北京地区老年患者衰弱现状及中医证候调查

Investigation on the frailty status,influencing factors and TCM syndromes of senile patients in Beijing

目的调查北京市综合医院中医科就诊的老年人衰弱现状及中医证候。方法采用便利抽样法,选取2021年1-7月北京市7个城区各1家综合医院中医科就诊的年龄≥60岁的老年患者为研究对象,采用一般情况调查表搜集基础资料,对研究对象进行衰弱评估,并进行中医辨证。结果获得有效问卷共1052份。无衰弱者179例(17.0%)、衰弱前期者267例(25.4%)、衰弱者606例(57.6%)。衰弱指数(IM-FI):女性>男性;重体力劳动者低于中体力劳动者、轻体力劳动者、非体力劳动者;自理程度越差即生理失能越高,IM-FI越高;与过敏史、独居史、多重用药、长期疼痛史、慢性病史相关;采取干预措施(西医、中医、中西医结合)者高于无干预者(P<0.05)。慢性疾病前5依次为:高血压508例(48.29%)、血脂异常302例(28.71%)、冠心病290例(27.57%)、糖尿病280例(26.62%)、慢性胃炎196例(18.63%)。症状前5依次为健忘、倦怠乏力、夜尿频数、气短、不寐。无衰弱、衰弱前期、衰弱老年人群的主要证素均为气虚证,占60.30%~70.62%;血瘀证在衰弱前期和衰弱老年人中分别占44.57%、58.42%;痰浊证则是无衰弱老年人常见的第2证素,占44.13%。本研究涉及中医证候213种,前3位依次为气虚痰浊证、气虚血瘀证、阴虚夹热证;无衰弱组52种,气虚痰浊证居首位占20.67%;衰弱前期组93种,气虚血瘀证占10.11%、气虚痰浊证占9.36%,分居前2位;衰弱组188种,兼夹证多且复杂交织,证候占比均小于5%。各证型的IM-FI以阳虚证最高,其次为血虚证、气滞证、血瘀证、湿证。中西医结合干预方法在老年人中接受度较高。结论北京市综合医院中医科就诊的老年人衰弱程度与性别、年龄、职业类型、独居现状、过敏史、多重用药、长期疼痛、自理程度、中医干预情况、老年常见病有相关性;衰弱老年人常合并多系统病症,中医证候复杂多样,兼夹证候越多,衰弱程度越高;血瘀证可能是影响老年衰弱的重要证素;中西医结合是干预老年衰弱的主要手段。

Objective To investigate the current status of frailty and its correlation with TCM syndromes among the elderly who visited the Department of TCM of General Hospitals in Beijing.Methods Convenience sampling method was used to collect the basic data of the elderly who visited the department of traditional Chinese medicine of one of the general hospitals in seven urban areas of Beijing from January 2021 to July 2021,and"FI-IM"was used to evaluate frailty,TCM syndrome differentiation was made.Results 1052 effective questionnaires were obtained.Of them,179(17.0%)were not frail,267(25.4%)were pre-frail,and 606(57.6%)were frail.IM-FI:female>male;heavy manual workers were lower than medium manual workers and light manual workers,and non-manual workers;the worse the degree of self-care,that is,the higher the physical disability,the higher the index IM-FI;it was positively correlated with allergy history,living alone history,multiple medication,long-term pain history,and chronic disease history.The population with IM-FI of western medicine,TCM and integrated TCM and western medicine was higher than that of no intervention(P<0.05).The top 5 chronic diseases were hypertension(508 cases,48.29%),dyslipidemia(302 cases,28.71%),coronary heart disease(290 cases,27.57%),diabetes(280 cases,26.62%),chronic gastritis(196 cases,18.63%).The top 5 symptoms were forgetfulness,fatigue,frequent nocturia,shortness of breath,and insomnia.Qi-deficiency syndrome was the main syndrome element of the elderly cases with non-frailty,pre-frailty and frailty,accounting for 60.30%to 70.62%;blood stasis syndrome accounted for 44.57%and 58.42%respectively in pre-frailty and frailty;phlegm-turbid syndrome was the second common element of the non-frailty,accounting for 44.13%.This study involved 213 TCM syndromes,the top 3 were Qi deficiency and phlegm turbidity syndrome,Qi deficiency and blood stasis syndrome,and Yin deficiency and heat syndrome.There were 52 types of syndromes in the non-frailty group,and the qi deficiency and phlegm turbidity syndrome accounted for 20.67%.Among 93 types in pre-frailty group,10.11%of Qi deficiency and blood stasis syndrome and 9.36%of Qi deficiency and phlegm syndrome were in the top two positions;among 188 types of the frailty group,multiple and complex syndromes were more commonly seen,and no syndrome accounted for more than 5%.In"IM-FI",the percentage of yang deficiency syndrome was the highest,followed by blood deficiency syndrome,qi stagnation syndrome,blood stasis syndrome and damp syndrome.Intervention methods of integrated TCM and western medicine were highly accepted among the elderly.Conclusion The degree of frailty of the elderly in the Department of TCM of Beijing’s general hospitals is significantly correlated with the gender,age,occupation type,living alone status,allergy history,multiple medication,long-term pain,self-care level,TCM intervention,and common diseases of the elderly;the frail elderly more suffer from multiple system diseases,TCM syndromes of the frail elderly are complex and diverse,and the more syndromes are complicated,the higher the degree of frailty;the blood stasis syndrome may be an important factor affecting the frailty of the elderly;the integration of TCM and western medicine is the main mean to intervene frailty in the elderly.