摘要
目的探讨老年综合评估(comprehensive geriatric assessment,CGA)在老年慢性心力衰竭(chronic heart failure,CHF)合并肌少症患者中的应用价值。方法本研究为前瞻性随机对照研究。选取合肥市第三人民医院2019年1月至2022年2月收治的老年CHF合并肌少症患者110例,应用随机数字表法分为观察组(56例)和对照组(54例)。治疗前对照组患者进行有选择的单项评估,包括跌倒风险评估、营养风险筛查简表评估,并常规给予改善心脏功能和预后的药物治疗;观察组患者治疗前进行CGA,包括躯体功能状态评估、精神心理状态评估、多重用药管理评估、疼痛评估、睡眠障碍评估、社会环境评估,并根据评估结果制定、实施和动态调整个体化诊疗方案。两组患者均治疗12周,比较两组患者的一般资料、治疗依从性,治疗前后血浆B型脑钠肽(B-type natriuretic peptide,BNP)水平、左心室射血分数(left ventricular ejection fraction,LVEF)、6 min步行距离(6-minute walking distance,6MWD)、上肢臂力和6 m步速,临床疗效和预后。计量资料以x¯±s表示,组间比较采用成组t检验,组内治疗前后比较采用配对t检验;计数资料以例(%)表示,组间比较采用χ^(2)检验,等级资料比较采用秩和检验。结果两组患者性别、年龄、CHF病程、吸烟、饮酒、合并症数量和心功能分级以及治疗依从性比较,差异均无统计学意义(均P>0.05),具有可比性。治疗前,两组患者血浆BNP、LVEF、6MWD、上肢握力和6 m步速比较差异均无统计学意义(均P>0.05);治疗后,两组患者血浆BNP水平均低于治疗前且观察组低于对照组[(343.45±34.95)ng/L比(387.09±46.96)ng/L],LVEF、6MWD、上肢握力和6 m步速均高于治疗前且观察组均高于对照组[(49.61±7.11)%比(42.94±5.72)%,(348.92±37.73)m比(297.74±43.48)m,(22.64±3.82)kg比(19.48±3.88)kg,(0.97±0.10)m/s比(0.83±0.12)m/s],差异均有统计学意义(t值分别为5.51、-5.40、-6.60、-4.31�
Objective To investigate the therapeutic effect of comprehensive geriatric assessment(CGA)in elderly patients with chronic heart failure(CHF)complicated with sarcopenia,and to provide a theoretical reference for clinical application.Methods This study was a prospective randomized controlled study.110 elderly CHF patients with myopenia admitted to the Third People's Hospital of Hefei from January 2019 to February 2022 were selected.Using the random number table method,56 cases were divided into an observation group and 54 cases into a control group.Before treatment,the control group of patients underwent a selective single assessment based on the hospital's requirements and the patient's actual situation,including a fall risk assessment,nutritional risk screening checklist assessment,and routine medication to improve cardiac function and prognosis;Before treatment,the patients in the observation group were assessed with CGA,including the assessment of physical function,mental and psychological status,multiple drug management,pain,Sleep disorder,and social environment.According to the assessment results,individual diagnosis and treatment plans were formulated,implemented,and dynamically adjusted.The two groups were treated for 12 weeks.The general information,treatment compliance,B-type brain natriuretic peptide(BNP)level,left ventricular Ejection fraction(LVEF),6 min walking distance(6MWD),arm strength of upper limbs and 6 m walking speed,clinical efficacy and prognosis of the two groups were compared before and after treatment.The measurement data is represented by x¯±s,group t-tests are used for inter group comparison,and paired t-tests are used for intra group comparison before and after treatment;Counting data is represented as an example(%),and inter group comparisons are made usingχ^(2) test,non parametric rank sum test was used for inter group comparison of hierarchical data.Results There was no statistically significant difference in gender,age,course of CHF,smoking,alcohol consumption,number of comorbi
作者
周应基
陈继群
苗连海
杨志勇
宋诗涛
宋文玲
张云凤
朱德发
Yingji Zhou;Jiqun Chen;Lianhai Miao;Zhziyong Yang;Shitao Song;Wenling Song;Yunfeng Zhang;Defa Zhu(Department of Geriatrics,Hefei Third People's Hospital,Anhui Province,Hefei 230022,China;Department of Geriatrics,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《中国综合临床》
2023年第4期292-298,共7页
Clinical Medicine of China
关键词
慢性心力衰竭
肌少症
老年综合评估
Chronic heart failure
Sarcopenia
Comprehensive geriatric assessment
