N端脑钠尿肽激素原血浆浓度与慢性心衰严重程度的关系

目的　分析慢性心衰患者心衰程度与N -终端脑钠尿肽激素原 (Nt-proBNP)的血浆浓度的关系 ,了解心衰发生发展过程中神经内分泌方面的变化 ,以探讨心衰早期诊断和治疗的理论依据。方法　 5 6例心脏病患者根据纽约心脏病协会 (NYHA)分级标准分为心功能Ⅰ级 (A组 )、Ⅱ级 (B组 )、Ⅲ级及Ⅳ级 (C组 )三组 ,正常对照组 2 2例。用ELISA法检测Nt -proBNP血浆浓度和心脏彩色B超检测其射血分数 (EF)。结果　B组和C组患者的Nt-proBNP与正常对照组比较有统计学意义 (P <0 0 5 ) ,且与射血分数呈负相关 (BVsC ,P <0 0 5 )。在无症状性心衰患者 (EF <5 0 %但无心衰症状 ) ,Nt-proBNP浓度升高也有统计学意义 (EF≥ 5 0 %VsEF <5 0 % ,P <0 .0 5 )。结论　慢性心力衰竭患者存在神经内分泌的过度激活 ,Nt -proBNP血浆浓度升高较为敏感 ,可作为评价心衰严重程度和早期心功能受损的指标     

慢性充血性心力衰竭合并肺部感染临床特征分析

目的 探讨慢性充血性心力衰竭(CHF)合并肺部感染临床特征.方法 回顾性分析180例CHF住院患者的临床资料.结果 该组患者共发生肺部感染94例,占52.2%,入院前感染78例,占43.3%,医院感染16例,占8.9%;94例合并肺部感染的患者共分离出111株细菌,革兰阴性菌84株,占75.7%,革兰阳性菌27株,占24.3%;分布最多的3种细菌为铜绿假单胞菌(25.3%)、金黄色葡萄球菌(18.0%)和肺炎克雷伯菌(15.3%);主要细菌呈现出较高的耐药性;单因素分析显示,年龄≥60岁、住院时间≥30 d、侵入性操作、糖尿病和心功能Ⅲ、Ⅳ级为肺部感染的危险因素.结论 CHF合并肺部感染病以革兰阴性菌为主,应根据药敏试验选用合理的抗菌药物,同时应根据高危因素来控制和预防医院感染.     

生脉注射液联合厄贝沙坦治疗冠心病慢性心力衰竭的疗效

目的 研究生脉注射液联合厄贝沙坦治疗冠心病慢性心力衰竭的疗效.方法 选取我院2017年3月—2018年3月收治的100例慢性心力衰竭患者,随机分为两组各50例.对照组患者口服厄贝沙坦片,1片/次,1次/d,治疗组患者在对照组基础上每日给予生脉注射液,将30 mL生脉注射液溶于250 mL 5％葡萄糖注射液中,两组患者均...     

慢性肾功能衰竭并发心力衰竭临床分析

目的 对慢性肾功能衰竭合并心力衰竭患者的临床治疗进行研究分析.方法 我院于2019年1月—2020年1月收治了58例慢性肾功能衰竭合并心力衰竭患者,将其作为本次研究的研究目标,查看患者的临床资料后,对所有患者的治疗前与治疗后的临床治疗指标进行研究比较.结果 治疗后的患者的心率水平、血氧饱和度、收缩压、舒张压、呼吸频率、...     

Disease Management in Skilled Nursing Facilities Improves Outcomes for Patients With a Primary Diagnosis of Heart Failure

ObjectiveSkilled nursing facilities (SNFs) are common destinations after hospitalization for patients with heart failure (HF). Our objective was to determine if patients in SNFs with a primary hospital discharge diagnosis of HF benefit from an HF disease management program (HF-DMP).DesignThis is a subgroup analysis of multisite, physician and practice blocked, cluster-randomized controlled trial of HF-DMP vs usual care for patients in SNF with an HF diagnosis. The HF-DMP standardized SNF HF care using HF practice guidelines and performance measures and was delivered by an HF nurse advocate.Setting and ParticipantsPatients with a primary hospital discharge diagnosis of HF discharged to SNF.MethodsComposite outcome of all-cause hospitalization, emergency department visits, and mortality were evaluated at 30 and 60 days post SNF admission. Linear mixed models accounted for patient clustering at the physician level.ResultsOf 671 individuals enrolled in the main study, 125 had a primary hospital discharge diagnosis of HF (50 HF-DMP; 75 usual care). Mean age was 79 ± 10 years, 53% women, and mean ejection fraction 46% ± 15%. At 60 days post SNF admission, the rate of the composite outcome was lower in the HF-DMP group (30%) compared with usual care (52%) (P = .02). The rate of the composite outcome at 30 days for the HF-DMP group was 18% vs 31% in the usual care group (P = .11).Conclusions and ImplicationsPatients with a primary hospital discharge diagnosis of HF who received HF-DMP while cared for in an SNF had lower rates of the composite outcome at 60 days. Standardized HF management during SNF stays may be important for patients with a primary discharge diagnosis of HF.     

