二元疾病管理理论在心血管疾病患者及其照顾者中的应用进展

Research Progress on the Application of the Theory of Dyadic Illness Management among Patients with Cardiovascular Diseases and Their Caregivers

摘要: 目的：系统梳理二元疾病管理理论在心血管疾病患者–照顾者二元照护体系中的国内外研究现状，剖析现有研究短板与发展局限，为构建契合我国国情的老年心血管疾病本土化二元管理方案提供依据。方法：检索中英文数据库中二元疾病管理、心血管慢病协同照护、照顾者二元干预相关文献，从理论溯源、落地应用、影响因素分层、干预方案优劣对比多维度归纳总结，评述现有研究成果与缺陷。结果：二元疾病管理理论打破传统单一个体慢病管理局限，以二元评价、二元管理行为、二元健康为核心要素，强调患者与照顾者相互依存、双向影响；个体特质、二元亲密关系、家庭社会资源三维度共同制约心血管二元管理质量；现有四大类干预手段均可改善患者预后、缓解照护负荷，但各类干预模式适用场景、实施成本与远期疗效差异显著。国内相关研究起步晚，存在选题同质化、干预方案照搬国外、本土化改良不足等问题。结论：二元疾病管理为心血管慢病长期居家照护开辟新思路，后续需立足国内老龄化、城乡医疗资源不均衡的现实，开展分层化、长期纵向队列研究，优化适配本土的二元干预体系。

Abstract: Objectives: The study systematically reviewed the current research status of the theory of dyadic illness management in the dual care system for cardiovascular disease patients and caregivers both domestically and internationally, analyzed the shortcomings and limitations of the existing research, and provided a basis for constructing a localized dual management plan for elderly cardiovascular diseases that is in line with China’s national conditions. Methods: Relevant literature on dual disease management, collaborative care for cardiovascular chronic diseases, and dual caregiver intervention was retrieved from Chinese and English databases. The research was summarized from multiple dimensions such as theoretical origin, practical application, factor stratification, and comparison of intervention schemes’ advantages and disadvantages. The existing research results and deficiencies were evaluated. Results: The theory of dyadic illness management breaks through the limitations of traditional individual-based chronic disease management, with the core elements being dual evaluation, dual management behaviors, and dual health. It emphasizes the interdependence and mutual influence between patients and caregivers. The quality of cardiovascular dual management is jointly constrained by three dimensions: individual traits, dual intimate relationships, and family and social resources. The existing four types of intervention methods can all improve patient prognosis and alleviate the burden of care, but the applicable scenarios, implementation costs, and long-term efficacy of each intervention mode vary significantly. Domestic related research started late and has problems such as homogeneity in topic selection, direct adoption of foreign intervention schemes, and insufficient local modification. Conclusion: Dual disease management opens up new ideas for long-term home care of cardiovascular chronic diseases. In the future, it is necessary to base on the reality of domestic aging and the imbalance of medical resources between urban and rural areas, conduct stratified, long-term longitudinal cohort studies, and optimize a localized dual intervention system.