患者与家属互述式健康教育在慢性心力衰竭患者中的应用

目的 探讨患者与家属互述式健康模式在心力衰竭患者中的应用效果。 方法 选取2016年7月-2017年1月我科收治的慢性心力衰竭患者128例为研究对象,采用随机数字表法将其分为对照组和观察组,各64例,对照组采用常规健康教育,观察组采用患者与家属互述式健康教育模式。 随访6个月,比较2组患者健康教育知识掌握程度、生活质量及再住院率。 结果 2组患者的健康教育掌握程度和生活质量在时间效应和组间效应上均存在统计学差异(F_组间=11.038,P=0.001;F_组间=17.213,P＜0.001);出院6个月内,观察组再住院率低于对照组(χ²=4.137,P=0.042)。 结论 患者与家属互述式健康教育可有效的提升慢性心力衰竭患者健康教育效果,改善心衰患者的生活质量,降低患者再住院率。     

基于跨理论模型的护理干预对心力衰竭患者生活质量的影响

目的：探讨基于跨理论模型的护理干预对心力衰竭患者生活质量的影响。方法将100例心力衰竭患者按简单随机分组方法分为研究组和对照组各50例,对照组给予心内科常规护理干预,研究组实施以跨理论模型为理论依据制定的干预措施。应用中文版明尼苏达心力衰竭患者生活质量量表（ MLHFQ）分别于干预前、干预后1个月和干预后3个月对两组患者进行测评,比较其差异。结果在出院后1个月和3个月的后续资料收集过程中,研究组死亡2例,失访5例,43例患者完成研究。对照组死亡3例,失访7例,40例患者完成研究。干预前、干预后1个月和3个月研究组患者生活质量总分分别为（40．14±17．59）,（59．98±17．44）,（52．28±16．46）分,对照组分别为（38．45±16．00）,（45．25±14．80）,（41．30±14．40）分,两组患者入组时MLHFQ总分比较,差异无统计学意义（P＞0．05）,干预后1,3个月两组比较,差异均有统计学意义（t分别为3．29,3．22;P＜0．05）。结论以跨理论模型为依据制定的干预方案能显著改善心力衰竭患者的生活质量。     

Effectiveness of an educational self‐management program for outpatients with chronic heart failure

Aim: The occurrence rate of chronic heart failure (CHF) in Japan is estimated to be 50 000 per one million persons. It is important for the Japanese medical financial system to institute a program of disease management in order to prevent the deterioration of persons with CHF. However, there are still few studies on the disease management of CHF in Japan. Therefore, the purpose of this study was to provide an educational self‐management program to Japanese outpatients with CHF in order to improve their clinical outcomes. Methods: A randomized, controlled trial with 102 outpatients with CHF was conducted. There were 50 participants in the intervention group and 52 participants in the control group. The control group received medical treatment and standard care. In addition to this, the intervention group also received an educational program for 6 months. The program consisted of six nurse‐directed sessions that were provided to each outpatient once per month in a clinical setting for a total of 6 months. A follow‐up session was conducted each month for 6 months. The data collection was carried out at the start of the program and at 3, 6, 9, and 12 months. Results: Significant differences could be observed in the primary and secondary outcomes and in the process indicators between the two groups after the program began. In other words, all the indicators improved for the intervention group, compared to the control group. Therefore, this program was considered to be effective. Conclusion: Further long‐term care is necessary for outpatients with CHF in order to prevent their deterioration and to maintain their health status, even though this 6 month program did provide them with proper knowledge regarding self‐care for CHF and affected their therapy results.     

