心力衰竭患者膳食钠摄入水平及其影响因素分析

Analysis of dietary sodium intake level and its influencing factors in patients with heart failure

目的 调查心力衰竭患者膳食钠摄入量水平,并分析其影响因素,为制定心力衰竭患者的饮食干预策略提供参考.方法 2018年7月-2019年4月,采用便利抽样方法选取南京医科大学第一附属医院心血管内科心力衰竭患者155例为研究对象,采用患者一般资料调查表和限钠饮食问卷收集资料,并对其进行24 h尿钠测定以评价患者膳食钠摄入水平.结果共发放问卷155份,回收问卷153份.153例心力衰竭患者平均膳食钠摄入量为(3 725.39±1 741.84)mg/d,24例患者膳食钠摄入量处于指南推荐范围(2 000~3 000 mg/d),占15.7%(24/153).限钠饮食问卷总得分(54.83±9.15)分,态度和主观规范维度、认知维度、知觉行为控制维度得分分别为(23.24±3.15)、(11.77±2.08)、(19.82±6.13)分.单因素分析显示,不同性别、口味、牙齿健康状况以及是否给开具低钠饮食处方的患者膳食钠摄入量不同,差异有统计学意义(P<0.05);相关分析结果显示,食欲评分与心力衰竭患者钠摄入量相关,差异有统计学意义(r=0.174,P=0.031),限钠饮食知觉行为控制得分与心力衰竭患者钠摄入量相关(r=-0.329,P<0.001).多重线性回归分析显示,患者性别、口味、对限钠饮食的知觉行为控制是心力衰竭患者膳食钠摄入的主要影响因素,解释膳食钠摄入量总变异的21.5%.结论心力衰竭患者膳食钠摄入量高于指南推荐量,现状不容乐观.医护人员尤其要注重男性、口味偏咸和限钠饮食知觉行为得分较低患者的个性化饮食指导和干预,以减少心力衰竭加重及再入院率.

Objective To investigate the dietary sodium intake level of patients with heart failure and analyze its influencing factors, so as to provide reference for formulating dietary intervention strategies for patients with heart failure. Methods From July 2018 to April 2019, 153 patients with heart failure in the First Affiliated Hospital of Nanjing Medical University were selected as the subject by convenient sampling. The General Questionnaire and Dietary Sodium Restriction Questionnaire(DSRQ) were collected, and 24-hour urine sodium determination was used to assess the patient's dietary sodium intake level. Results A total of 155 questionnaires were distributed and 153 questionnaires were returned. The average dietary sodium intake of 153 patients with heart failure was (3 725.39±1 741.84) mg/d. The dietary sodium intake of 24 patients was within the recommended range (2 000-3 000 mg/d), accounting for 15.7%(24/153). The total score of the DSRQ was (54.83±9.15), and the scores of attitude and subjective normative dimension, cognitive dimension and perceptual behavior control were (23.24±3.15), (11.77±2.08), and (19.82±6.13), respectively.Univariate analysis showed different genders, tastes, dental health status, and whether the dietary sodium intake was different for patients prescribed a low-sodium diet, the differences were statistically significant (P< 0.05);correlation analysis showed that appetite score and sodium intake in patients with heart failure was correlated, the difference was statistically significant (r=0.174, P=0.031), and the sodium-stable diet behavioral control score was associated with sodium intake in patients with heart failure (r=-0.329, P< 0.001). Multiple linear regression analysis showed that the patient's gender, taste, and patient's perceptual behavioral control of sodium-restricted diet were the main influencing factors of dietary sodium intake in patients with heart failure, explaining 21.5% of the total variation in dietary sodium intake. Conclusions The dietary sodium intake of patients with heart failure is higher than the recommended amount of the guideline, and the current situation is not optimistic. In particular, health care workers should pay attention to individualized dietary guidance and interventions in men with low salty taste and low sodium-stable dietary behavioral scores to reduce heart failure and readmission rates.