老年综合评估干预对老年心力衰竭合并情绪障碍患者的影响

Impact of comprehensive geriatric assessment on treatment outcomes of chronic heart failure in elderly patients complicated with emotional disorders

目的探索老年心衰合并情绪障碍患者在常规内科治疗的基础上采用老年综合评估干预(CGA)对患者预后的影响。方法选取2017年9月至2019年3月河南省人民医院收治的216例心衰伴情绪障碍的老年患者,随机分为常规治疗组和CGA组(各108例),CGA组在常规治疗基础上积极进行综合评估干预。治疗前和治疗8周后采用24项汉密尔顿抑郁量表(HAMD-24)、14项汉密尔顿焦虑量表(HAMA-14)评估患者的心理障碍水平,并检测患者血浆N-末端脑利钠肽原(NT-proBNP)水平、6 min步行试验距离(6MWT)及左心室射血分数(LVEF),并综合评估患者的认知状态、营养状况、跌倒风险等指标的变化。结果治疗前和治疗8周后,常规治疗组和CGA组患者的HAMD-24得分[常规组:(31.78±9.08)分、(23.69±10.16)分;CGA组:(32.09±8.98)分、(15.35±7.91)分;P<0.05]和HAMA-14得分[常规组:(22.38±7.09)分、(15.28±6.54)分;CGA组:(21.99±8.12)、(10.48±6.82)分;P<0.05]、血浆NT-proBNP水平[常规组:(4672±392)ng/L、(3279±282)ng/L;CGA组:(4861±378)ng/L、(2387±215)ng/L;P<0.05]均低于治疗前,LVEF[常规组:(34.5±6.2)%、(39.8±7.5)%;CGA组:(35.1±3.9)%、(42.5±6.1)%;P<0.05]和6MWT水平[常规组:(298±79±7.5)m、(358±102)m;CGA组:(305±98)m、(402±178)m;P<0.05]均高于治疗前,CGA组较常规治疗组的变化更加显著(P<0.05)。结论老年心衰合并情绪障碍患者及早采用综合评估干预,能够更加显著改善患者的心衰状况及预后。

Objective To investigate the impact of comprehensive geriatric assessment(CGA)on treatment outcomes of chronic heart failure(CHF)complicated with emotional disorders in the elderly.Methods A total of 216 CHF patients with emotional disorders at Henan Provincial People’s Hospital were recruited from September 2017 to March 2019 and were randomly divided into a CGA group and a control group with 108 cases in each group.The control group was given standard drug treatment and psychological counseling,whereas individualized treatment was given to participants in the CGA group in compliance with CGA guidelines.The clinical effects after intervention for 8 weeks in the two groups were examined,using measures such as Hamilton Depression Rating Scale for Depression(HAMD)-24,Hamilton Anxiety Scale(HAMA)-14,amino-terminal pro-brain natriuretic peptide(NT-proBNP),the 6 minute walk test(6MWT)and left ventricular ejection fraction(LVEF).The changes of cognitive status,nutritional status,fall risk and other indicators in patients were comprehensively assessed and statistically analyzed.Results Compared with pre-treatment data,8 weeks of treatment for both the control group and the CGA group resulted in decreased HAMD-24 scores(Control group:31.78±9.08,23.69±10.16;CGA group:32.09±8.98,15.35±7.91;P<0.05),HAMA-14 scores(Control group:22.38±7.09,15.28±6.54;CGA group:21.99±8.12,10.48±6.82;P<0.05)and NT-proBNP levels[Control group:(4672±392)ng/L,(3279±282)ng/L;CGA group:(4861±378)ng/L,(2387±215)ng/L;P<0.05],and increased LVEF(%)[Control group(34.5±6.2)%,(39.8±7.5)%;CGA group(35.1±3.9)%,(42.5±6.1)%;P<0.05]and 6MWT scores[Control group(298±79±7.5)m,(358±102)m;CGA group(305±98)m,(402±178)m;P<0.05],with more marked changes in all the measures in the CGA group than in the control group(P<0.05).Conclusions The early application of CGA can improve the condition and prognosis in elderly heart failure patients complicated with emotional disorders.