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健康生态学视域下医联体模式的健康管理对慢性心力衰竭患者心功能的影响
作者:郝天天1  徐翠荣2  蔡雪2  徐筱璐3  谈雅茹4 
单位:1. 东南大学医学院 护理系, 江苏 南京 210009;
2. 东南大学附属中大医院 护理部, 江苏 南京 210009;
3. 南京医科大学附属口腔医院 整形颌面外科, 江苏 南京 210009;
4. 中国医学科学院 皮肤病医院, 江苏 南京 210009
关键词:慢性心力衰竭 健康生态学 医联体 健康管理 心功能 
分类号:R541.6; R473.54
出版年·卷·期(页码):2023·42·第六期(841-849)
摘要:

目的:探索并分析健康生态学视域下医联体模式的健康管理对慢性心力衰竭患者心功能的影响。方法:于2020年11月至2021年2月从南京市某三甲医院技术辐射社区卫生服务中心中通过掷硬币的方法抽取试验社区与对照社区,在2个中心的辖区内招募符合纳排标准的慢性心力衰竭患者作为研究对象,分别组成试验组(n=115)和对照组(n=103)。试验组采用健康生态学视域下医联体模式的健康管理,对照组采用健康管理教育。干预周期为12个月,比较干预前后患者心功能的变化。结果: 干预前,两组差异无统计学意义(P>0.05)。干预后试验组患者左心室射血分数、二尖瓣环舒张早期运动速度峰值、6 min步行试验结果与对照组相比提高了0.049%、0.01 cm·s-1、19.669 m,左室内径与对照组相比降低了0.304 mm,差异均有统计学意义(P<0.05),再入院率显著低于对照组(χ2=6.524,P<0.05)。试验组干预前后左室内径降低了0.155 mm、左心室射血分数提高了0.032%,对照组左室内径升高了0.123 mm、左心室射血分数降低了0.026%,差异均有统计学意义(P<0.05)。试验组二尖瓣环舒张早期运动速度峰值、6 min步行试验结果提高了0.008 cm·s-1、25.669 m,差异有统计学意义(P<0.05),再入院率变化有统计学意义(χ2=6.179,P<0.05),对照组变化差异无统计学意义(P>0.05)。两组左室内径、左心室射血分数、二尖瓣环舒张早期运动速度峰值、6 min步行试验结果以及再入院率的时间效应、组间效应分析和时间与组间的交互效应,差异均有统计学意义(P<0.05)。结论: 健康生态学视域下医联体模式的健康管理有助于改善慢性心力衰竭患者的心功能,降低再入院率。

Objective: To explore and analyze the effects of health management of medical treatment alliance model on cardiac function in patients with chronic heart failure from the perspective of health ecology. Methods: From November 2020 to February 2021, experimental communities and control communities were selected from the technical radiation community health service center of a Grade-A hospital in Nanjing by coin toss, and chronic heart failure patients meeting the exclusion criteria were recruited in the jurisdiction of the two centers as study objects.They were divided into the experimental group(n=115) and the control group(n=103). The experimental group adopted the health management mode of medical treatment alliance from the perspective of health ecology, and the control group adopted the health management education. The intervention period was 12 months, and the changes of cardiac function before and after intervention were compared. Results: Before intervention, there was no significant difference between the two groups(P>0.05). After intervention, left ventricular ejection fraction, peak mitral ring diastolic motion velocity and 6 min walking test results of experimental group were increased by 0.049 %, 0.01 cm·s-1 and 19.669 m compared with control group, and left ventricular diameter was decreased by 0.304 mm compared with control group,the differences were statistically significant(P<0.05), and the readmission rate was significantly lower than that of the control group(χ2=6.524,P<0.05). Before and after intervention, the left ventricular diameter of the experimental group was decreased by 0.155 mm and the left ventricular ejection fraction was increased by 0.032 %, while the left ventricular diameter was increased by 0.123 mm and the left ventricular ejection fraction was decreased by 0.026% in the control group, with statistical significance(P<0.05). The peak mitral ring diastolic motion velocity and 6 min walking test results in the experimental group were increased by 0.008 cm·s-1 and 25.669 m, the differences were statistically significant(P<0.05), and the readmission rate was changed(χ2=6.179,P<0.05), while the changes in the control group were not statistically significant(P>0.05). There were statistically significant differences in left ventricular diameter, left ventricular ejection fraction, peak mitral ring diastolic motion velocity, 6 min walking test results and time effect of readmission rate, inter group effect analysis, and interaction effect of time and intergroup between the two groups(P<0.05). Conclusion: The health management of the medical treatment alliance model from the perspective of health ecology can improve the cardiac function of patients with chronic heart failure and reduce the readmission rate.

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