Effects of a psychoeducational intervention for secondary prevention in Korean patients with coronary artery disease: A pilot study

This intervention study was designed to examine whether a 12‐week psychoeducational intervention influenced recurrent cardiac events, symptom experience and treatment adherence of patients with coronary artery disease. Fifty‐eight patients were randomized to either the intervention or the control group. Measures were taken at baseline, after intervention, and at 6‐month follow‐up. Recurrent cardiac events included revascularization, rehospitalization, emergency room visits and mortality. Symptom experiences were measured using the Seattle Angina Questionnaire‐Korean and Hospital Anxiety and Depression Scale. Treatment adherence included health behaviours, routine check‐up and medication adherence. At 6‐month follow‐up, the intervention group had significantly better physical functions and lower anxiety and depressive symptoms. Treatment adherence was also significantly higher in the intervention group than the control group. No significant difference was noticed in the incidence of recurrent cardiac events between the groups. A longer follow‐up study is needed to determine the long‐term effects on the prevention of recurrent cardiac events.     

基于微信的延续性护理在慢性心力衰竭患者中的应用

目的探讨基于微信的延续性护理对慢性心力衰竭患者疾病自我管理能力及再住院率的影响。方法采用便利抽样法,选取2019年1—7月首都医科大学附属北京潞河医院收治的130例慢性心力衰竭患者作为研究对象。按住院时间将其分为试验组(n=65)和对照组(n=65),对照组给予常规护理,试验组在对照组基础上实施基于微信的延续性护理。比较两组患者入院时,出院1、3个月慢性心力衰竭自我管理知识量表、自我护理指数6.2版的得分,并比较两组患者出院3个月内的再住院率。结果试验组62例患者完成研究,对照组59例患者完成研究。入院时两组患者慢性心力衰竭自我管理知识量表、自我护理指数量表6.2版得分比较,差异无统计学意义(P>0.05)。出院1、3个月,试验组患者慢性心力衰竭自我管理知识量表、自我护理指数量表6.2版得分高于对照组,差异有统计学意义(P<0.01)。出院3个月内,对照组患者的再住院率高于试验组,差异有统计学意义(P<0.05)。结论基于微信的延续性护理便捷、专业、可操作性强,能够提高慢性心力衰竭患者的自我管理能力,降低患者的再住院率。     

Polyunsaturated fatty acids supplementation impairs anti‐oxidant high‐density lipoprotein function in heart failure

Background

The underlying reasons for the highly inconsistent clinical outcome data for omega‐3‐polyunsaturated fatty acids (n3‐PUFAs) supplementation in patients with cardiac disease have not been understood yet. The aim of this prospective, randomized, double‐blind, placebo controlled study was to determine the effects of oral treatment with n3‐PUFAs on the anti‐oxidant capacity of HDL in heart failure (HF) patients.

Methods

A total of 40 patients with advanced HF of nonischaemic origin, defined by NT‐proBNP levels of >2000 pg/mL, NYHA class III or IV and a LVEF <35% who were on stable optimized medical therapy for ≥3 months, were consecutively enrolled into this prospective, double‐blind, placebo‐controlled trial and randomized in a 1:1:1 fashion to receive 1 g/day or 4 g/day of n3‐PUFA, or placebo, respectively, for 12 weeks.

Results

After 12 weeks of treatment, the anti‐oxidant function of HDL, measured by the HDL inflammatory index, was found significantly impaired in the treatment group in a dose‐dependent fashion with 0.67 [IQR 0.49‐1.04] for placebo vs 0.71 [IQR 0.55‐1.01] for 1 g/day n3‐PUFA vs 0.98 [IQR 0.73‐1.16] for 4 g/day n3‐PUFA (P for trend = 0.018).

Conclusion

We provide evidence for an adverse effect of n3‐PUFA supplementation on anti‐oxidant function of HDL in nonischaemic heart failure patients, establishing a potential mechanistic link for the controversial outcome data on n3‐PUFA supplementation.     

