心力衰竭患者症状群变化研究及对患者生活质量的影响

Study on Changes of Symptom Cluster in Patients with Heart Failure and Its Influence on Patients’Quality of Life

目的:探讨心力衰竭患者症状群的变化情况,并分析其对生活质量的影响。方法:前瞻性选取我院2018年10月~2020年10月收治的心力衰竭患者122例,分别在患者入院时及出院3后个月、6个月进行Memorial心力衰竭症状评估量表(MSAS-HF)、明尼苏达心力衰竭生活质量量表(MLHFQ)评分,分析患者MSAS-HF评分与MLHFQ评分的相关性以及患者出院后6个月生活质量的影响因素。结果:心力衰竭患者出院后3个月、6个月的疲倦、不适、情绪、淤血、缺血、呼吸困难症状群评分及总分均低于入院时,且出院后6个月的情绪症状群评分低于出院后3个月(P<0.05);心力衰竭患者出院后3个月、6个月的情绪领域、躯体领域、其他领域评分及总分低于入院时,且出院后6个月的情绪领域评分、总分低于出院后3个月(P<0.05);出院后6个月心力衰竭患者MSAS-HF各维度评分及总分与MLHFQ总分呈正相关(P<0.05);单因素分析显示:患者出院后6个月生活质量与入院时左室射血分数(LVEF)、入院时MSAS-HF总分、入院时纽约心功能分级(NYHA)、病程有关(P<0.05);Logistic多元回归分析提示:入院时LVEF≤40%、入院时NYHAⅣ级、病程>5年是患者出院后6个月生活质量的危险因素(P<0.05),而入院时MSAS-HF总分<40分是患者出院后6个月生活质量的保护因素(P<0.05)。结论:心力衰竭患者出院后3、6个月的症状群程度均减轻,生活质量有所改善,患者入院时症状群对生活质量有影响。

Objective:To explore the changes of symptom cluster in patients with heart failure,and to analyze its influence on the quality of life.Methods:122 patients with heart failure who were admitted to our hospital from October 2018 to October 2020 were prospectively selected.Memorial Heart Failure Symptom Assessment Scale(MSAS-HF)and Minnesota Heart Failure Quality of Life Scale(MLHFQ)were scored of patients at admission,3 months and 6 months after discharge,respectively.The correlation between MSAS-HF score and MLHFQ score,as well as the influencing factors of patients’quality of life 6 months after discharge were analyzed.Results:The scores of fatigue,discomfort,mood,congestion,ischemia and dyspnea of patients with heart failure at 3 and 6 months after discharge were lower than those at admission,and the scores of mood symptom cluster at 6 months after discharge were lower than those at 3 months after discharge(P<0.05).The scores and total scores of emotional field,physical field and other fields of patients with heart failure at 3 months and 6 months after discharge were lower than those at admission,and the scores and total scores of emotional field at6 months after discharge were lower than those at 3 months after discharge(P<0.05).At 6 months after discharge,the scores and total scores of MSAS-HF all dimensions were positively correlated with the total scores of MLHFQ(P<0.05).Univariate analysis showed that the quality of life at 6 months after discharge was related to the left ventricular ejection fraction(LVEF)at admission,the total score of MSAS-HF at admission,the New York heart Association(NYHA)at admission and the course of disease(P<0.05).Logistic multiple regression analysis suggested:LVEF≤40%at admission,NYHAⅣat admission,and disease course>5 years were risk factors for 6 months after discharge of patient of life quality(P<0.05),while MSAS-HF total score<40 scores at admission was protective factor for6 months after discharge of patient of life quality(P<0.05).Conclusion:The symptoms of patients with heart failure are reduced at 3 and6 months after discharge,and the quality of life is improved.The symptoms of patients at admission have an impact on the quality of life.