标题：院外延续性护理对慢性心力衰竭患者自我管理行为的影响

      作者：罗红英 1，翟明华 1，史春丽 2    北京中医药大学孙思邈医院/铜川市中医医院护理部 1、老年病科 2，陕西 铜川 727000

      卷次： 2019年30卷19期

      【摘要】 目的 研究信息化引导院外延续性护理对慢性心力衰竭患者自我管理行为的影响。方法 选取北京中医药大学孙思邈医院于2017年1月至2019年1月收治的86例慢性心力衰竭患者进行研究，按照随机数表法将患者分为观察组(n=43)和对照组(n=43)。对照组患者院外采取常规电话随访等护理，观察组则应用信息化引导院外延续性护理干预。护理3个月后，比较两组患者血清高敏心肌钙蛋白(hs-cTnT)和N末端脑钠肽原(NT-proBNP)的水平、心功能指标变化情况、自我管理行为评分情况、生活质量评分情况、生活完全自理、6 min步行距离和再次住院情况以及患者对护理的满意度情况。结果 护理3个月后，观察组患者的hs-cTnT水平由(0.68±0.16) μg/L降至(0.36±0.12) μg/L，NT-proBNP水平由(3.82±0.27) μg/L降至(1.90±0.23) μg/L，对照组hs-cTnT水平由(0.66±0.21) μg/L降至(0.50±0.15) μg/L，NT-proBNP水平由(3.79±0.32) μg/L降至(2.86±0.28) μg/L，且观察组患者较对照组下降更为明显，两组比较差异均具有统计学意义(P<0.05)；观察组患者左室收缩末内径(LVESD)由(50.74±2.63) mm降至(38.27±2.34) mm、左室舒张末内径(LVEDD)由(55.36±3.16) mm降至(47.49±2.67)mm，而左室射血分数(LVEF)则由(44.93±2.51) mm升至(55.07±2.77) mm，对照组患者 LVESD由(51.10±2.84) mm降至(46.38±2.18) mm、LVEDD由(55.85±2.91) mm降至(51.38±3.34) mm，而LVEF则由(45.15±2.38) mm升至(49.32±2.57) mm，且观察组较对照组变化水平更为显著，两组比较差异均具有统计学意义(P<0.05)；护理3个月后，观察组自我管理各行为评分显著高于对照组，两组比较差异均具有统计学意义(P<0.05)；护理3个月后，观察组患者的日常生活能力评分、社会活动情况评分、焦虑心理症状评分以及抑郁心理症状评分明显低于对照组，差异均具有统计学意义(P<0.05)；护理3个月后，观察组患者的生活完全自理率为65.12%，明显高于对照组的39.53%，再次住院率为27.91%，明显低于对照组的53.49%，6 min步行距离为(381.45±13.32) m，明显长于对照组的(257.87±18.74) m，差异均具有统计学意义(P<0.05)；观察组患者的护理满意度达88.37%，明显高于对照组的69.77%，差异有统计学意义(P<0.05)。结论 信息化引导院外延续性护理对慢性心力衰竭患者的治疗具有促进作用，可以有效改善患者心功能、自我管理行为以及生活质量，患者对护理的满意度也较高，极具临床应用价值。
      【关键词】 慢性心力衰竭；护理干预；延续性护理；生活质量；自我管理
      【中图分类号】 R473.5 【文献标识码】 A 【文章编号】 1003—6350（2019）19—2577—05

Effect of informationization-guided continuous nursing after discharge on self-management behavior of patientswith chronic heart failure.
LUO Hong-ying 1, ZHAI Ming-hua 1, SHI Chun-li 2. Department of Nursing 1, Department ofGeriatrics 2, the Sun Simiao Hospital of Beijing University of Traditional Chinese Medicine/Tongchuan Traditional ChineseMedicine Hospital, Tongchuan 727000, Shaanxi, CHINA
【Abstract】 Objective To study the effect of informationization-guided continuous nursing after discharge onself-management behavior of patients with chronic heart failure. Methods Eighty-six patients with chronic heart fail-ure who were admitted to Tongchuan Traditional Chinese Medicine Hospital from January 2017 to January 2019 were en-rolled in the study, which were randomly assigned to the observation group (n=43) and the control group (n=43) accord-ing to the random number table method. The treatment of heart failure was the same in both groups. Patients in the con-trol group received routine telephone follow-up, while patients in the observation group received informationiza-tion-guided continuous nursing after discharge. After 3 months, the levels of serum high-sensitivity cardiac troponin(hs-cTnT), N-terminal brain natriuretic peptide (NT-proBNP), changes of cardiac function indexes, self-management be-havior score, quality of life score, self-care status, 6-minute walking distance, re-hospitalization, patient’s satisfactionwith nursing were compared between the two groups. Results In the observation group, the hs-cTnT level in the obser-vation group decreased from (0.68±0.16) μg/L before nursing to (0.36±0.12) μg/L after nursing, and the NT-proBNP lev-el decreased from (3.82±0.27) μg/L to (1.90±0.23) μg/L; the hs-cTnT level in the control group decreased from (0.66±0.21) μg/L to (0.50±0.15) μg/L, and the NT-proBNP level decreased from (3.79±0.32) μg/L to (2.86±0.28) μg/L; the de-crease in the observation group was more significant than that in the control group, and the difference between the twogroups was statistically significant (P<0.05). The left ventricular end-systolic diameter (LVESD) of the observationgroup decreased from (50.74±2.63) mm to (38.27±2.34) mm, the left ventricular end-diastolic diameter (LVEDD) de-·护理·doi:10.3969/j.issn.1003-6350.2019.19.038