阿托伐他汀对冠心病并慢性心衰的治疗作用观察

目的 观察阿托伐他汀对冠心病并慢性心衰（CHF）患者高敏C反应蛋白（hsCRP）、高敏心肌肌钙蛋白T（hs‐cTnT）水平及预后的影响。方法 将100例冠心病并CHF患者随机分为对照组和观察组各50例。对照组予常规抗心衰治疗,观察组在常规治疗的基础上加用阿托伐他汀（20 mg／d）。两组患者治疗前及治疗后1个月均检测hsCRP、hs‐cTnT。治疗后1年随访,记录主要心血管不良事件（MACE）发生率及心衰再住院率。结果 ①治疗1个月后,观察组较对照组hsCRP、hs‐cTnT 下降更明显[（3．02±0．53） mg／L与（3．88±0．64） mg／L ,P＜0．05;（0．018±0．009） ng／mL与（0．029 ± 0．008） ng／mL ,P＜0．05）];②随访1年内,观察组较对照组MACE率及心衰再住院率均更低（15．6％与21．7％,P ＜0．05;26．7％与37．0％,P ＜0．05）。结论 阿托伐他汀治疗可降低冠心病并CHF患者炎症因子水平、心肌损伤程度,并改善其预后。     

系统干预对老年慢性心力衰竭病人自我护理行为的影响1）

[目的]观察系统干预对老年慢性心力衰竭病人出院后1个月和3个月时自我护理行为的影响。[方法]将200例老年慢性心力衰竭住院病人随机分为观察组与对照组。对照组实施一般护理干预,观察组在一般护理干预基础上实施包括教育干预、行为干预、心理干预以及疾病与症状管理的系统干预。比较两组病人出院1个月和3个月时自我护理行为的情况。[结果]观察组病人出院1个月和3个月时自我护理行为能力高于对照组（P＆lt;0.05）。[结论]系统干预能有效提高老年慢性心力衰竭病人出院后自我护理行为,但对远期的效果仍需进一步观察。     

以跨理论模型为框架构建原发性心力衰竭患者自护行为干预方案的应用效果评价

目的 探讨跨理论模型为框架构建原发性心力衰竭患者自护行为干预方案的价值.方法 将2012年1月至2013年6月收治的150例原发性心力衰竭患者按随机数字表法分为实验组和对照组,每组各75例,实验组应用跨理论模型为框架构建干预方案,对照组给予常规健康教育.应用原发性心力衰竭患者自护行为量表（SCHFI）分别于干预前、干预后1个月和3个月对2组患者进行测评.结果 实验组患者干预后1个月和3个月自护维持、自护管理、自护信心得分均高于对照组,差异有统计学意义.结论 与常规心内科的健康教育相比,以跨理论模型为框架制订的干预方案能显著改善原发性心力衰竭患者的自护行为.     

对慢性心力衰竭患者家属实施健康教育的效果评价

目的 探讨对慢性心力衰竭患者家属实施健康教育对慢性心力衰竭患者疗效的影响.方法 将150例有家属陪护的慢性心力衰竭患者随机分成观察组和对照组各75例.观察组对患者进行常规健康教育,同时对其家属实施健康教育;对照组只对患者本人实施健康教育.15d后比较观察组患者家属对疾病相关知识掌握情况的变化;2组患者出院6个月后,采用电话回访调查2组患者再住院情况.结果 观察组患者家属在实施健康教育后掌握疾病相关知识的程度比教育前显著提高;出院6个月后观察组患者再次住院率13.3%,显著低于对照组的44.00%.结论 对慢性心力衰竭患者家属实施健康教育可提高患者的疗效,减少病情复发,降低再住院率.     

行为干预对慢性心力衰竭患者心脏康复的影响

目的：探讨行为干预对慢性心力衰竭患者的应用效果。方法：将56例患者采用随机抽样法分为两组，实验组30例，对照组26例。两组均给予纠正心力衰竭治疗，在药物种类、剂量及护理措施不变的前提下，实验组在对照组基础上给予行为干预。两组于干预前及干预6月后进行彩色多普勒超声心动图检查，测量心率、脉搏及血压，并随访6月。结果：干预后两组的心率、脉搏、血压及再入院例数比较均有统计学意义（P〈0．05）。结论：实施行为干预能改善CHF患者的临床症状，促进心功能恢复，减少患者再次入院率，减轻经济负担。     

Omega‐3 polyunsaturated acids and cardiovascular disease: notable ethnic differences or unfulfilled promise?

