80岁以上慢性心力衰竭患者的综合治疗

The comprehensive therapy for patients aged over 80 years old with chronic heart failure

目的：探讨药物结合运动、心理康复治疗的综合方案对80岁以上心力衰竭患者的效果。方法：选择2006年1月至2011年8月沈阳军区总医院收治的52例80岁以上慢性心力衰竭患者，将其中36例肢体活动无障碍患者分为运动康复组（18例）和对照组（18例）。对照组患者采取药物治疗与心理治疗，运动康复组在此基础上辅以运动康复锻炼。比较治疗3个月后两组患者心脏功能、心理状态及生存状况。结果：（1）运动康复组和对照组患者BNP值均较治疗前有所下降，但两组比较，差异无统计学意义（P〉0．05）；运动康复组和对照组患者心脏功能NYHA分级中I级分别为16例和11例，差异无统计学意义（X^2=2．370，P=0．124）；（2）运动康复组患者6MWT步行距离和MLHFQ评分均优于对照组（P〈0．05）；（3）52例患者认知障碍、焦虑、抑郁发生率较治疗前下降（P〈0．05）；运动康复组与对照组比较，差异无统计学意义（P〉0．05）。（4）截至2012年2月，52例患者中仍生存38例，其中超过5年病期的3例；死亡14例（均为长期卧床患者）。运动康复组患者住院时间及住院次数均较对照组减少（P〈0．05）。结论：80岁以上慢性心力衰竭患者经药物结合运动锻炼和心理疏导可使其心脏功能、生存质量得到改善，缩短住院时间及次数。但仍需进一步随访观察。

Objective：To explore the efficacy of comprehensive therapy combined with drug therapy and psychotherapy in patients aged over 80 years with chronic heart failure （CHF）. Methods：Between January 2006 and August 2011, from 52 CHF patients aged over 80 years registered in General Hospital of Shenyang Military Command, 36 patients without physical activity disability were included in this study and divided into sport rehabilitation and control groups （ n = 18, each）. For control group, the drug therapy and psychotherapy were given based on which exercise rehabilitation was added in sport rehabilitation group. The heart function, psychological state and survival state were compared between the two groups at 3 months after treatment. Results： （ 1 ） The BNP value was deceased in both sport rehabilitation and control groups. Nevertheless, no difference was found in BNP value between the two groups （P 〉 O. 05 ）. The patients with NYHA class I of heart function were 16 cases and 11 cases in sport rehabilitation and control groups, respectively. However, there was no difference between the two groups （X^2 =2. 370, P =0. 124）. （2）Both 6MWT walking distance and MLHFQ scoring in sport rehabilitation group were better than those in control group （ P 〈 0. 05 ）. （ 3 ） The occurrence rates of cognitive disorder, anxiety and depression were decreased in 52 patients （P 〈 0. 05 ）. Nevertheless, no difference was found in occurrence rates of cognitive disorder, anxiety and depression between the two groups （P〉 0.05）. （4） By February 2012, 38 patients still survived among a total of 52 patients. Notably, 3 cases were found with more than 5 years of disease period. The remaining 14 dead patients were all long-term bed patients. For sport rehabilitation group, the hospitalization time and times were relatively less as compared with control group （ P 〈 O. 05 ）. Conclusion： Drug therapy combined with exercise rehabilitation and psychotherapy could improve the heart function and survival quality and shorten the hospitalization time and times. Nevertheless, the further observation was still required in the following-up.