体重管理对慢性射血分数降低心力衰竭病人心功能的影响

The Influence of Weight Management on Cardiac Function in Patients of Chronic Heart Failure with Reduced Ejection Fraction

目的探讨体重管理对慢性射血分数降低心力衰竭(HFrEF)病人心功能的影响。方法采用随机对照研究方法,连续入选2016年1月—2018年12月于山西医科大学第一医院住院的慢性射血分数降低心力衰竭病人360例,采用随机数字表法分为对照组和体重管理组,每组180例。对照组和体重管理组均给予基础心力衰竭治疗、常规健康宣教,体重管理组给予强化体重健康教育,尽早发现钠水潴留和体重变化,及时调整利尿剂剂量使体重恢复如前。观察出院前1 d和随访1年后两组体重、Bathel指数(BI)、左心室射血分数(LVEF)、血浆N末端脑钠肽前体(NT-proBNP)、6 min步行试验距离(6MWT)的变化情况及随访1年期间内住院率。结果随访期间,对照组失访3例,退出9例;体重管理组失访2例,退出7例,最终对照组168例、体重管理组171例完成本研究。两组入组时基线资料和体重、BI评分、LVEF、血浆NT-proBNP、6 min步行试验距离比较差异无统计学意义(P>0.05)。随访1年结束时,体重管理组LVEF、6 min步行试验距离、BI评分明显高于对照组(P<0.05),血浆NT-proBNP、体重低于对照组(P<0.05);体重管理组LVEF、6 min步行试验距离、BI评分、血浆NT-proBNP变化量高于对照组(P<0.001),而体重变化量明显低于对照组(P<0.001)。随访1年期间,体重管理组再住院率为19.88%,明显低于对照组的35.12%(P<0.05)。结论通过强化体重管理,可以改善慢性射血分数,降低心力衰竭病人的心功能,提高其生活质量,降低住院率,改善预后。

Objective To explore the Effect of weight management on cardiac function in patients of chronic heart failure with reduced ejection fraction(HFrEF).Methods Using the method of randomized,controlled study,a series of 360 patients with chronic HFrEF were randomly divided into control group(n=180)and weight management group(n=180).Both the control group and the weight management group were given basic heart failure treatent and routine health education,in addition,the weight management group were given intensive weight health education,we early detected sodium retention and weight changes in the weight management group,and timely adjusted diuretic dose to restore weight as before.Before patients discharged and at the end of the 1-year follow-up,body weight,Bathel(BI)score,left ventricular ejection fraction(LVEF),plasma NT-proBNP,6 min walking distance(6MWT)and hospitalization rate in this one year were recorded.Results In one year,there were patients lost to follow-up and 9 patients dropped out of the control group,2 patients lost to follow-up and 7 patients dropped out of the weight management group,so,168 patients in the control group and 171 patients in the weight management group completed this study.There was no statistical difference in the general baseline data,body weight,BI score,LVEF,plasma NT-proBNP,and 6MWT between the two groups when the patients were enrolled in the group(P>0.05).At the end of the 1-year follow-up,the LVEF,6MWT and BI score in the weight management group were significantly higher than that in the control group(P<0.05),while plasma NT-proBNP and body weight were significantly lower than those in the control group(P<005).The changes of LVEF,6MWT,BI score and plasma NT-proBNP during this one year in the weight management group were significantly higher than those in the control group(P<0.001),while the changes of body weight were significantly lower than that in the control group(P<0.001).The rehospitalization rate in the weight management group was significantly lower than that in the control group(19.88%vs 35.12%,P<0.05).Conclusion For patients with chronic HFrEF,rigorous weight management can improve the cardiac function、improve the quality of life,reduce the rehospitalization rate and improve the prognosis.