老年慢性心力衰竭住院病人抑郁状态及相关因素分析

Analysis of depression status and related factors in hospitalized elderly patients with chronic heart failure

目的分析住院的老年心力衰竭(心衰)病人抑郁的发生情况及影响因素。方法连续纳入2017年6月至2018年6月收入我院老年心血管科的老年慢性心衰病人,收集病人的临床资料,采用汉密尔顿焦虑量表(HAMA)和老年抑郁量表(GDS)对病人焦虑、抑郁状态进行评估,并对抑郁相关危险因素进行分析。结果纳入的123例慢性心衰病人当中,轻度抑郁35例(28.46%),中度抑郁9例(7.32%)。相关分析显示,年龄(r=0.191,P=0.035)、HAMA评分(r=0.459,P<0.001)、FRAIL衰弱量表评分(r=0.238,P=0.008)、简易营养评估量表(MNA-SF)评分(r=0.359,P<0.001)、病人健康问卷-9项评分(PHQ-9)(r=0.343,P<0.001)与抑郁评分呈正相关,而6 min步行距离(r=-0.298,P=0.001)、修订版跌倒效能量表(MFES)评分(r=-0.429,P<0.001)、社会支持量表评分(r=-0.288,P=0.001)、Barthel指数评分(r=-0.102,P<0.001)与抑郁评分呈负相关。多因素线性回归分析显示,HAMA评分、MFES评分以及PHQ-9评分是住院老年慢性心衰病人抑郁的独立危险因素。结论老年住院慢性心衰病人抑郁患病率高,需要重视及提高住院老年慢性心衰病人的心理健康。

Objective To analyze the current situation and the influencing factors of depression in the elderly patients with chronic heart failure.Methods The clinical data of the elderly patients with chronic heart failure who were hospitalized in the Geriatric Cardiovascular Department of the First Affiliated Hospital of Nanjing Medical University from June 2017 to June 2018 were analyzed.The Hamilton Anxiety Scale(HAMA)and the Geriatric Depression Scale(GDS)were used to evaluate the patients'anxiety and depression.A multi-factor linear regression analysis of depression-related risk factors was performed.Results Of the 123 patients with chronic heart failure,there were 35 cases(28.46%)with mild depression and 9 cases(7.32%)with moderate depression.Pearson correlation showed that age(r=0.191,P=0.035),frailty(r=0.238,P=0.008),nutritional status(r=0.359,P<0.001),health status(r=0.343,P<0.001)were positively associated with depression,while 6-minute walking distance(r=-0.298,P=0.001),fall effectiveness(r=-0.429,P<0.001),social support(r=-0.288,P=0.001),self-care ability(r=-0.102,P<0.001)were negatively associated with depression.The analysis of multi-factor linear regression showed that anxiety,fall effectiveness and health status were independent risk factors for chronic heart failure patients with depression in hospital.Conclusions The prevalence of depression is high in the elderly inpatients with chronic heart failure,and it is necessary to pay attention and improve the mental health of elderly patients with chronic heart failure in hospital.