanghai Pudong New Area Huamu Community Health Service Center, Shanghai 201204, China

摘要

摘要: 目的探讨对心房颤动(简称“房颤”)患者开展基于互联网+医联体的新型智慧化管理模式的建设，分析其对社区房颤患者的管理效果，科学规范管理房颤患者。方法于花木社区卫生服务中心选取2021年5月—2022年5月“仁济-花木”房颤医联体现有房颤患者60例为研究对象，采用随机数字法分为对照组和观察组各30例，对照组进行常规随访管理，观察组在常规随访基础上增加智慧化随访管理。比较2组不良事件发生率，采用房颤患者生活质量量表(AFEQT)、医院焦虑抑郁自评量表(HADs，包括焦虑评分A值、抑郁评分D值)、Morisky服药依从性量表(MMAS-8)对管理效果进行评价。结果随访12个月时，观察组与对照组AFEQT评分(Z=-2.972)、HADs评分(Z_A值=-5.255，Z_D值=-5.105)、MMAS-8评分(Z=-5.353)比较差异均有统计学意义(P＜0.05)。2组缺血性卒中/短暂性脑缺血发作率、小出血事件发生率、心血管原因住院或二三级医院就诊率、术后复发率差异均无统计学意义(P＞0.05)。结论新型智慧化管理模式有利于改善房颤患者生活质量，提高用药依从性，减少焦虑抑郁。
- 心房颤动 /
- 智慧化管理 /
- 不良事件 /
- 生活质量 /
- 焦虑抑郁 /
- 服药依从性
Abstract: Objective To explore the construction of a new intelligent management model based on the Internet + medical combination for patients with atrial fibrillation, analyze its management effect on community patients with atrial fibrillation, and scientifically and standardized management of patients with atrial fibrillation. Methods In Huamu Community Health Service Center, 60 patients with atrial fibrillation in Renji-Huamu Medical Union from May 2021 to May 2022 were selected as the research objects, and 30 patients were divided into control group and observation group by random number method. Routine follow-up management was performed in the control group, and intelligent follow-up management was added to the observation group based on routine follow-up. The incidence of adverse events was compared between the two groups. The management effect was evaluated by the atrial fibrillation effect on quality-of-life (AFEQT), the hospital anxiety and depression scale (HADs, including anxiety score A and depression score D), and the Morisky medication adherence scale-8 (MMAS-8). Results After 12 months of follow-up, AFEQT score (Z=-2.972), HADs score (Z_{A value}=-5.255, Z_{D value}=-5.105) and MMAS-8 score (Z=-5.353) between the two groups were statistically significant (P < 0.05). There was no significant difference in the rates of ischemic stroke/transient ischemic attack, small bleeding events, hospitalization for cardiovascular reasons or visits to secondary or tertiary hospitals, and postoperative recurrence rates between the two groups (P>0.05). Conclusion The new intelligent management model is beneficial for improving the quality of life of atrial fibrillation patients, enhancing medication compliance, and reducing anxiety and depression.
- Atrial fibrillation /
- Intelligent management /
- Adverse events /
- Quality of life /
- Anxiety and depression /
- Medication compliance

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图 1 智慧化随访系统工作模式

Figure 1. Intelligent Follow-up System Working Mode

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表 1 2组房颤患者基线资料比较[例(%)]

Table 1. Comparison of baseline data of patients with atrial fibrillation between the two groups[cases (%)]

