MDT驱动下的路径式SME对CHF患者生活质量的影响

  目的  以症状管理教育为基础，通过构建多学科团队驱动的“路径式”核心症状群管理模式，有效提升慢性心力衰竭患者的院外生活质量。  方法  收集昆明医科大学附属延安医院全科医学科心衰病房72例慢性心衰患者，采用随机数字表法分为对照组和干预组。对照组执行慢性心衰护理常规，干预组构建多学科团队驱动下的“路径式”症状管理教育模式。出院后选取2个时间点对比分析2组的生活质量。  结果  出院后2个时间点（3个月、6个月）的组间对比，干预组生活质量各项得分均优于对照组，差异有统计学意义（P < 0.05）。2组干预前后生活质量总评及3个领域维度得分，重复测量方差分析，组间、时间、交互效应差异均具有统计学意义（P < 0.05）。2组的组内比较显示，干预组生活质量总评及3个领域维度得分均呈现明显下降趋势，且各维度整体下降幅度及下降速度均优于对照组。  结论  多学科团队驱动的“路径式”核心症状群管理模式可有效提高慢性心力衰竭患者的自我症状管理能力，保持院外良好的生活质量。

Impact of Path-based Symptom Management Education Driven by Multidisciplinary Teams on The Quality of Life of Patients with Chronic Heart Failure

  Objective  To improve effectively the quality of life outside the hospital for patients with Chronic Heart Failure （CHF） through the construction of a Multidisciplinary Teams （MDT）-driven “path-based” core symptom group management mode based on Symptom Management Education （SME）.   Methods  72 patients with CHF hospitalized in the heart failure ward of our department were studied, and the patients were divided into control a group and an intervention group by randomized number table method. The control group was given routine care for CHF, and the intervention group built a path-based SME model driven by a MDT. Three months and six months after discharge from the hospital, the quality of life scores were compared and analyzed.   Results  Compared with the two groups of patients with CHF at 3 months and 6 months after discharge from the hospital, the difference in the total quality of life score of heart failure and the three-dimensional score was statistically significant （P < 0.05）, and the score of the intervention group in the same period was lower than the control group. Before and after the intervention, the quality of life of the two groups of patients with heart failure and the score of each dimension were analyzed repeatedly measured variance. The inter-group effect, time effect and interaction effect were statistically significant （P < 0.05）. The intra-group comparison between the two groups showed that the total quality of life score and the three-dimensional score in the intervention group showed a significant downward trend, and the overall decline and speed of each dimension were better than those in the control group.   Conclusion  The path-based SME model driven by MDT can effectively improve the self-symptom management ability of patients with CHF and maintain a good quality of life outside the hospital.