营养干预联合康复锻炼对高龄慢性心力衰竭合并肌少症患者的疗效分析  

Efficacy of nutrition intervention combined with rehabilitation exercise in elderly patients with chronic heart failure complicated by sarcopenia

作　　者：胡晖[1] 高少平[2] 赵阿云 王希[2] 王云云 王可婧 刘爽 闫少西[2] 乔薇[2] Hu Hui;Gao Shaoping;Zhao Ayun;Wang Xi;Wang Yunyun;Wang Kejing;Liu Shuang;Yan Shaoxi;Qiao Wei(The First Department of Surgical Center of Coronary Heart Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;the First Department of Health Care,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院冠心病外科中心一病区,北京100029 [2]中日友好医院保健部一部,北京100029

出　　处：《中华健康管理学杂志》2023年第11期811-815,共5页Chinese Journal of Health Management

基　　金：中央保健科研基金(2020YB27)。

摘　　要：目的分析营养干预联合康复锻炼对高龄慢性心力衰竭(CHF)合并肌少症患者的疗效。方法本研究为随机对照试验,连续选取2021年6月至2022年10月于中日友好医院门诊就诊的已接受标准CHF药物治疗且病情稳定的≥80岁射血分数保留的70例CHF合并肌少症患者,按随机数字表法分为试验组和对照组(各35例)。试验组继续原CHF药物治疗方案,并在日常进餐基础上,补充乳清蛋白粉[37 g/次(含乳清蛋白16.2 g,热量145 kcal),2次/d]联合以抗阻练习为主的康复锻炼(共5组动作,循序渐进,逐步达到运动3 d/周,2次/d,5组/次,20遍/组),对照组维持原CHF药物治疗方案及生活方式不变。采用t检验和χ2检验比较两组在干预前及干预3个月后的体重指数、四肢骨骼肌质量指数(ASMI)、握力、5次起坐试验、6 m步速、6 min步行距离、脑钠肽(BNP)、左室射血分数、二尖瓣口舒张早期血流峰速与二尖瓣环舒张早期心肌运动峰速的比值(E/e′)、血清白蛋白、血红蛋白、糖化血红蛋白及血肌酐变化,分析营养干预联合康复锻炼对高龄CHF合并肌少症患者的疗效。结果纳入分析的70例患者中,男性42例,女性28例,试验组与对照组基线资料差异均无统计学意义(均P>0.05)。干预3个月后,试验组ASMI、握力、6 min步行距离均显著高于对照组[(6.43±1.07)比(6.09±0.86)kg/m^(2)、(27.75±2.13)比(23.45±0.47)kg、(361.51±58.71)比(273.50±69.85)m],且显著高于干预前[(5.99±1.45)kg/m^(2)、(23.55±9.64)kg、(273.50±69.86)m],5次起坐时间、BNP、E/e′均显著低于对照组[(11.20±2.09)比(15.36±0.46)s、(278.80±58.69)比(400.80±87.86)ng/L、(11.10±0.81)比(14.66±1.90)],且显著低于干预前[(18.51±2.90)s、(407.50±122.74)ng/L、(14.00±1.15)](均P<0.05);其余指标差异均无统计学意义(均P>0.05)。结论高龄CHF合并肌少症患者在CHF药物治疗基础上补充乳清蛋白联合以抗阻练习为主的康复锻炼,可明显改善四肢�Objective To analyze the efficacy of nutrition intervention combined with rehabilitation exercise in elderly patients with chronic heart failure(CHF)complicated by sarcopenia.Methods In this randomized controlled trial,seventy CHF patients with sarcopenia,aged 80 years or older,who had received standard CHF medication treatment and had stable conditions with preserved ejection fraction(HFpEF)from June 2021 to October 2022 at the China-Japan Friendship Hospital outpatient clinic were continuously selected.The patients were randomly divided into a test group(n=35)and a control group(n=35)using a random number table.The test group continued the original heart failure medication treatment,and on the basis of daily meal,supplemented with whey protein powder[37 g per serving(including 16.2 g of whey protein,145 kcal),twice a day];they were given resistance exercise primarily focused on resistance training(5 sets of exercises,progressively increasing to 3 days per week,twice a day,5 sets per session,20 repetitions per set).The control group maintained the original heart failure medication treatment plan and lifestyle.The body mass index,appendicular skeletal muscle mass index(ASMI),grip strength,Five-Times-Sit-to-Stand Test,6-meter walking speed,6-minute walk test,brain natriuretic peptide(BNP),left ventricular ejection fraction,ratio of early mitral flow peak velocity to early mitral annulus diastolic peak velocity(E/e′),serum albumin,hemoglobin,and serum creatinine were compared between the two groups before and after 3 months of intervention using t-tests and chi-square tests to analyze the efficacy of nutrition intervention combined with rehabilitation exercise in elderly patients with CHF complicated by sarcopenia.Results Among the 70 patients,there were 42 males and 28 females.There was no significant difference in baseline data between the test group and the control group(all P>0.05).After 3 months of intervention,ASMI,grip strength and 6 min walking distance in the test group were all significantly higher than

关 键 词：高龄 慢性心力衰竭 肌少症 营养疗法 康复 

分 类 号：R541.6[医药卫生—心血管疾病] R685[医药卫生—内科学]