Summary. The consumption of long chain omega‐3 polyunsaturated acids (PUFA) is considered to protect against cardiovascular disease and promote longevity following a heart attack. Historically, research in this area was fuelled by compelling reports of the cardiovascular benefits of omega‐3 PUFA in select populations and cultures. More recent studies, in wider populations, suggest discordant findings: differences that are difficult to reconcile as the mechanism of action of omega‐3 PUFA are poorly understood. As such, the use of this ‘natural treatment’ for cardiovascular disease is increasingly controversial, and potentially one of unfulfilled promise. To what extent does ethnicity influence the impact that omega‐3 PUFA have on cardiovascular disease and its associated complications? We were interested to review the benefits of omega‐3 PUFA in the management of cardiovascular risk amongst diverse ethnic groups. Using a systematic review of literature relating to omega‐3 PUFA and cardiovascular disease, we found ethnicity to be a factor that accounts for inconsistency between studies. Some of the effects of omega‐3 PUFA are limited to cultures with a very high omega‐3 intake, and in turn, ethnicity moderates the efficiency with which PUFA are derived from the diet. Moreover, omega‐3 PUFA are an important health care intervention in the current climate of globalization, where supplementation is likely to give protection to cultural groups undergoing dietary transition. Future epidemiological research into the efficacy of omega‐3 PUFA in cardiovascular disease should consider the influence of ethnicity.     

“互联网+”慢性心力衰竭患者立体化健康教育模式构建及应用效果

目的 构建互联网为载体、护士为主导、多学科合作的立体化慢性心力衰竭健康教育方案，并探究其在慢性心力衰竭患者中的应用效果。 方法 构建慢性心力衰竭立体化健康教育新模式，并延续至出院患者的指导。将心力衰竭患者随机分为实验组（n=105）和对照组（n=105），实验组采用“互联网+”慢性心力衰竭患者立体化健康教育模式，对照组则给予常规健康教育措施。分别在入院时和干预6个月后评估研究对象自我管理能力、生活质量及心衰知识水平。 结果 干预6个月后，实验组自我管理水平、生活质量及心衰知识水平均显著优于对照组（P＜0.001）。 结论 “互联网+”慢性心力衰竭患者立体化健康教育方案可有效提升患者疾病知识水平、自我管理能力和生活质量。     

对慢性心力衰竭患者实施基于自我效能健康教育成效的探讨

目的比较基于自我效能健康教育对慢性心力衰竭患者的效果。方法选择2009年1月至5月来我院心力衰竭门诊就诊患者82例,依据患者入院奇偶周数将患者分别纳入传统组和自我效能组,进行相应健康教育,分别在患者入组时、健康教育结束后3个月和6个月采用心力衰竭自理行为量表和心力衰竭知识问卷进行测评。结果自我效能组患者在自理行为和心力衰竭知识方面测评优于传统组患者,且该干预效果在时间、干预和交互作用方面差异具有统计学意义(P0.01或P0.05)。结论自我效能指导下的健康教育有助于心力衰竭患者形成较好自我行为和增加心力衰竭知识。     

