慢性心力衰竭患者自我管理的最佳证据总结

doi:10.3761/j.issn.1672-9234.2022.06.015

摘要/Abstract

摘要：

目的评价和整合慢性心力衰竭患者自我管理的最佳证据。方法检索BMJ Best Practice、UpToDate、国际指南协作网、苏格兰院际间指南网、加拿大安大略注册护士协会、Cochrane图书馆、PubMed、CINAHL、中国知网、万方等数据库中有关慢性心力衰竭患者自我管理的相关证据,包括推荐实践、证据总结、指南、专家共识、系统评价等。采用AGREE Ⅱ评价指南质量,采用JBI循证卫生保健中心对应的评价标准对系统评价、专家共识、随机对照试验进行质量评价,并对符合质量标准的文献进行证据提取和总结。结果共纳入17篇文献,其中临床决策1篇,指南5篇,证据总结4篇,系统评价5篇,专家共识2篇。经过阅读,提取和归类,最终在自我管理目的、原则、评估、指导内容、促进策略5个方面,总结了22条最佳证据。结论临床医护人员需结合医院实际、临床情景、患者意愿选择最佳证据应用于临床,从而规范临床实践行为,提高患者自我管理能力,最终改善患者结局。

关键词: 自我护理, 心力衰竭, 循证护理学

Abstract:

Objective To evaluate and integrate the best evidence of self-management in patients with chronic heart failure. Methods We searched for relevant evidence on self-management of patients with chronic heart failure in BMJ Best Practice,UpToDate,Guidelines International Network,Scottish Intercollegiate Guidelines Network,Registered Nurses Association of Ontario,Cochrane Library,PubMed,CINAHL,CNKI,Wanfang,etc. Practice,evidence summary,guidelines,expert consensus and systematic evaluation were all eligible. The quality assessment was conducted by researchers using AGREE Ⅱ for guidelines and JBI evidence-based health care center evaluate standards for systematic review,expert consensus,randomized controlled trials. Results A total of 17 articles were enrolled,including 1 clinical decision,5 guidelines,4 evidence summaries,5 systematic reviews,and 2 expert consensus. Finally,22 pieces of evidence were extracted and integrated into 5 dimensions,including objective,principle,evaluation,guiding contents,and promotion strategies. Conclusion Clinical medical and nursing staff should select the best evidence for clinical application in combination with hospital reality,clinical situation and patient willingness,so as to standardize clinical practice behaviors,improve patients’ self-management ability and ultimately improve patient outcomes.

Key words: Self Care, Heart Failure, Evidence-Based Nursing

王蒙,张玲玲,王春华,张延红,孙立. 慢性心力衰竭患者自我管理的最佳证据总结[J]. 中华护理教育, 2022, 19(6): 555-561.

WANG Meng,ZHANG Ling-ling,WANG Chun-hua,ZHANG Yan-hong,SUN Li. Summary of the best evidence of self-management in patients with chronic heart failure[J]. Chinese Journal of Nursing Education, 2022, 19(6): 555-561.

