营养配方饮食结合心脏康复治疗对老年慢性心力衰竭患者心功能的影响

Effects of nutritional formula diet combined with cardiac rehabilitation of cardiac function in elderly patients with chronic heart failure

目的分析营养配方饮食干预结合心脏康复治疗对老年慢性心力衰竭(CHF)患者心肺功能的影响。方法选取新疆医科大学第一附属医院心血管病中心综合心脏内科2020年1月—2021年1月收治的120例老年CHF患者为研究对象,随机分为对照组和研究组,每组60例。对照组采用心脏康复治疗配合常规饮食指导,研究组采用心脏康复治疗配合营养配方饮食干预。干预3个月后,测量干预前后的上臂肌围(AMC)、上臂肱三头肌皮褶厚度(TSF)、体质量(BW);抽取外周静脉血检测血清白蛋白(ALB)、前白蛋白(PAB)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、甘油三酯(TG)、总胆固醇(TC)和B型钠尿肽前体(pro-BNP);使用德国Cortex运动心肺功能测试仪检测峰值耗氧量(peakVO_(2))、二氧化碳通气当量斜率(VE/VCO_(2),slope)、无氧阈氧耗量(VO_(2)AT),以迈瑞DC-N3S彩色多普勒超声检测计算左心射血分数(LVEF)。结果与干预前比较,干预3个月后,两组患者的AMC、TSF、BW均提高,差异有统计学意义(P<0.05)。与对照组治疗后比较,研究组治疗后AMC、TSF升高,差异有统计学意义(P<0.05)。与干预前比较,干预3个月后,两组患者的ALB、PAB、HDL均提高,LDL、TC均降低,差异有统计学意义(P<0.05)。与对照组治疗后比较,研究组治疗后ALB、PAB均升高,差异有统计学意义(P<0.05)。与干预前比较,干预3个月后,两组患者的peakVO_(2)、VO_(2)AT均升高,VE/VCO_(2)slope均降低,差异有统计学意义(P<0.05)。与对照组治疗后比较,研究组治疗后peakVO_(2)、VO_(2)AT均升高,VE/VCO_(2)slope降低,差异有统计学意义(P<0.05)。与干预前比较,干预3个月后,两组患者的LVEF均升高,pro-BNP均降低,差异有统计学意义(P<0.05)。与对照组治疗后比较,研究组治疗后LVEF升高,pro-BNP降低,差异有统计学意义(P<0.05)。结论在老年CHF患者中应用营养配方干预结合心脏康复治疗能改善患者的营养状态和心肺功能,具有推广价值。

Objective To analyze the effects of nutritional formula diet intervention combined with cardiac rehabilita⁃tion of cardiopulmonary function in elderly patients with chronic heart failure(CHF).Methods A total of 120 elderly patients with CHF who were admitted to the hospital from January 2020 to January 2021 were selected as the research subjects.The patients were randomly divided into the control group and the study group,60 cases in each group.The control group received cardiac rehabilitation therapy combined with routine dietary guidance.The study group used cardiac rehabilitation therapy combined with nutritional formula diet intervention.After 3 months of intervention,the upper arm muscle circumference(AMC),upper arm triceps skinfold thickness(TSF),and dry body weight(BW)were measured before and after the intervention.Peripheral venous blood was drawn to detect serum albumin(ALB),preal⁃bumin(PAB),high-density lipoprotein(HDL),low-density lipoprotein(LDL),triacylglycerol(TG),total cholesterol(TC)and pro-brainnatriureticpeptide(pro-BNP).The German Cortex exercise cardiopulmonary function tester was used to detect peak oxygen consumption(peak VO_(2)),ventilatory equivalent of carbon dioxide(VE/VCO_(2),slope),oxygen consumption ant anaerobic threshold(VO_(2) AT).The left ventricular ejection fraction(LVEF)was calculated by Mind⁃ray DC-N3S color Doppler ultrasonography.Results Compared with the group before intervention,after 3 months of intervention,the AMC,TSF and BW of the two groups were increased,and the difference was statistically significant(P<0.05).Compared with the control group after treatment,the AMC and TSF of the study group were increased after treatment,and the difference was statistically significant(P<0.05).Compared with the group before intervention,after intervention for 3 months,the ALB,PAB and HDL of the two groups were increased,and the LDL and TC were de⁃creased,and the difference was statistically significant(P<0.05).Compared with the control group after treatment,ALB and PAB in the study group were increased after the treatment,and the difference was statistically significant(P<0.05).Compared with before the intervention in the group,after intervention for 3 months,the peak VO_(2) and VO_(2) AT of the two groups were increased,and the VE/VCO_(2) slope was decreased,and the difference was statistically significant(P<0.05).Compared with the control group after treatment,the peak VO_(2) and VO_(2) AT of the study group increased after the treatment,and VE/VCO_(2) slope decreased with statistical significance(P<0.05).Compared with the intervention be⁃fore in the group,after intervention for 3 months,the LVEF of the two groups were increased,and the pro-BNP were decreased,and the difference was statistically significant(P<0.05).Compared with the control group after the treat⁃ment,LVEF in the study group was increased and the pro-BNP was decreased after the treatment,and the difference was statistically significant(P<0.05).Conclusion The application of nutritional formula intervention combined with cardiac rehabilitation in elderly patients with CHF can improve the nutritional status and cardiopulmonary function of patients,and it has promotional value.