慢性心力衰竭患者限钠饮食依从性现状及其影响因素研究

Current Status and Influencing Factors of Sodium-restricted Diet Compliance in Patients with Chronic Heart Failure

背景限钠饮食可减轻慢性心力衰竭患者身体负担、改善临床结局,是其非药物治疗的重要环节。尽管国内外心力衰竭管理指南中均推荐慢性心力衰竭患者应遵循限钠饮食,但患者依从性不容乐观。目前针对国内慢性心力衰竭患者限钠饮食依从性及其影响因素的研究较少。目的分析慢性心力衰竭患者限钠饮食依从性现状及其影响因素。方法选取2019年5—10月在阜外华中心血管病医院、河南省人民医院、郑州大学第一附属医院心内科收治的慢性心力衰竭患者240例。分别采用一般资料调查表、医院焦虑抑郁自评量表(HADS)、社会支持评定量表(SSRS)及限钠饮食问卷(DSRQ)评估患者一般资料、焦虑情绪、抑郁情绪、社会支持水平及限钠饮食依从性。比较不同临床资料及有无焦虑、抑郁的慢性心力衰竭患者DSRQ评分。采用Pearson相关分析慢性心力衰竭患者SSRS评分与DSRQ评分的相关性;采用多元线性逐步回归模型分析慢性心力衰竭患者DSRQ评分的影响因素。结果不同性别、文化程度、工作状况、人均月收入、病程、纽约心脏病协会(NYHA)分级、左心室射血分数、合并症严重程度及有无配偶、抑郁患者DSRQ评分比较,差异有统计学意义(P<0.05)。Pearson相关分析结果显示,慢性心力衰竭患者SSRS总分及客观支持、主观支持和对支持的利用度得分与DSRQ总分均呈正相关(r值分别为0.667、0.309、0.644、0.687,P值均<0.001)。多元线性逐步回归分析结果显示,文化程度(β=0.961)、人均月收入(β=-0.635)、NYHA分级(β=-1.251)、抑郁(β=-1.928)、主观支持得分(β=0.419)及对支持的利用度得分(β=1.169)与慢性心力衰竭患者DSRQ评分独立相关(P<0.05)。方程的决定系数(R2)=0.661,可解释慢性心力衰竭患者限钠饮食依从性总变异的66.1%。结论慢性心力衰竭患者限钠饮食依从性不容乐观,有待改善,而文化程度、人均月收入、NYHA分级、抑郁及社会支持水平是慢性心力衰竭患者限钠饮食依从性的影响因素。

Background Sodium-restricted diet can reduce the burden of symptoms and improve the clinical outcomes of patients with chronic heart failure,and it is an important part of non-drug therapy for the patients.Although it has been recommended that patients with chronic heart failure should follow sodium-restricted diet in the guidelines of heart failure management at home and abroad for a long time,but patients'compliance is not optimistic.At present,there are few studies on the compliance of sodium-restricted diet and its influencing factors in patients with chronic heart failure in China.Objective To investigate current statue of sodium-restricted diet compliance in patients with chronic heart failure,and to analyze its influencing factors.Methods A total of 240 patients with chronic heart failure hospitalized in Department of Cardiology of Fuwai Central China Vascular Disease Hospital,Henan Provincial People's Hospital and the First Affiliated Hospital of Zhengzhou University from May to October in 2019 were selected.General information,anxiety,depression,social support level,sodium-restriction compliance were recorded by general data questionnaire,Hospital Anxiety and Depression Scale(HADS),Social Support Rating Scale(SSRS)and Dietary Sodium Restriction Questionaire(DSRQ),respectively.DSRQ score was compared in chronic heart failure patients with different clinical data,anxiety and depression.Pearson correlation analysis was used to analyse the correlation between SSRS score and DSRQ score in patients with chronic heart failure.Multiple linear stepwise regression was used to analyze the influencing factors of DSRQ score in patients with chronic heart failure.Results There were significant differences in the DSRQ score among the patients with different gender,degree of education,working situation,per capita monthly income,course of disease,NYHA grading,LVEF,serious degree of complication,spouse or not and depression or not(P<0.05).Pearson correlation analysis results showed that,the SSRS total score,objective support score,subjective support score and utilization support score were positively correlated with the DSRQ score(r value was 0.667,0.309,0.644,0.687,respectively,P<0.001).Multiple linear stepwise regression analysis showed that,degree of education(β=0.961),per capita monthly income(β=-0.635),NYHA grading(β=-1.251),depression(β=-1.928),subjective support score(β=0.419)and utilization support score(β=1.169)were independently related to DARQ score in patients with chronic heart failure(P<0.05).The R2 of the equation was 0.661,which can explain 66.1%of the total variation of sodium restriction diet compliance in patients with chronic heart failure.Conclusion The sodium restriction diet compliance in patients with chronic heart failure is not optimistic,which needs to be improved.However,degree of education,per capita monthly income,NYHA grading,depression,and social support level are influencing factors of sodiumrestricted diet compliance in patients with chronic heart failure.