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参考文献 44

[1]	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Kardiol Pol, 2016, 74(10):1037-1147. doi: 10.5603/KP.2016.0141 pmid: 27748494
[2]	Pandolfi MM, Wang Y, Spenard A, et al. Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction,heart failure and pneumonia at the healthcare community level in the United States[J]. Int J Older People Nurs, 2017, 12(4):e12154.
[3]	Bergethon KE, Ju C, DeVore AD, et al. Trends in 30-day readmission rates for patients hospitalized with heart failure:find-ings from the get with the guidelines-heart failure registry[J]. Circ Heart Fail, 2016, 9(6):e002594.
[4]	Barlow J, Wright C, Sheasby J, et al. Self-management approaches for people with chronic conditions:a review[J]. Patient Educ Couns, 2002, 48(2):177-187. pmid: 12401421
[5]	岳爱学, 朱丽芹, 何佳倩, 等. 基于护士主导的自我管理教育对慢性心力衰竭患者生活质量的影响[J]. 中华现代护理杂志, 2017, 23(1):45-48.
	Yue AX, Zhu LQ, He GQ, et al. Effect of self-management education based on nurse-leading on the quality of life in patients with chronic heart failure[J]. Chin J Mod Nurs, 2017, 23(1):45-48.
[6]	杜颖平. 自我管理在慢性心力衰竭病人护理中的应用[J]. 护理研究, 2018, 32(8):1327-1328.
	Du YP. Application of self management in nursing of patients with chronic heart failure[J]. Chin Nurs Res, 2018, 32(8):1327-1328.
[7]	Jovicic A, Holroyd-Leduc JM, Straus SE. Effects of self-management intervention on health outcomes of patients with heart failure:a systematic review of randomized controlled trials[J]. BMC Cardiovasc Disord, 2006, 6:43. doi: 10.1186/1471-2261-6-43
[8]	Scottish Intercollegiate Guidelines Network. SIGN 147 management of chronic heart failure[EB/OL].(2016-03-02)[2020-12-20]. https://www.sign.ac.uk/sign-147-management-of-chronic-heart-fai-lure.html.
[9]	NHFA CSANZ Heart Failure Guidelines Working Group, Ather-ton JJ, Sindone A, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand:guidelines for the prevention,detection,and management of heart failure in Australia 2018[J]. Heart Lung Circ, 2018, 27(10):1123-1208. doi: 10.1016/j.hlc.2018.06.1042
[10]	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
[11]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
[12]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. doi: 10.1136/ebn.12.4.99-b pmid: 19779069
[13]	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018, 25(18):56-58.
[14]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
[15]	朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020, 35(11):996-1000.
	Zhu Z, Hu Y, Zhou YF, et al. Promotion evidence to clinical transformation:evidence resource retrieval for the purpose of clinical transformation[J]. J Nurses Train, 2020, 35(11):996-1000.
[16]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018:58-77.
[17]	Pleil JD, Sobus JR. Estimating lifetime risk from spot biomar-ker data and intraclass correlation coefficients(ICC)[J]. J Toxicol Environ Health A, 2013, 76(12):747-766. doi: 10.1080/15287394.2013.821394
[18]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
[19]	Horwitz L. Heart failure self-management[EB/OL]. [2020-12-25]. https://www-uptodate-com.1ibpublic3.1ibrary.isu.edu/.
[20]	Ezekowitz JA, O’Meara E, McDonald MA, et al. 2017 comprehensive update of the Canadian cardiovascular society guidelines for the management of heart failure[J]. Can J Cardiol, 2017, 33(11):1342-1433. doi: S0828-282X(17)30973-X pmid: 29111106
[21]	RNAO Development Panel. Strategies to support self-management in chronic conditions:collaboration with clients[EB/OL].(2010-09-11)[2020-12-23]. http://www.rnao.org/bestpractices27.
[22]	Slade DS, BScApp(Physio), Grad Dip Manip Ther, et al. Chro-nic heart failure:assessment of self-care[EB/OL].(2019-03-04)[2020-12-23]. https://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi.
[23]	James AH, PGCE MA, Hons BA, et al. Chronic heart failure:self-care[EB/OL].(2019-08-05)[2020-12-23]. https://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi.
[24]	Porritt K. Heart failure:disease management programs[EB/OL].(2020-11-11)[2020-12-23]. https://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi.
