老年心衰患者衰弱共病现状及短期预后的影响因素  

The status quo of weakness comorbidity and the influencing factors of short-term prognosis in elderly patients with heart failure

作　　者：汤莉莹[1] 李培[1] 白玉芝[1] 王晶[1] 赵霞[1] 田甜[1] 茹静[1] 安芸[1] 黄秀婷 Tang Li-ying;Li Pei;Bai Yu-zhi;Wang Jing;Zhao Xia;Tian Tian;Ru Jing;An Yun;Huang Xiu-ting(Geriatrics Department,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院(石景山院区)老年科,北京100043

出　　处：《中国急救医学》2023年第6期451-455,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨老年心衰患者衰弱共病现状及短期预后的影响因素。方法选取2018年11月至2022年7月在首都医科大学附属北京朝阳医院(石景山院区)老年科治疗的老年心衰患者180例,采用Fried衰弱量表评估患者衰弱情况,分析衰弱和无衰弱患者临床资料差异,以及随访期间死亡和存活患者临床资料差异。结果经Fried衰弱量表评估,衰弱患者有56例,衰弱发生率为31.11%。所有患者均随访6个月,随访期间死亡患者29例,病死率为16.11%。衰弱患者年龄(岁:76.65±6.64 vs.70.20±6.01)、NYHA分级Ⅲ~Ⅳ级比例(60.71%vs.37.10%)、主动脉内径(mm:35.53±4.54 vs.31.12±5.22)、血肌酐[SCr(μmmol/L):90.43±10.45 vs.82.23±9.94]明显高于无衰弱患者(P<0.05),而左室射血分数[LVEF:(41.19±8.82)%vs.(47.75±8.70)%]和血红蛋白[Hb(g/L):118.29±11.32 vs.124.43±10.52],明显低于无衰弱患者(P<0.05)。Logistic回归分析显示,年龄、NYHA分级、SCr、LVEF和Hb是老年心衰患者发生衰弱的影响因素(P<0.05)。死亡患者年龄(岁:77.12±6.90 vs.71.26±6.64)、NYHA分级Ⅲ~Ⅳ级比例(65.52%vs.40.40%)、血肌酐[SCr(μmol/L):95.46±9.70 vs.82.73±9.18]、衰弱比例(72.41%vs.23.18%)明显高于存活患者(P<0.05),而LVEF[(38.89±8.11)%vs.(47.02±8.25)%]、Hb[(g/L):(110.06±12.12 vs.124.91±11.41)]和白蛋白[Alb(g/L):(34.46±5.06 vs.38.47±5.14)],明显低于存活患者(P<0.05)。Logistic回归分析显示,年龄、NYHA分级、SCr、衰弱和LVEF是老年心衰患者死亡的影响因素(P<0.05)。结论老年心衰患者有较高比例发生衰弱,衰弱发生受患者年龄、NYHA等因素的影响,而短期预后受年龄、NYHA分级、衰弱等因素的影响。Objective To explore the status quo of weakness comorbidity and the influencing factors of short-term prognosis in elderly patients with heart failure.Methods 180 elderly patients with heart failure who were treated in Geriatrics Department,Beijing Chaoyang Hospital Affiliated to Capital Medical University from November 2018 to July 2022 were selected,and the condition of patients′weakness was evaluated with the Fried asthenia scale,and the differences in clinical data of patients with and without asthenia were analyzed,as well as the differences in clinical data of patients who died and survived during the follow-up period.Results According to the evaluation of Fried asthenia scale,there were 56 patients with asthenia,and the incidence of asthenia was 31.11%.All the patients were followed up for 6 months.During the follow-up period,29 patients died,and the death rate was 16.11%.The age,the proportion of NYHA gradeⅢto IV,the diameter of aorta,and the serum creatinine(SCr)in patients with asthenia were significantly higher than those without asthenia[(76.65±6.64)years vs.(70.20±6.01)years,60.71%vs.37.10%,(35.53±4.54)mm vs.(31.12±5.22)mm,(90.43±10.45)μmol/L vs.(82.23±9.94)μmol/L,P<0.05],while left ventricular ejection fraction(LVEF)and hemoglobin(Hb)were(41.19±8.82)%and(118.29±11.32)g/L,respectively,which were significantly lower than those without asthenia[(47.75±8.70)%,(124.43±10.52)g/L,P<0.05].Logistic regression analysis showed that age,NYHA grade,SCr,LVEF and Hb were the influencing factors of senile heart failure(P<0.05).The age(77.12±6.90)years old,the proportion of NYHA gradeⅢtoⅣ(65.52%),SCr(95.46±9.70)μmol/L and the proportion of asthenia(72.41%)in dead patients were significantly higher than those of living patients[(71.26±6.64)years,40.40%,(82.73±9.18)μmol/L,23.18%,P<0.05],while LVEF[(38.89±8.11)%,Hb(110.06±12.12)g/L]and albumin[Alb,(34.46±5.06)g/L]were significantly lower than those of living patients[(47.02±8.25)%,(124.91±11.41)g/L,(38.47±5.14)g/L,(P<0.05)].Logistic regr

关 键 词：老年人 心力衰竭 衰弱 短期预后 影响因素 左室射血分数(LVEF) 

分 类 号：R541.6[医药卫生—心血管疾病]