康复运动对慢性心力衰竭患者生活质量的影响

目的：探讨康复运动对慢性心力衰竭患者生活质量的影响。方法：将37例慢性心力衰竭患者按随机数字表法分成康复组和对照组,康复组在药物治疗的基础上进行康复运动,对照组只进行药物治疗。治疗前后以明尼苏达心力衰竭生活质量问卷表调查两组患者的生活质量。结果：两组治疗后生活质量均有改善,但康复组生活质量改善明显优于对照组（P=0.001）。结论：在常规药物治疗的同时进行康复运动能够更好地改善心衰患者的生活质量,值得临床推广应用。     

家庭-社区-医院一体化管理对慢性心衰患者照顾者支持性需求的质性研究

目的探讨对慢性心衰患者进行家庭-社区-医院一体化管理的效果。方法回顾性分析2018年6月—2019年6月内,选择62例在该院收治的慢性心衰患者,随机抽取各31例设为研究和对照两组,用家庭-社区-医院一体化管理的为研究组,用常规管理的为对照组,比较两组患者的生活质量以及SF-36评分。结果研究组的生活质量以及SF-36评分均比对照组优(P<0.05)。结论对慢性心衰患者进行家庭-社区-医院一体化管理,可以改善患者的生活质量,提高患者生理、心理以及社会功能,确保患者更好的生活,因此具有推广的价值。     

Home Health Care With Telemonitoring Improves Health Status for Older Adults With Heart Failure

Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalization or emergency visit between those who received telemonitoring versus usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore, for older adults with heart failure, telemonitoring may be an important adjunct to home health care services to improve health status.     

慢性充血性心力衰竭的中医分型与血清尿酸的关系

目的观察慢性充血性心力衰竭的中医分型与血清尿酸的关系。方法慢性充血性心力衰竭中医辩证分型分为气阴两虚、气虚血瘀、阳虚水泛3型,对87例病人均测定血清尿酸,并把各型的血清尿酸水平进行比较。结果中医症型不同高尿酸血症的发生率和尿酸水平有明显不同,气阴两虚型〈气虚血瘀型〈阳虚水泛。结论慢性充血性心力衰竭病人血尿酸水平升高对判断中医症型有一定意义。     

NT-proBNP与呼吸衰竭及慢性肺源性心脏病的相关性研究

目的：研究N端脑钠肽前体（NT-ProBNP）与呼吸衰竭及慢性肺源性心脏病的相关性。方法：筛选和收集2012年1月-2013年12月本科收治的符合单纯呼吸衰竭（A组50例）和呼吸衰竭合并慢性肺心病（B组50例）诊断标准的患者。并选取在本院进行健康体检者（C组）的血样50份,进行血液NT-proBNP水平检测。比较三组的血液NT-proBNP水平,并对A、B两组治疗前后的NT-proBNP水平、血气指标进行比较。记录患者6个月内不良事件发生情况。结果：A、B两组治疗前、后的NT-proBNP水平均显著高于C组,差异均有统计学意义（P〈0.05）;B组在治疗前NT-proBNP水平显著高于A组,差异有统计学意义（P〈0.05）;A、B两组在治疗后的NT-proBNP水平比较无统计学意义（P〉0.05）。经过6-12个月随访,在100例呼吸衰竭患者中,因住院期间发生的病情加重需机械通气、心肺复苏或任何原因的死亡等不良事件共23次,因病情加重需再次住院有37次。发生相关不良事件的患者的NT-proBNP水平为（2849.7±394.7）pg/L显著高于未发生不良事件者的（988.7±93.1）pg/L,差异有统计学意义（P〈0.05）。结论：NT-proBNP水平与呼吸衰竭患者是否有肺心病及右心受累程度密切相关,是快速判断右心功能不全严重程度以及疗效判断的良好指标。