老年慢性便秘患者营养和焦虑抑郁状态及认知功能分析

Analysis of nutrition,anxiety and depression status and cognitive function in elderly patients with chronic constipation

目的了解老年慢性便秘患者营养、精神心理、认知及生活质量的情况。方法纳入老年内科住院患者160例,根据罗马Ⅳ诊断标准和患者主诉对慢性便秘进行诊断。慢性便秘的患者为85例,非慢性便秘患者75例。患者入院时采用微型营养评估量表(MNA)进行营养状态评估,采用老年抑郁量表(GDS)和汉密尔顿焦虑量表(HAMA)评估所有患者的抑郁和焦虑情绪,采用简易智能评估量表(MMSE)筛查所有患者认知功能,并采用便秘患者生存质量自评量表(PAC-QOL)评估所有患者的生活质量。对慢性便秘患者进行单因素及多因素logistic回归分析。记录所有便秘患者的便秘相关用药等情况,并出院时再次对其进行PAC-QOL评分。结果老年慢性便秘患者与非便秘的老年患者相比较,MNA评分偏低,但差异无统计学意义;GDS评分[(15.2±4.2)分比(9.8±1.6)分,P<0.01]、HAMA评分[(13.8±4.4)分比(10.1±1.9)分,P<0.01]和PAC-QOL量表评分[(78.6±14.8)分比(50.9±12.5)分,P<0.01]均较高,差异有统计学意义;而MMSE评分较低[(16.6±4.1)分比(23.9±3.5)分],差异有统计学意义(P<0.01)。单因素分析结果显示,存在焦虑情绪(χ^(2)=20.51,P<0.01)、抑郁情绪(χ^(2)=30.15,P<0.01)、认知障碍(χ^(2)=21.80,P<0.001)、平素服用5种以上药物(χ^(2)=32.09,P<0.01)以及合并3种以上慢性疾病(χ^(2)=10.53,P<0.01)均增加了老年慢性便秘发生的风险。logistic回归分析结果显示,焦虑状态(OR=9.507,95%CI:3.048~29.654,P<0.01)、抑郁状态(OR=5.922,95%CI:2.510~13.975,P<0.01)和多重用药(OR=4.765,95%CI:2.037~11.143,P<0.01)均增加了老年慢性便秘发生的风险。结论老年慢性便秘患者易合并有焦虑抑郁情绪障碍,且生活质量下降明显。积极认识并干预可能导致慢性便秘的各种危险因素,综合管理老年便秘患者的身心健康及认知等,可能有利于提高老年慢性便秘患者的生活质量。

Objective To investigate the nutrition,mental psychology,cognition and quality of life in elderly patients with chronic constipation.Methods 160 cases of hospitalized patients in geriatric department were enrolled.85 cases were diagnosed as chronic constipation according to the RomanⅣcriteria.The other 75 cases of patients have no chronic constipation.MNA Scale was used to evaluate the nutritional status of all patients,Geriatric Depression Scale(GDS)and Hamilton Anxiety Scale(HAMA)were used to evaluate the Depression and Anxiety of all patients,and Mini-Mental State Examination(MMSE)was used to screen the cognitive function of all patients.The Patient Assessment of Constipation Quality of Life(PAC-QOL)was used to evaluate the Quality of Life of all patients.The patients with chronic constipation were analyzed by univariate and logistic regression.Results Compared with the elderly patients without chronic constipation,higher GDS score(15.2±4.2 vs.9.8±1.6,P<0.01),higher HAMA score(13.8±4.4 vs.10.1±1.9,P<0.01)and higher PAC-QOL scale score(78.6±14.8 vs.50.9±12.5,P<0.01).And the chronic constipation patients have lower MMSE score(16.6±4.1 vs.23.9±3.5,P<0.01).Univariable analysis showed that anxiety(χ^(2)=20.51,P<0.01),depression(χ^(2)=30.15,P<0.01),cognitive impairment(χ^(2)=21.8,P<0.01),taking more than five kinds of drugs(χ^(2)=32.09,P<0.01)and complicated with more than three kinds of chronic diseases(χ^(2)=10.53,P<0.01)increased the risk of constipation in the elderly.Logistic regression analysis showed that anxiety state(OR=9.507,95%CI:3.048-29.654,P<0.01),depression state(OR=5.922,95%CI:2.510-13.975,P<0.01)and multiple drug use(OR=4.765,95%CI:2.037-11.143,P<0.01)increased the risk of chronic constipation respectively in the elderly.Conclusions Chronic constipation is a common disease in elderly inpatients,and the elderly patients with chronic constipation are easy to have anxiety and depression disorder,and the decreased quality of life significantly.Actively finding and intervening various risk factors that may lead to chronic constipation,and comprehensively managing the physical and mental health and cognition of elderly patients with constipation may be beneficial to improve the quality of life of elderly patients with chronic constipation.