优护+容量自我管理模式对慢性心衰患者生存质量的影响

  目的  探讨优护+容量自我管理模式对慢性心力衰竭患者心功能及生存质量的影响。  方法  将72例慢性心力衰竭患者随机数字表法分为对照组和观察组各36例。对照组给予常规健康宣教及电话随访；干预组开展优护+容量自我管理模式。分别于干预前、干预后3个月、干预后6个月评估2组患者的阶段性行为改变状况，评价2组患者的心功能及生存质量，对比2组患者出院30 d内再入院率。  结果  干预后3个月、6个月，干预组处于行为改变阶段的分别为44.4%和63.9%，且干预组处于行动维持阶段的人数明显多于对照组，差异有统计学意义（P < 0.05）；干预后3个月、6个月，干预组6MWT距离均高于对照组，差异有统计学意义（P < 0.05）；干预后6个月，2组的时间与组间交互效应，差异有统计学意义 (F = 5.928，P < 0.05)。与对照组相比，干预组6MWT距离随着干预时间的延长而呈缓慢上升的趋势；干预后6个月，干预组的生存质量总分、身体领域、情绪领域及其他领域均比同期对照组高，差异有统计学意义（P < 0.05）；干预组出院30 d内再入院率明显低于对照组，差异有统计学意义（P < 0.05）。  结论  开展优护+容量自我管理模式，能有效改善慢性心力衰竭患者心功能及生存质量，降低再次入院率，减轻心衰对世界卫生医疗系统及社会经济环境的压力，真正实现院外有效长期自我管理的目标。

Effect of Optimal Care + Volume Self-management on Quality of Life in Patients with Chronic Heart Failure

  Objective  To explore the effect of optimal care + volume self-management model on cardiac function and quality of life in patients with chronic heart failure.   Method  72 patients with chronic heart failure were randomly divided into control group （n = 36） and observation group （n = 36）. The control group was given routine health education and telephone follow-up, and the intervention group received the model of optimal nursing + volume self-management. Before intervention, 3 months after intervention and 6 months after intervention, the stage behavior changes of patients in the 2 groups were evaluated, the cardiac function and quality of life of patients in the 2 groups were evaluated, and the readmission rate within 30 days after discharge was compared between the 2 groups.   Results  At 3 and 6 months after intervention, 44.4% and 63.9% of the intervention group were in the stage of behavior change, and the number of the intervention group in the stage of action maintenance was significantly higher than that of the control group, the difference was statistically significant （P < 0.05）. At 3 and 6 months after intervention, the 6MWT distance in the intervention group was higher than that in the control group, with statistical significance （P < 0.05）. 6 months after intervention, there was a significant difference in time and interaction between the two groups （F = 5.928, P < 0.05）. Compared with the control group, the 6MWT distance in the intervention group increased slowly with the extension of the intervention time. 6 months after intervention, the total score of quality of life, physical domain, emotional domain and other domains in the intervention group were higher than those in the control group, and the difference was statistically significant （P < 0.05）. The readmission rate within 30 days after discharge in the intervention group was significantly lower than that in the control group, with statistical significance （P < 0.05）.   Conclusion  The optimal care + capacity self-management model can effectively improve the cardiac function and quality of life of patients with chronic heart failure, reduce the readmission rate, reduce the pressure of heart failure on the world health care system and social and economic environment, and truly achieve the goal of effective long-term self-management outside the hospital.