营养风险对老年射血分数减低型心力衰竭患者住院期间体适能的影响  

Effect of nutritional risk on physical fitness during hospitalization in elderly patients with reduced ejection fraction heart failure

作　　者：康云鹏[1] 郭雯[1] 任爱红[1] 雒芳芳[2] 刘文娴[1] KANG Yunpeng;GUO Wen;REN Aihong;LUO Fangfang;LIU Wenxian(Cardiac Intensive Care Medical Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院心内重症医学中心,北京100029 [2]首都医科大学附属北京安贞医院营养科

出　　处：《中华全科医学》2023年第6期932-935,944,共5页Chinese Journal of General Practice

基　　金：北京市医院管理局科研培育计划项目(PX2018026)。

摘　　要：目的通过本研究判断营养风险程度对老年射血分数减低型心力衰竭(HFrEF)患者在住院期间体适能的影响程度。方法连续纳入2019年1月—2021年12月在首都医科大学附属北京安贞医院心内重症医学中心收治的老年HFrEF患者228例,根据老年营养风险指数(GNRI)分为合并营养不良风险组121例和对照组107例,分析2组基线资料和住院期间体适能状况;根据简易躯体能力测试(SPPB)分为体适能较差患者185例和体适能良好患者43例;采用二分类logistic回归分析研究导致2组患者院内体适能下降的主要影响因素。结果营养不良风险组的HFrEF患者椅子站立测试评分[(2.19±0.87)分vs.(2.46±0.82)分,P=0.017]及简易躯体能力测试总分明显低于对照组[(7.65±1.79)分vs.(8.23±1.79)分,P=0.039];女性握力水平低于对照组[(17.65±4.43)kg vs.(19.89±3.74)kg,P=0.041];与体适能良好患者比较,体适能较差患者年龄更大,血BNP水平更高,血清白蛋白水平、GNRI分值、LVEF值更低(均P<0.05)。二分类logistic回归分析显示:BNP升高(OR=1.003,95%CI:1.001~1.005,P<0.001)、营养不良风险(OR=2.642,95%CI:1.248~5.591,P=0.011)是影响老年HFrEF患者住院期间体适能的主要危险因素。结论营养不良是导致老年HFrEF患者住院期间体适能下降的独立危险因素。Objective To evaluate the effect of nutritional risk on physical fitness in elderly patients with reduced ejection fraction heart failure(HFrEF)during hospitalization.Methods A total of 228 elderly patients with HFrEF admitted to the Cardiac Intensive Care Center of Beijing Anzhen Hospital affiliated with Capital Medical University from January 2019 to December 2021 were included.According to the geriatric Nutritional risk index(GNRI),they were divided into 121 patients in the malnutrition risk group and 107 patients in the control group.Baseline data and physical fitness during hospitalization of the two groups were analyzed.According to short physical performance battery(SPPB),there were 185 patients with poor physical fitness and 43 patients with good physical fitness.Binary logistic regression was used to analyze the main influencing factors leading to the two groups'decline in-hospital fitness.Results The chair standing test score and total score of the simple body achievement test of HFrEF patients in the malnutrition risk group were significantly lower than those in the control group[(2.19±0.87)points vs.(2.46±0.82)points,P=0.017;(7.65±1.79)points vs.(8.23±1.79)points,P=0.039].The grip strength level of women in the malnutrition risk group was lower than that of the control group[(17.65±4.43)kg vs.(19.89±3.74)kg,P=0.041].Compared with patients with good physical fitness,patients with poor physical fitness were older and had higher blood B-type natriuretic peptide(BNP)levels,lower serum albumin levels,GNRI scores,and LVEF values(all P<0.05).Binary logistic regression analysis showed that elevated BNP(OR=1.003,95%CI:1.001-1.005,P<0.001)and malnutrition(OR=2.642,95%CI:1.248-5.591,P=0.011)were the main risk factors affecting physical fitness in elderly patients with HFrEF during hospitalization.Conclusion Malnutrition is an independent risk factor for the decline of physical fitness in elderly patients with HFrEF during hospitalization.

关 键 词：老年营养风险指数 射血分数减低型心力衰竭 简易躯体功能 

分 类 号：R541.6[医药卫生—心血管疾病]