对慢性心力衰竭患者进行院外干预的依从性及其效果

目的观察对慢性心力衰竭（CHF）患者进行院外干预的效果。方法：通过前瞻性随机对照方法，将215名出院的心力衰竭（HF）患者随机分为普通随访组和强化干预组，通过1年的随访观察，最终完成随访的患者共计205例。普通随访组仅进行常规的门诊随访，强化干预组患者接受电话咨询、专门的心力衰竭门诊随诊及定期健康宣教。结果：强化干预组和普通组相比较，限水限钠达标率和坚持每天监测体质量的比例大幅度增加（P〈0-01），强化干预组利尿剂的使用率明显高于普通组（P〈0-01），血管紧张素转换酶抑制剂（ACEI）／血管紧张素II受体拮抗剂（ARB）类药物、B受体阻滞剂的靶剂量达标率方面明显高于普通组（P〈0-01），强化干预组左室射血分数高于普通随访组；与普通随访组相比，强化干预组氨基端脑钠肽前体（NT-pro-BNP）降低更明显（P〈0-05），且6分钟步行试验优于普通组（P〈0-05）。两组再次入院和总心血管事件发生率有显著差异（3％伪．11％，P〈0-05），强化于预措施显著降低了死亡和再住院联合终点事件的发生率。结论：对CHF患者进行院外强化干预，可以提高患者的自我管理能力，提高抗HF治疗药物的使用比例及二级预防药物的靶剂量达标率，降低再住院率和心血管事件发生率。

Impact of out-of-hospital multifactorial intensive intervention on patients with chronic heart failure

AIM To observe the efficacy of out-of-hospital muhifactorial intensive intervention on pa-tients with chronic heart failure. METHODS： A prospective study was conducted in 215 patients withchronic heart failure. Patients were discharged from hospital and randomized into conventional follow-upgroup and intensive intervention group. The 215 patients were followed for 12 months and 205 of thepatients completed the follow-up. Conventional follow-up group received only routine follow-up examina-tion, whereas the intensive intervention group, in addition to the routine follow-up examination, receivedtelephone counseling, specialized follow-up from heart failure clinics, and regular health education.RESULTS： The percentages of patients limiting water and salt intake and measuring body weight in in-tensive intervention group were markedly increased （ P 〈 0-01 ）. The percentages of using diuretics andachieving target dose rate of ACEI/ARB/beta blockers were higher in intensive intervention group. Thepercentages of left ventricular ejection fraction and completing the 6-minute walking test were also higherin intensive intervention group, whereas the level of NT-pro-BNP was lower in intensive interventiongroup. Compared with those in the conventional follow-up group, the rehospitalization rate and incidenceof cardiovascular events were lower in the intensive intervention group. CONCLUSION： Out-of-hospitalmultifactorial intensive intervention is helpful in improving the clinical outcome for patients with chronicheart failure.