摘要
目的探讨社区管理模式对老年非瓣膜性心房颤动(NVAF)患者的影响,为社区老年NVAF患者的管理提供方法和思路。方法本研究采用前瞻性随机对照方法,选取2022年12月至2023年11月在合肥市和芜湖市两个社区卫生服务中心就诊的305例老年NVAF患者为研究对象。采用随机数字表法随机分为对照组(n=152)和试验组(n=153),对照组采取常规诊疗措施,试验组采取社区管理模式,两组均进行6个月的治疗。采用纽约心脏病协会(NYHA)心功能分级评估患者的心功能,采用欧洲心律协会(EHRA)评分评估患者的房颤症状,采用Morisky服药依从性量表(MMAS-8)评估患者的服药依从性,采用一般自我效能感量表(GSES)评估患者的自我效能感;记录两组患者心室率,心血管危险因素的控制情况,抗凝药物使用率,出血及动脉栓塞发生率。结果干预6个月后,试验组患者的NYHA心功能分级优于对照组,EHRA评分及心室率低于对照组,MMAS-8、GSES评分、血压、空腹血糖达标率和抗凝药物使用率高于对照组,差异有统计学意义(P<0.05);两组患者出血及动脉栓塞发生率比较,差异无统计学意义(P>0.05)。结论社区管理模式可改善老年NVAF患者的症状及心功能、抗凝药物使用率、服药依从性,患者生活质量得到提升。
Objective To investigate the effect of community management model on elderly patients with non-valvular atrial fibrillation(NVAF),and to provide methods and ideas for the management of elderly patients with NVAF in community.Methods A prospective randomized controlled trial was conducted in 305 elderly patients with NVAF who visited two community health service centers in Hefei and Wuhu from December 2022 to November 2023.The patients were randomly divided into the control group(n=152)and the experimental group(n=153)by random number table method.The control group received routine diagnosis and treatment measures,while the experimental group adopted the community management model.Both groups were treated for 6 months.The New York Heart Association(NYHA)cardiac function classification was used to evaluate patients’cardiac function,the European Heart Rhythm Association(EHRA)score was used to assess patients,atrial fibrillation symptoms,the Morisky Medication Adherence Scale(MMAS-8)was used to evaluate patients’medication adherence,and the general self-efficacy scale(GSES)was used to assess patients’self-efficacy.The ventricular rate,control of cardiovascular risk factors,use rate of anticoagulant drugs,and the incidence of bleeding and arterial embolism were recorded in both groups.Results After 6 months of intervention,the NYHA cardiac function classification,EHRA score and ventricular rate control in the experimental group were better than those in the control group,and the patients’MMAS-8 and GSES scores were higher.The compliance rate of blood pressure and fasting blood glucose,and the use rate of antico-agulant drugs in the experimental group were higher than those in the control group.There was no statistically significant difference in the incidence of bleeding and arterial embolism between the two groups(P>0.05).Conclusion The community management model can improve the symptoms,cardiac function,use rate of anticoagulant drugs,and medication adherence of elderly NVAF patients,and enhance their quality of life.
作者
张云凤
陈继群
宋诗涛
范浩
关文莉
ZHANG Yunfeng;CHEN Jiqun;SONG Shitao;FAN Hao;GUAN Wenli(Department of Geriatrics,the Third People’s Hospital of Hefei,Hefei,Anhui 230022,China;Department of General Practice,Liulang Town Community Health Service Center,Wuhu,Anhui 241111,China;Tongan Street Community Health Service Center,Baohe District,Hefei,Anhui 230051,China)
出处
《重庆医学》
2025年第7期1648-1654,共7页
Chongqing Medical Journal
基金
合肥市第三人民医院院级科研项目(SYKY202409)。
关键词
社区慢性病管理
非瓣膜性心房颤动
老年综合评估
抗凝
心血管危险因素
community chronic disease management
non-valvular atrial fibrillation
geriatric comprehensive assessment
anticoagulation
cardiovascular risk factors
作者简介
通信作者:范浩,E-mail:fh1631632024@163.com。
