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目的 对协调员模式在左心室辅助装置（LVAD）植入术后多中心综合管理中的应用现状进行调查，以期为LVAD术后多中心综合管理提供依据。方法 对我国9个省市11家单位的LVAD植入术后多中心综合管理协调员进行问卷调查，包括协调员基本情况、对LVAD患者一般协调工作和心脏指标管理情况以及协调员自我认知状况。结果 11家单位共有LVAD协调员16人，均完成问卷调查。协调员中，男女各8人，年龄（34±6）岁，均为本科及以上学历、工作年限>5年，护士6人、医生10人，兼职11人、全职5人；94%协调员接受过LVAD系统培训，56%协调员每天从事LVAD协调管理时间≥2 h。在一般协调工作中，协调员与患者所在地医生建立联络、遇到紧急情况与协调员联系、对患者复查再次进行考核等内容肯定回答比例较低，对支持患者淋浴、关注患者心理变化等内容肯定回答比例较高。在心脏指标协调管理中，对患者血压、LVAD参数、复查抗凝、更换敷料等协调频率较高，要求患者佩戴远程心电监护协调频率较低。在LVAD协调员自我认知中，协调员存在工作疲劳、单位的奖金鼓励政策较弱和职责界定不明确等问题。结论 在LVAD植入术后多中心综合管理中协调员主要为中青年医护人员，兼职为主，培训比例较高，协调工作基本到位，但应强化LVAD患者心脏指标管理。
Abstract：Objective To investigate the application status of the coordinator model in multicenter comprehensive management after left ventricular assist device(LVAD) implantation, with the aim of providing a basis for postoperative multicenter comprehensive management. Methods A questionnaire survey was conducted among multicenter comprehensive management coordinators for LVAD implantation from 11 institutions in 9 provinces and municipalities of China. The survey covered three aspects: the coordinators' basic information, their general coordination work for LVAD patients, their management of cardiac indicators, and their self-perception of the job. Result A total of 16 LVAD coordinators from 11 institutions completed the questionnaire. Among these coordinators: there were 8 males and 8 females, with an average age of(34 ± 6) years; all had a bachelor's degree or above, and had more than 5 years of work experience; 6 were nurses and 10 were doctors; 11 held part-time positions and 5 held full-time positions. Additionally, 94% of the coordinators had received systematic training on LVAD, and 56% spent ≥ 2 h per day on LVAD coordination and management. In terms of general coordination work: the proportion of positive responses was low for items such as "establishing contact with patients' local doctors", "contacting coordinators in case of emergencies", and "reassessing patients' reexamination results"; while the proportion of positive responses was high for items including "supporting patients to take showers" and "paying attention to patients' psychological changes". In the coordination and management of cardiac indicators: the coordination frequency was high for items like "monitoring patients' blood pressure", "adjusting LVAD parameters", "urging reexamination for anticoagulation", and "replacing dressings"; however, the coordination frequency was low for "requiring patients to wear remote ECG monitors". Regarding the coordinators' self-perception of the LVAD coordination job: the coordinators reported problems such as work fatigue, weak bonus incentive policies of their institutions, and unclear definition of job responsibilities. Conclusions In the multicenter comprehensive management following LVAD implantation, coordinators are primarily young and middle-aged healthcare professionals, most of whom work on a part-time basis. While the training participation rate is relatively high and coordination tasks are generally adequately performed, the management of cardiac parameters for LVAD patients should be strengthened.
[1] GOLDSTEIN D J, NAKA Y, HORSTMANSHOF D, et al. Association of clinical outcomes with left ventricular assist device use by bridge to transplant or destination therapy intent:the multicenter study of maglev technology in patients undergoing mechanical circulatory support therapy with heartmate 3(momentum 3)randomized clinical trial[J]. JAMA Cardiol,2020,5(4):411-419.
[2] SCHL?GLHOFER T, ROBSON D, BANCROFT J, et al. International coordinator survey results on the outpatient management of patients with the HeartWare?ventricular assist system[J]. Int J Artif Organs,2017,39(11):553-557.
