慢性心力衰竭患者衰弱变化轨迹及其影响因素

Trajectories of frailty in patients with chronic heart failure and their influencing factors

目的探索慢性心力衰竭患者衰弱变化轨迹及其影响因素,为针对性干预提供参考。方法采用方便抽样法选取住院治疗的105例慢性心力衰竭患者,对其入院至出院后6个月期间分为4个时间点进行衰弱评估,了解衰弱变化轨迹,分析影响因素。结果4个时间点患者衰弱评分分别为2(1,3)分、2(0.3)分、1(0,3)分、1(0,3)分;衰弱轨迹分为低水平缓降组(47.6%)、中水平下降组(18.1%)、中水平上升组(34.3%)3个潜类别;多分类logistic回归分析结果显示,年龄、身体质量指数、共病种数、血红蛋白、心功能分级、抑郁和体力活动是患者衰弱轨迹的影响因素(均P<0.05)。结论慢性心力衰竭患者经住院治疗护理,衰弱水平总体呈好转趋势,衰弱轨迹分为3个潜类别,轨迹具有异质性;护理人员可针对不同类别、不同阶段及影响因素制定干预计划,实现精准护理。

Objective To explore the trajectories of frailty and their influencing factors among patients with chronic heart failure(CHF),and to provide a reference for targeted intervention.Methods A total of 105 CHF patients were selected by convenience sampling method,and their frailty was assessed at four time points from admission to 6 months after discharge.The trajectory of frailty and influencing factors were determined.Results The median(P 25-P 75)of frailty score was 2(1,3),2(0,3),1(0,3),and 1(0,3)at four time points,respectively.Three distinct frailty trajectories were identified:low-level slow decline group(47.6%),medium-level decline group(18.1%),and medium-level rise group(34.3%).Multivariate logistic regression analysis revealed that age,body mass index,the number of co-morbidities,hemoglobin value,cardiac function grading,depression,and physical activity were the influencing factors for the frailty trajectories(all P<0.05).Conclusion CHF patients,after inpatient treatment and nur-sing care,show an overall trend of improvement in frailty.There are three frailty trajectories,with significant heterogeneity in the trajectory.Frailty trajectories may offer a way to target individuals in different subgroups,at different periods and with different influencing factors for precise interventions.