[25]	James AH, PGCE MA, Hons BA, et al. Heart failure(self-care):interactions between patients and healthcare professionals[EB/OL].(2018-11-26)[2020-12-23]. https://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi.
[26]	Casimir YE, Williams MM, Liang MY, et al. The effectiveness of patient-centered self-care education for adults with heart failure on knowledge,self-care behaviors,quality of life,and readmissions:a systematic review[J]. JBI Database Syst Rev Implement Rep, 2014, 12(2):188-262.
[27]	Son YJ, Choi J, Lee HJ. Effectiveness of nurse-led heart failure self-care education on health outcomes of heart failure patients:a systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2020, 17(18):6559. doi: 10.3390/ijerph17186559
[28]	Peng Y, Fang JJ, Huang W, et al. Efficacy of cognitive behavioral therapy for heart failure[J]. Int Heart J, 2019, 60(3):665-670. doi: 10.1536/ihj.18-408 pmid: 31105150
[29]	Zhao QG, Chen CC, Zhang J, et al. Effects of self-management interventions on heart failure:systematic review and meta-analysis of randomized controlled trials[J]. Int J Nurs Stud, 2020, 110:103689.
[30]	Lee TW, Lee SH, Kim HH, et al. Effective intervention strategies to improve health outcomes for cardiovascular disease patients with low health literacy skills:a systematic review[J]. Asian Nurs Res(Korean Soc Nurs Sci), 2012, 6(4):128-136.
[31]	Barnason S, White-Williams C, Rossi LP, et al. Evidence for therapeutic patient education interventions to promote cardiovascular patient self-management:a scientific statement for healthcare professionals from the American heart association[J]. Circ Cardiovasc Qual Outcomes, 2017, 10(6):e000025.
[32]	Jaarsma T, Hill L, Bayes-Genis A, et al. Self-care of heart fai-lure patients:practical management recommendations from the Heart Failure Association of the European Society of Cardiology[J]. Eur J Heart Fail, 2021, 23(1):157-174. Epub 2020-10-20. doi: 10.1002/ejhf.2008
[33]	Inglis SC, Clark RA, Dierckx R, et al. Structured telephone support or non-invasive telemonitoring for patients with heart failure[J]. Cochrane Database Syst Rev, 2015,(10):CD007228.
[34]	Sookhoo D, Pellowe C, Derham C. The experiences of heart failure patients following their participation in self-management patient education programmes:a systematic review[J]. JBI Library Syst Rev, 2013, 11(2):236-280.
[35]	Takeda A, Martin N, Taylor RS, et al. Disease management interventions for heart failure[J]. Cochrane Database Syst Rev, 2019, 1(1):CD002752.
[36]	Creber RM, Patey M, Lee CS, et al. Motivational interviewing to improve self-care for patients with chronic heart failure:MITI-HF randomized controlled trial[J]. Patient Educ Couns, 2016, 99(2):256-264. doi: 10.1016/j.pec.2015.08.031
[37]	Vellone E, Rebora P, Ausili D, et al. Motivational interviewing to improve self-care in heart failure patients (MOTIVATE-HF):a randomized controlled trial[J]. ESC Heart Fail, 2020, 7(3):1309-1318. doi: 10.1002/ehf2.12733 pmid: 32343483
[38]	Cameron J, Worrall-Carter L, Driscoll A, et al. Measuring self-care in chronic heart failure:a review of the psychometric properties of clinical instruments[J]. J Cardiovasc Nurs, 2009, 24(6):E10-E22. doi: 10.1097/JCN.0b013e3181b5660f
[39]	OHTAC OCDM Collaborative. Optimizing chronic disease management in the community(outpatient) setting (OCDM):an evidentiary framework[J]. Ont Health Technol Assess Ser, 2013, 13(3):1-78.
[40]	郭金玉, 李峥, 康晓凤. 心力衰竭自我护理指数量表的汉化及信效度检测[J]. 中华护理杂志, 2012, 47(7):653-655.
[41]	王丽萍. 老年慢性心力衰竭患者自我护理能力调查及干预效果的研究[D]. 广州: 南方医科大学, 2009.
[42]	Jonkman NH, Westland H, Groenwold RH, et al. Do self-management interventions work in patients with heart failure? An individual patient data meta-analysis[J]. Circulation, 2016, 133(12):1189-1198. doi: 10.1161/CIRCULATIONAHA.115.018006 pmid: 26873943
[43]	Wang CC, Chen JH, Yu WC, et al. 2012 Guidelines of the Taiwan Society of Cardiology(TSOC) for the diagnosis and treatment of heart failure[J]. Acta Cardiol Sin, 2012, 28:161-195.
[44]	Jurgens CY, Goodlin S, Dolansky M, et al. Heart failure management in skilled nursing facilities:a scientific statement from the American Heart Association and the Heart Failure Society of America[J]. Circ Heart Fail, 2015, 8(3):655-687. doi: 10.1161/HHF.0000000000000005