2006-2008年内蒙古克山病治疗管理干预效果分析

目的 对慢型克山病患者实施健康管理及药物治疗干预,观察和分析干预效果.方法 在内蒙古克山病病区选择一定数量的慢型克山病患者进行治疗管理干预,包括以治疗慢性充血性心力衰竭为主的药物干预,以健康教育并指导生活方式为主的管理干预.2006-2008年共进行3次干预,每次为期6个月.以干预对象干预初期,末期心电图诊断结果、心胸比例结果、心功能分级结果、克山病类型、劳动能力为判定指标,以其中一项指标改善即为干预有效,统计有效人数及有效率,观察干预次数和不同用药对干预结果的影响.结果 345人参与治疗管理干预,207人有效,有效率为60%(207/345).其中180人参与1次干预,有效率为44%(79/180);91人参与2次干预,有效率为66%(60/91);74人参与3次干预,有效率为92%(68/74).不同干预次数有效率比较差异有统计学意义(χ2=52.16,P<0.01);其中干预3次高于干预2次及干预1次(χ2值分别为15.81、49.56,P均<0.0125),干预2次高于干预1次(χ2=11.76,P<0.0125),有效率随干预次数增多而增加.不同药物组间有效率比较差异有统计学意义(χ2=19.56,P<0.01);其中血管紧张素转化酶抑制剂(ACEI)组有效率最高,为77%(82/106),强心药组有效率为50%(47/94)以及心肌能量药组有效率为54%(78/145),ACEI组药物治疗干预有效率高于强心药组和心肌能量药组(χ2值分别为16.28、14.71,P均<0.0125).结论 对克山病患者进行健康管理及药物治疗干预,对改善患者健康状况有意义.加强健康教育,指导正确生活方式以及用ACEI、β受体阻滞剂、利尿剂联合治疗慢型克山病充血性心力衰竭,对改善患者健康状况效果更明显.

Effect analysis of health management and intervention for Keshan disease treatment in Inner Mongolia autonomous region from 2006 to 2008

Objective This study aims to observe and analyze the result of implementing health management and intervention for chronic Keshan disease treatment. Methods Certain amounts of chronic Keshan disease patients in Keshan disease area were chosen and given health management and treatment intervention including primarily pharmacological treatment for the chronic congestive heart failure together with health education and life style instruction. From 2006 to 2008, three interventions were conducted every six month. Electrocardiogram description, proportion of heart to chest, classification of heart function, types of Keshan disease and labour capacity at the initial and the last stage of the intervention were taken as judging indexes. If one of the indexes was improved then the intervention will be regarded as effective. The number of effective cases and effective rate were counted in order to observe the impact of intervention times and different medicine on intervention results. Results Altogether 345 Keshan disease patients were involved in the study, among them 207 were effective, the effective rate was 60%(207/345). One hundred and eighty were involved in the intervention for once, and the effective rate was 44%(79/180). Ninty-one took part in the intervention twice, and the effective rate was 66%(60/91). Seventyfour attended the intervention for three times, and the effective rate was 92% (68/74). There were significant difference among groups of different intervention times (χ2 = 52.16, P < 0.01), and the effective rate increased with increased intervention times. Three times were higher than that of one or two times (χ2= 15.81, 49.56, all P< 0.0125). Twice were better than once(χ2 = 11.76, P < 0.0125). There were significant difference among groups of different medicine groups(χ2 = 19.56, P< 0.01). Among different medicine groups, the efficacy of angiotensin converting enzyme inhibitor(ACEI) group was the highest 77%(82/106) while the cardiotonic medicine group was 50%(47/94) and cardiac muscle nutrition poisons was 54% (78/145). The efficacy rate of ACEI group was higher than that of cardiotonic medicine group and cardiac muscle nutrition poisons(χ2 = 16.28, 14.71, P< 0.0125). Conclusions The implement of health management and treatment intervention to Keshan disease patients is of great significant in improving the healthy condition of Keshan disease patients. Health education and life-style instruction as well as the use of ACEI, β-blockers and diuretic have comparatively obvious effect on treatment of chronic Keshan disease congestive cardiac failure.