Dietary omega-3 fatty acid deficiency and visual loss in infant rhesus monkeys

Linolenic acid (18:3 omega 3) is a dietary precursor of docosahexaenoic acid (22:6 omega 3), the major fatty acid in the photoreceptor membranes of the retina. We hypothesized that rhesus monkeys deprived of dietary omega-3 fatty acids during prenatal and postnatal development would show plasma depletion of these fatty acids and visual impairment. Semipurified diets low in omega-3 fatty acids were fed to one group of adult female rhesus monkeys throughout pregnancy and to their infants from birth. A control group of mothers and infants received similar diets but supplying ample linolenic acid. In the plasma phospholipids of deficient infants, linolenic acid was generally undetectable and 22:6 omega 3 levels became progressively depleted, falling from 42% of control values at birth to 21% at 4 wk, 9% at 8 wk, and 6% at 12 wk of age. In the other plasma lipid classes, 22:6 omega 3 was undetectable by 12 wk. The visual acuity of the deprived infants, as measured by the preferential looking method, was reduced by one-fourth at 4 wk (P less than 0.05) and by one-half at 8 and 12 wk (P less than 0.0005) compared with control infants. These results suggest that omega-3 fatty acids may be an essential nutrient, and that 22:6 omega 3 may have a specific function in the photoreceptor membranes of the retina.     

干预图在急性冠脉综合征合并中重度慢性肾病患者中的应用研究

目的 基于干预图制订干预策略,以探讨其对急性冠脉综合征合并中重度慢性肾病患者服药依从性的影响。方法 采用便利抽样法,选取2020年9月—2021年4月温州市某三级甲等医院心内科收治的101例急性冠脉综合征合并中重度慢性肾病患者作为研究对象,随机分为试验组与对照组。试验组采用干预图制订的用药干预策略,对照组采用常规用药策略。比较两组的服药依从性、生活质量和因心血管事件再住院情况。 结果 共有97例患者完成研究,试验组48例,对照组49例。出院时和出院1个月,两组的服药依从性评分和36条简明健康状况调查量表总分比较,差异无统计学意义（P>0.05）,出院3个月和出院6个月时,两组的服药依从性评分和36条简明健康状况调查量表总分比较,差异有统计学意义（P<0.05）。两组出院后6个月因心血管事件再住院率比较,差异有统计学意义（P<0.05）,且Cox比例风险模型显示,试验组再住院风险相对较低（HR=0.430,95%CI为0.187~0.990）。 结论 采用干预图制订的用药干预策略可提高急性冠脉综合征合并中重度慢性肾病患者的服药依从性,提升其生活质量,改善其临床预后。     

Effects of WeChat platform-based health management on health and self-management effectiveness of patients with severe chronic heart failure

BACKGROUNDEpidemiological studies have found that the prevalence of chronic heart failure in China is 0.9%, the number of people affected is more than 4 million, and the 5-year survival rate is even lower than that of malignant tumors.AIMTo determine the impact of WeChat platform-based health management on severe chronic heart failure patients’ health and self-management efficacy.METHODSA total of 120 patients suffering from chronic heart failure with cardiac function grade III-IV, under the classification of the New York Heart Association, were admitted to our hospital in May 2017. In January 2020, they were divided into two groups: A control group (with routine nursing intervention) and an observation group (with WeChat platform-based health management intervention). Changes in cardiac function, 6-min walking distance (6MWD), high-sensitivity cardiac troponin (hs-cTnT), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were detected in both groups. The Self-Care Ability Scale (ESCA) score, Minnesota Living with Heart Failure Questionnaire score, and compliance score were used to evaluate self-management ability, quality of life, and compliance of the two groups. During a follow-up period of 12 mo, the occurrence of cardiovascular adverse events in both the groups was counted.RESULTSThe left ventricular ejection fraction, stroke output, and 6MWD increased, and the hs-cTnT and NT-proBNP decreased in both the groups, as compared to those before the intervention. Further, cardiac function during the 6MWD, hs-cTnT, and NT-proBNP improved significantly in the observation group after intervention (P < 0.05). The scores of self-care responsibility, self-concept, self-care skills, and self-care health knowledge in the observation group were higher than those of the control group before intervention, and their ESCA scores were significantly improved after intervention (P < 0.05). The Minnesota heart failure quality of life (LiHFe) scores of physical restriction, disease symptoms, psychological emotion, social relations, and other items were decreased compared to those of the control group before intervention, and the LiHFe scores of the observation group were significantly improved compared to those of the control group (P < 0.05). With intervention, the compliance scores of rational diet, regular medication, healthy behavior, and timely reexamination were increased, thereby leading to the compliance scores of the observation group being significantly improved compared to those of the control group (P < 0.05). During the 12 mo follow-up, the incidence rates of acute myocardial infarction and cardiogenic rehospitalization in the observation group were lower than those of the control group, and the hospitalization time in the observation group was shorter than that of the control group, but there was no significant difference between the two groups (P > 0.05).CONCLUSIONWeChat platform-based health management can improve the self-care ability and compliance of patients with severe chronic heart failure, improve the cardiac function and related indexes, reduce the occurrence of cardiovascular adverse events, and enable the avoidance of rehospitalization.     

