Reilly Carolyn Miller, Higgins Melinda, Smith Andrew, Culler Steven D, Dunbar Sandra B
Nell Hodgson Woodruff School of Nursing, Emory University, USA
Nell Hodgson Woodruff School of Nursing, Emory University, USA.
Eur J Cardiovasc Nurs. 2015 Dec;14(6):495-505. doi: 10.1177/1474515114541729. Epub 2014 Jul 2.
Fluid restriction (FR) in persons with heart failure (HF) is often prescribed, yet self-regulation and the troublesome symptom of thirst are difficult for patients to manage.
The purpose of this pilot study was to test an educational and behavioral intervention (EBI) on adherence with prescribed FR and outcome measures of fluid congestion, symptom distress, and health related quality of life (HRQL). Secondary aims were to describe the relationships between self-reported and objectively measured determinants of fluid status and symptoms, and assess the psychometric properties of piloted instruments, and intervention effect sizes.
NYHA Class II-IV (n=25, 44-83 years, 56% male, 20% minority, mean EF 23.0+11.7%) participants were randomized to the EBI or attention control (AC) and evaluated at baseline, 3 and 6 months.
EBI patients trended toward decreasing fluid ingestion (p=0.08), experienced less HF symptom frequency (p=0.13) and severity (p=0.06), and increased symptoms of thirst (p<0.01) across time. Whereas HRQL remained stable in the EBI group, it improved in the AC group over time (p=0.01). There were no significant differences in clinical measures of fluid congestion between groups.
These outcomes suggest that patients receiving the EBI drank slightly less fluid, experienced less typical HF symptoms, greater thirst distress and stable HRQOL. Moderate to large effect sizes for the measures used were observed, and outcomes suggest that a randomized trial of various levels of FR would not potentiate fluid congestion but should specifically address preservation of HRQOL and thirst symptoms.
心力衰竭（HF）患者常被要求限制液体摄入（FR），但患者很难自我调节且难以应对令人困扰的口渴症状。
本初步研究旨在测试一种教育与行为干预（EBI）对遵医嘱进行FR的依从性以及液体潴留、症状困扰和健康相关生活质量（HRQL）等结局指标的影响。次要目的是描述自我报告的和客观测量的液体状态及症状决定因素之间的关系，评估试用工具的心理测量特性，以及干预效应大小。
将纽约心脏协会（NYHA）心功能II-IV级（n = 25，年龄44 - 83岁，男性占56%，少数族裔占20%，平均射血分数23.0 + 11.7%）的参与者随机分为EBI组或注意力控制（AC）组，并在基线、3个月和6个月时进行评估。
EBI组患者的液体摄入量呈下降趋势（p = 0.08），随时间推移HF症状发作频率降低（p = 0.13）、严重程度减轻（p = 0.06），但口渴症状增加（p < 0.01）。EBI组的HRQL保持稳定，而AC组随时间推移有所改善（p = 0.01）。两组间液体潴留的临床指标无显著差异。
这些结果表明，接受EBI的患者液体摄入量略有减少，典型HF症状较少，口渴困扰更大，HRQOL稳定。观察到所使用测量指标的效应大小为中度至重度，结果表明不同程度FR的随机试验不会加重液体潴留，但应特别关注HRQOL和口渴症状的维持。