[3] PINNEY S P, ANYANWU A C, LALA A, et al. Left ventricular assist devices for lifelong support[J]. J Am Coll Cardiol, 2017,69(23):2845-2861.
[4] AHSAN I, FARAZ A, MEHMOOD A,et al. Clinical approach to manage gastrointestinal bleeding with a left ventricular assist device(LVAD)[J]. Cureus,2019,11(12):e6341.
[5] FRONTERA JA, STARLING R, CHO S M, et al. Risk factors,mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices[J]. J Heart Lung Transplant, 2017,36(6):673-683.
[6] BEN GAL T, AVRAHAM B B E N, MILICIC D, et al. Guidance on the management of left ventricular assist device(LVAD)supported patients for the non-LVAD specialist healthcare provider:executive summary[J]. Eur J Heart Fail,2021,23(10):1597-1609.
[7] LONG B, ROBERTSON J, KOYFMAN A, et al. Left ventricular assist devices and their complications:a review for emergency clinicians[J]. Am J Emerg Med, 2019 ,37(8):1562-1570.
[8] COWGER J A, SHAH P, PAGANI F D, et al. Outcomes based on blood pressure in patients on continuous flow left ventricular assist device support:an interagency registry for mechanically assisted circulatory support analysis[J]. J Heart Lung Transplant,2020,39(5):441-453.
[9] CASTAGNA F, ST?HR E J, PINSINO A, et al. The unique blood pressures and pulsatility of lvad patients:current challenges and future opportunities[J]. Curr Hypertens Rep,2017,19(10):85.
[10] SCHL?GLHOFER T, HORVAT J, MOSCATO F,et al. A standardized telephone intervention algorithm improves the survival of ventricular assist device outpatients[J]. Artif Organs,2018,42(10):961-969.
[11] SAGE W, GOTTIPARTHY A, LINCOLN P, et al. Improving anticoagulation of patients with an implantable left ventricular assist device[J]. BMJ Open Qual,2018,7(4):250.
[12] MALTAIS S, KILIC A, NATHAN S,et al. PREVENT study investigators. prevention of heartmate ii pump thrombosis through clinical management:the prevent multi-center study[J]. J Heart Lung Transplant,2017,36(1):1-12.
[13] TAN C S S, LEE S W H. Warfarin and food, herbal or dietary supplement interactions:a systematic review[J]. Br J Clin Pharmacol, 2021,87(2):352-374.
[14] COOK C, COLE G, ASARIA P, et al. The annual global economic burden of heart failure[J]. Int J Cardiol, 2014,171(3):368-376.
[15] BERNHARDT A M, SCHL?GLHOFER T, LAUENROTH V,et al. Driveline expert staging and care destine study group, a ventricular assist device driveline infection study group. prevention and early treatment of driveline infections in ventricular assist device patients-the destine staging proposal and the first standard of care protocol[J]. J Crit Care,2020,56:106-112.
[16] KUSNE S, MOONEY M, DANZIGER-ISAKOV L, et al. An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection[J]. J Heart Lung Transplant, 2017,36(10):1137-1153.
[17] SCHROEDER S E, BOSCHI S, SCHL?GLHOFER T. The role of the ventricular assist device coordinator:quo vadis[J]. Ann Cardiothorac Surg,2021,10(3):386-388.
[18] BUCHANAN D A, GOLDSTEIN J, PFALZER A C,et al. Empowering the clinical research coordinator in academic medical centers[J]. Mayo Clin Proc Innov Qual Outcomes, 2020, 5(2):265-273.
基本信息:
DOI：
中图分类号:R654.2
引用信息:
[1]张秀娟,刘文贤,曹敬,等.协调员模式在左心室辅助装置植入术后多中心综合管理中的应用现状调查[J].山东医药,2025,65(09):10-13.
基金信息:
天津市医学重点学科建设资助项目（TJYXZDXK-3-035C）; 滨海新区卫生健康委科技项目（2023BWKY018）