结构化思维下慢性心力衰竭患者易损期自我管理方案对其自我管理水平的影响 [中文引用][英文引用]

目的 构建基于结构化思维慢性心力衰竭患者易损期自我管理方案并探讨其应用效果。方法 通过文献回顾、专家函询和专家论证构建基于结构化思维的慢性心力衰竭患者易损期自我管理方案。采用便利抽样法，选取江苏省某三级甲等综合医院心内科 2024 年 5 月— 7 月收治的 48 例慢性心力衰竭患者作为观察组，选取 2024 年 8 月— 10 月收治的 48 例慢性心力衰竭患者作为对照组。观察组患者在常规护理基础上实施基于结构化思维的慢性心力衰竭患者易损期自我管理方案，对照组患者实施常规护理，干预时间 3 个月。比较两组患者自我管理水平、服药依从性、自我效能、抑郁程度、心功能和再住院率。结果 共 90 例患者完成研究，观察组和对照组各 45 例。两组患者自我管理水平、服药依从性、自我效能、抑郁评分干预前后差值比较，差异具有统计学意义（P<0.05），观察组患者干预前后相应差值均高于对照组；两组患者心功能干预前后差值比较，差异具有统计学意义（P<0.05）；干预后观察组患者再住院率低于对照组，差异具有统计学意义（P<0.05）。结论 该方案能提高慢性心力衰竭患者在易损期内的自我管理水平、服药依从性和自我效能，并减轻患者的抑郁情绪、改善患者的心功能，从而降低其在易损期内的再住院率，具有较好的临床推广价值。

Objective To develop and preliminarily explore the effect of a self-management program based on structured thinking for patients in vulnerable phase of chronic heart failure（CHF). Methods Based on structured thinking，a self-management program for patients in vulnerable phase of chronic heart failure was developed through literature review，expert consultation，and an expert panel review. A total of 96 CHF patients were recruited by convenience sampling from the Department of Cardiology of our hospital. Forty-eight patients were assigned to an observation group and received the self-management program between May and July 2024 and 48 patients were assigned to a control group with routine care between August and October 2024. The self-management level，medication compliance，self-efficacy in chronic disease management，degree of depression，cardiac function and rehospitalization rate of the two groups of patients were compared. Results A total of 90 patients，with 45 per group，completed the study. Patients in the observation group exhibited significantly greater improvements in self-management，medication adherence，self-efficacy，depression scores and cardiorespiratory function，as well as a significant lower re-admission rate than those in the control group（all P<0.05). Conclusion For the patients in vulnerable-phase of CHF，the self-management program based on structured thinking not only enhances self-care abilities，medication adherence and self-efficacy，but also alleviates depression and improves heart function，thereby reducing vulnerablephrase hospital re-admission with good clinical promotion value