运动康复训练对老年冠心病慢性心力衰竭患者心功能及预后的影响

目的:探讨运动康复训练对老年冠心病慢性心力衰竭患者心功能及预后的影响。方法:选取我院2010年6月~2013年3月收治的冠心病慢性心力衰竭患者90例,将其随机等分为对照组和试验组,对照组给予慢性心力衰竭常规治疗,试验组在对照组基础上给予运动康复训练,比较两组各检测指标的变化。结果:出院6个月后,试验组患者左室射血分数、A峰E峰流速比值高于治疗前和对照组,左室舒张末径、左房内径、心胸比低于治疗前和对照组;试验组治疗后6 min步行距离长于对照组,生活质量评分和再住院率均低于对照组,以上结果经比较有统计学意义(P0.05)。结论:运动康复训练方便易行、安全可靠、经济适用,可以改善老年心力衰竭患者的心功能和预后,降低再住院率,达到了早期康复、恢复劳动能力、提高生活质量的目的,具有良好的临床应用价值。     

开设社区祖孙互动营养课堂效果评价

目的:探索适合在城市社区开展的营养教育方式。方法:以北京市海淀区5个社区的211位居民为研究对象,将研究对象随机分为两组,互动教育组实施为期6个月的祖孙互动营养课堂系列教育活动,对照组同期接受常规健康教育。干预前后调查研究对象的相关资料并进行分析。结果:干预后互动教育组研究对象的多个营养知识点知晓率高于对照组,态度更为积极,饮食行为趋于健康。结论:社区祖孙互动营养课堂系列教育活动有助于提高中老年人和青少年的营养知识与饮食行为水平及端正其态度。     

Rationale and design of the treatment of hyponatremia based on lixivaptan in NYHA class III/IV cardiac patient evaluation (THE BALANCE) study

Hyponatremia is a common electrolyte disorder in patients with heart failure (HF) associated with cognitive dysfunction and increased mortality and rehospitalization rates. Loop diuretics worsen renal function, produce neurohormonal activation, and induce electrolyte imbalances. Lixivaptan is a selective, oral vasopressin V(2) -receptor antagonist that improves hyponatremia by promoting electrolyte-free aquaresis without significant side effects. The Treatment of Hyponatremia Based on Lixivaptan in NYHA Class III/IV Cardiac Patient Evaluation (BALANCE) study is a randomized, double-blind, placebo-controlled, phase 3 trial designed to evaluate the effects of lixivaptan on serum sodium in patients hospitalized with worsening heart failure (target N= 650), signs of congestion and serum sodium concentrations <135 mEq/L. Other endpoints include assessment of dyspnea, body weight, cognitive function, and days of hospital-free survival. Patients are randomized 1:1 to lixivaptan or matching placebo for 60 days, with a 30-day safety follow-up. Doses of lixivaptan or placebo are adjusted based on serum sodium and volume status. Lixivaptan was shown to increase serum sodium and reduce body weight, without renal dysfunction or hypokalemia. BALANCE seeks to address unmet questions regarding the use of vasopressin antagonists including their effects on cognitive function and clinical outcomes in patients with hyponatremia and worsening heart failure.