慢性心力衰竭患者系统化干预对心功能状况和再住院率的影响

目的 探讨系统化院外干预对慢性心力衰竭（CHF）患者心功能及再住院率的影响.方法 入选2008年7月至2010年7月中国医科大学北京顺义医院心内科住院CHF患者160例,按随机数字表法分为干预组79例,对照组81例.干预组患者根据心功能的变化和临床症状进行系统化干预,包括规范治疗方案,指导患者正确使用血管紧张素转换酶抑制剂和β-受体阻滞剂,并滴定其靶剂量等措施.对照组不做系统化干预,了解记录自用药情况和其他相关内容.6个月和12个月时分别对两组患者采用6分钟步行试验及超声心动图检查对患者的心功能状况进行评价,使用再住院率对患者临床症状改善进行评价.结果 6、12个月时干预组6分钟步行距离[（345.27±123.95）、（368.94±121.62） m]明显高于对照组[（282.53±94.63）、（260.07±86.13） m],差异有统计学意义（F组间=38.01,P＜0.01;F组内=19.62,P＜0.01;F交互=48.36,P＜0.01）.干预组的左心室射血分数[6个月（43.48±8.42）％,12个月（41.21±6.23）％]明显高于对照组[（37.70±7.13）％、（37.15±6.83）％]（P＜0.01）.6个月时干预组再住院率有下降趋势,12个月时干预组再住院次数（26次）明显低于对照组（36次）,差异有统计学意义（P =0.024）.结论 CHF患者采用系统化干预可以改善其心功能并降低再住院率.

The impact of systematic management on the cardiac function and readmission rate in patients with chronic heart failure

Objective To explore the impact of systematic management on the cardiac function and readmission rate in patients with chronic heart failure（CHF）.Methods One hundred and sixty CHF patients in Beijing Shunyi Hospital Affiliated to China Medical University from Jul.2008 to Jul.2010 were selected as our subjects and random divided into intervention （79 cases） and control group（81 cases）.Patients in intervention group were received systematic therapy based on heart function and clinical syndrome including therapy plan and guiding the application of angiotensin converting enzyme inhibitor and beta blockers,and in control group were received regular therapy.The cardiac function were evaluated by 6-minute walking test （6MWT） and echocardiography,and readmission rate was observed.Results （1）The result of 6MWT in the intervention group at 6 months and 12 months were （345.27 ± 123.95） m,（368.94 ± 121.62） m,significantly higher than that of 6MWT in the control group （（282.53 ± 94.63） m,（260.07 ± 86.13） m; F between groups =38.01,P 〈0.01 ;F inner group =19.26,P 〈 0.01 ; F across group =48.36,P 〈 0.01）.（2） Left ventricular ejection fraction in the intervention group at 6 months and 12 months were （43.48 ± 8.42） %,（41.21 ± 6.23） %,significantly higher than that in the control group （（37.70 ±7.13）%,（37.15 ±6.83）% ;P 〈0.001）.（3）The readmission rate in the intervention group showed a decreased trend but did not reach statistically significant difference at 6 months,while the readmission times in the intervention group at 12 months was 26,significantly lower than that in the control group （36,P =0.024）.Conclusion The systematic management might improve the heart function and reduce readmission rates in patients with CHF.