项目	对照组(n=30)	观察组(n=30)	统计量	P值	项目	对照组(n=30)	观察组(n=30)	统计量	P值
性别			< 0.001^a	0.999	CHA2DS2-VASc评分			5.694^b	0.458
男性	15(50.0)	15(50.0)			0分	1(3.3)	0
女性	15(50.0)	15(50.0)			1分	2(6.7)	4(13.3)
文化程度			2.705^b	0.608	2分	3(10.0)	6(20.0)
文盲	4(13.3)	2(6.7)			3分	9(30.0)	5(16.7)
小学	4(13.3)	7(23.3)			4分	8(26.7)	7(23.3)
初中	6(20.0)	9(30.0)			5分	4(13.3)	7(23.3)
高中	6(20.0)	5(16.7)			6分	3(10.0)	1(3.3)
大学及以上	10(33.3)	7(23.3)			HAS-BLED评分			0.357^b	0.837
房颤类型			3.082^a	0.544	0分	1(3.3)	2(6.7)
首诊房颤	0	2(6.7)			1分	22(73.3)	21(70.0)
阵发性房颤	10(33.3)	11(36.7)			2分	7(23.3)	7(23.3)
持续性房颤	3(10.0)	1(3.3)			血脂
长程持续性房颤	15(50.0)	14(46.7)			正常	29(96.7)	27(90.0)	1.071^a	0.301
永久性房颤	2(6.7)	2(6.7)			异常	1(3.3)	3(10.0)
房颤病程			2.497^b	0.476	血糖			0.351^a	0.554
≤1年	4(13.3)	8(26.7)			正常	29(96.7)	28(93.3)
2~5年	14(46.7)	9(30.0)			异常	1(3.3)	2(6.7)
6~10年	6(20.0)	7(23.3)			血肌酐			3.158^a	0.076
10年以上	6(20.0)	6(20.0)			正常	30(100.0)	27(90.0)
是否消融			0.300^a	0.584	异常	0	3(10.0)
无	19(63.3)	21(70.0)			肝功能			0.351^a	0.554
有	11(36.7)	9(30.0)			正常	28(93.3)	29(96.7)
若消融，消融情况			0.087^a	0.769	异常	2(6.7)	1(3.3)
首次消融	8(72.7)	6(66.7)			尿酸			0.162^a	0.688
重复消融	3(27.3)	3(33.3)			正常	27(90.0)	26(86.7)
EHRA症状评分			8.723^b	0.033	异常	3(10.0)	4(13.3)
1级	11(36.7)	7(23.3)			心房钠尿肽			0.162^a	0.688
2a级	8(26.7)	8(26.7)			正常	26(86.7)	27(90.0)
2b级	5(16.7)	14(46.7)			异常	4(13.3)	3(10.0)
3级	6(20.0)	1(3.3)
注：^a为χ²值，^b为Z值。

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表 2 2组房颤患者生活质量评分、焦虑抑郁评分、依从性评分比较[M(P₂₅, P₇₅), 分]

Table 2. Quality of life scores, anxiety and depression scores, and compliance scores of patients with atrial fibrillation in two groups[M(P₂₅, P₇₅), points]

组别	例数	第0个月评分
组别	例数	生活质量评分	焦虑抑郁评分A	焦虑抑郁评分D	依从性评分
观察组	30	55.50(48.25, 65.00)	4.00(3.00, 5.00)	3.00(1.00, 4.25)	5.00(4.00, 6.00)
对照组	30	57.00(47.75, 66.25)	4.00(3.00, 6.00)	4.00(2.00, 5.25)	4.38(4.00, 5.00)
Z值		-0.489	-0.600	-1.890	-2.110
P值		0.625	0.548	0.059	0.035

组别	例数	第6个月评分
组别	例数	生活质量评分	焦虑抑郁评分A	焦虑抑郁评分D	依从性评分
观察组	30	61.00(47.75, 78.00)	2.00(2.00, 4.00)	1.50(0.00, 3.00)	7.00(7.00, 8.00)
对照组	30	62.00(52.75, 70.25)	6.50(4.50, 8.00)	5.00(3.75, 7.00)	7.00(6.00, 7.90)
Z值		-0.436	-3.953	-4.685	-4.167
P值		0.662	＜0.001	＜0.001	＜0.001

组别	例数	第12个月评分
组别	例数	生活质量评分	焦虑抑郁评分A	焦虑抑郁评分D	依从性评分
观察组	30	70.00(55.00, 78.50)	2.00(1.00, 3.00)	3.00(1.50, 4.00)	7.00(7.00, 8.00)
对照组	30	58.00(50.00, 66.25)	7.00(4.00, 9.00)	7.00(5.00, 9.90)	5.38(4.75, 6.00)
Z值		-2.972	-5.255	-5.105	-5.353
P值		0.003	＜0.001	＜0.001	＜0.001

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表 3 2组房颤患者不良事件发生率比较[例(%)]

Table 3. Comparison of incidence of adverse events between the two groups[cases (%)]

组别	例数	缺血卒中/TIA	小出血事件	心血管原因住院或二三级医院就诊	术后复发
对照组	30	2(6.7)	7(23.3)	8(26.7)	8(26.7)
观察组	30	1(3.3)	1(3.3)	5(16.7)	2(6.7)
χ²值		< 0.001	3.606	0.884	3.000
P值		0.999	0.058	0.532	0.083

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