主管:国家卫生健康委员会
主办:国家卫生健康委医院管理研究所
中国科技核心期刊(中国科技论文统计源期刊)
中国科学引文数据库(CSCD)核心库期刊
《中文核心期刊要目总览》核心期刊

中国护理管理 ›› 2025, Vol. 25 ›› Issue (6): 801-806.doi: 10.3969/j.issn.1672-1756.2025.06.001

• 特别策划·慢性心力衰竭护理 • 上一篇    下一篇

智能化自我管理系统在慢性心力衰竭患者中的应用及效果评价

果迪 孙超 胡慧秀 赵雅洁 张祎 蔺亚婷 赵悦 冉梦迪 马永栓   

  1. 北京医院心内科/国家老年医学中心/中国医学科学院老年医学研究院,100730 北京市(果迪,赵雅洁,张祎,蔺亚婷,赵悦,冉梦迪,马永栓);护理部(孙超,胡慧秀)
  • 出版日期:2025-06-15 发布日期:2025-06-15
  • 通讯作者: 孙超,硕士,主任护师,护理部主任,E-mail:sunchaobjyy@163.com
  • 作者简介:果迪,本科,副主任护师,护士长
  • 基金资助:
    中央高水平医院临床科研业务费(BJ-2021-215,BJ-2023-212,BJ-2023-137);北京市卫生健康科技成果和适宜技术推广项目(BHTPP2024054)

Application and effectiveness evaluation of intelligent self-management system in Chronic Heart Failure patients

GUO Di, SUN Chao, HU Huixiu, ZHAO Yajie, ZHANG Yi, LIN Yating, ZHAO Yue, RAN Mengdi, MA Yongshuan   

  1. Cardiology Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
  • Online:2025-06-15 Published:2025-06-15
  • Contact: E-mail:sunchaobjyy@163.com

摘要: 目的:评价智能化自我管理系统在慢性心力衰竭患者中的应用效果,为此类患者的精准化自我管理提供依据。方法:开发智能化自我管理系统。采用便利抽样法选取2023年10月至2024年6月北京市某三级甲等综合医院的慢性心力衰竭住院患者为研究对象。采用类实验研究方法,将同期收治于2个心内科病房的患者按其所处不同病房分为对照组和干预组,其中91例对照组患者接受常规健康教育,102例干预组患者在对照组基础上结合智能化自我管理系统接受健康教育,包括住院期间的数字健康管理、个性化健康教育知识推送、自我管理数据上传与监测预警、激励机制与依从性促进及随访安排,干预时长为6个月。比较两组患者在出院后3个月及6个月相关评价指标的差异。结果:干预组在出院后3个月和6个月的自我护理能力、心力衰竭知识水平、生活质量均优于对照组;干预组在出院后6个月心功能分级优于对照组,再入院率为12.7%,低于对照组的24.2%,差异均有统计学意义(P<0.05)。结论:智能化自我管理系统的应用可有效提高慢性心力衰竭患者的自我护理能力和心力衰竭知识水平,改善心功能和生活质量,降低再入院率,改善患者远期预后。

关键词: 智能化;自我管理;慢性心力衰竭;健康教育

Abstract: Objective: To evaluate the application effect of intelligent self-management system in patients with Chronic Heart Failure (CHF), so as to provide a theoretical basis for precision self-management in these patients. Methods: We developed an intelligent self-management system. We used convenience sampling method to select CHF patients, patients admitted to a tertiary grade A general hospital in Beijing from October 2023 to June 2024 were divided into control group and intervention group according to their different wards. The control group (91 cases) received routine health education, while intervention group (102 cases) received routine health education combined with intelligent self-management system, including digital health management during hospitalization, personalized health education knowledge push, self-management data upload and monitoring warning, incentive mechanism and compliance promotion, and follow-up arrangements. The differences in relevant evaluation indicators between two groups of patients at 3 months and 6 months after discharge were compared. Results: After 6 months of intervention, the intervention group had better self-care ability, knowledge level of heart failure, and quality of life at 3 months and 6 months after discharge than the control group. The intervention group had better cardiac function grading than the control group at 6 months after discharge, with a readmission rate of 12.7%, which was lower than the control group's 24.2%. The differences were all statistically significant (P<0.05). Conclusion: The application of intelligent self-management system can effectively improve the self-care ability and knowledge level of heart failure, enhance the cardiac function and quality of life, reduce the readmission rate, and promote long-term prognosis in patients with CHF.

Key words: intelligent; self-management; Chronic Heart Failure; health education

中图分类号:  R47;R197