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基于微信平台的健康管理对重度慢性心力衰竭患者健康状况及自我管理效能的影响

Effects of WeChat platform-based health management on health and self-management effectiveness of patients with severe chronic heart failure.

作者信息

Wang Zhan-Ru, Zhou Jia-Wu, Liu Xiao-Ping, Cai Guo-Juan, Zhang Qi-Hong, Mao Jun-Fang

机构信息

Department of Critical Care Medicine, Shaoxing Hospital of China Medical University, Shaoxing 312000, Zhejiang Province, China.

Department of Emergency Medicine, Shaoxing Hospital of China Medical University, Shaoxing 312000, Zhejiang Province, China.

出版信息

World J Clin Cases. 2021 Dec 6;9(34):10576-10584. doi: 10.12998/wjcc.v9.i34.10576.

Abstract

BACKGROUND

Epidemiological studies have found that the prevalence of chronic heart failure in China is 0.9%, the number of people affected is more than 4 million, and the 5-year survival rate is even lower than that of malignant tumors.

AIM

To determine the impact of WeChat platform-based health management on severe chronic heart failure patients' health and self-management efficacy.

METHODS

A total of 120 patients suffering from chronic heart failure with cardiac function grade III-IV, under the classification of the New York Heart Association, were admitted to our hospital in May 2017. In January 2020, they were divided into two groups: A control group (with routine nursing intervention) and an observation group (with WeChat platform-based health management intervention). Changes in cardiac function, 6-min walking distance (6MWD), high-sensitivity cardiac troponin (hs-cTnT), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were detected in both groups. The Self-Care Ability Scale (ESCA) score, Minnesota Living with Heart Failure Questionnaire score, and compliance score were used to evaluate self-management ability, quality of life, and compliance of the two groups. During a follow-up period of 12 mo, the occurrence of cardiovascular adverse events in both the groups was counted.

RESULTS

The left ventricular ejection fraction, stroke output, and 6MWD increased, and the hs-cTnT and NT-proBNP decreased in both the groups, as compared to those before the intervention. Further, cardiac function during the 6MWD, hs-cTnT, and NT-proBNP improved significantly in the observation group after intervention ( < 0.05). The scores of self-care responsibility, self-concept, self-care skills, and self-care health knowledge in the observation group were higher than those of the control group before intervention, and their ESCA scores were significantly improved after intervention ( < 0.05). The Minnesota heart failure quality of life (LiHFe) scores of physical restriction, disease symptoms, psychological emotion, social relations, and other items were decreased compared to those of the control group before intervention, and the LiHFe scores of the observation group were significantly improved compared to those of the control group ( < 0.05). With intervention, the compliance scores of rational diet, regular medication, healthy behavior, and timely reexamination were increased, thereby leading to the compliance scores of the observation group being significantly improved compared to those of the control group ( < 0.05). During the 12 mo follow-up, the incidence rates of acute myocardial infarction and cardiogenic rehospitalization in the observation group were lower than those of the control group, and the hospitalization time in the observation group was shorter than that of the control group, but there was no significant difference between the two groups ( > 0.05).

CONCLUSION

WeChat platform-based health management can improve the self-care ability and compliance of patients with severe chronic heart failure, improve the cardiac function and related indexes, reduce the occurrence of cardiovascular adverse events, and enable the avoidance of rehospitalization.

摘要

背景

流行病学研究发现,我国慢性心力衰竭患病率为0.9%,患病人数超过400万,5年生存率甚至低于恶性肿瘤。

目的

探讨基于微信平台的健康管理对重度慢性心力衰竭患者健康状况及自我管理效能的影响。

方法

选取2017年5月我院收治的120例纽约心脏病协会心功能分级为Ⅲ-Ⅳ级的慢性心力衰竭患者。2020年1月将其分为两组:对照组(进行常规护理干预)和观察组(进行基于微信平台的健康管理干预)。检测两组患者的心功能、6分钟步行距离(6MWD)、高敏心肌肌钙蛋白(hs-cTnT)及N末端B型利钠肽原(NT-proBNP)的变化。采用自我护理能力量表(ESCA)评分、明尼苏达心力衰竭生活问卷评分及依从性评分评估两组患者的自我管理能力、生活质量及依从性。随访12个月,统计两组心血管不良事件的发生情况。

结果

与干预前相比,两组患者的左心室射血分数、每搏输出量及6MWD均升高,hs-cTnT及NT-proBNP均降低。此外,干预后观察组患者6MWD、hs-cTnT及NT-proBNP水平的心功能改善显著(P<0.05)。观察组患者干预前自我护理责任、自我概念、自我护理技能及自我护理健康知识得分均高于对照组,干预后其ESCA评分显著提高(P<0.05)。观察组患者干预前明尼苏达心力衰竭生活质量(LiHFe)量表中身体限制、疾病症状、心理情绪、社会关系等项目得分均低于对照组,干预后观察组LiHFe量表得分较对照组显著改善(P<0.05)。干预后,两组患者合理饮食、规律服药、健康行为及及时复查的依从性得分均升高,观察组依从性得分较对照组显著提高(P<0.05)。随访12个月,观察组急性心肌梗死及心源性再住院发生率低于对照组,观察组住院时间短于对照组,但两组比较差异无统计学意义(P>0.05)。

结论

基于微信平台的健康管理可提高重度慢性心力衰竭患者的自我护理能力及依从性,改善心功能及相关指标,减少心血管不良事件的发生,避免再住院。

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