老年慢性心力衰竭病人症状群亚组轨迹变化

Change of symptom cluster trajectory in elderly patients with chronic heart failure

目的:探讨老年心力衰竭病人不同时间点躯体症状群的变化轨迹及最佳干预时间点。方法:2021年9月—12月采用便利抽样法选取河南省某三级甲等心血管病医院的310例老年心力衰竭病人为研究对象,分别在出院当天(T1)、出院后1个月(T2)、3个月(T3)、6个月(T4)、9个月(T5)、12个月(T6)时采用一般资料调查表、中文版Memorial心力衰竭症状评估量表(MSAS-HF)对其调查。使用潜变量增长混合模型(LCGM)识别老年心力衰竭病人躯体症状群在6个时间点的变化轨迹。结果:最终216例病人完成随访。探索性因子分析在6个时间点均提取到休息相关症状群、消化道相关症状群。休息相关症状群拟合得到“先升后降组”“先升后降再稳定组”;消化道相关症状群拟合得到“先升后降组”“先升后降再上升组”“先升后降再稳定组”。结论:老年心力衰竭病人的躯体症状群存在不同变化轨迹特征,可根据其特征选择干预时间点或针对亚组轨迹特征呈上升趋势的病人进行干预。

Objective:To explore the trajectory of somatic symptoms at different time points in elderly patients with heart failure and the selection of the best intervention time point.Methods:From September 2021 to December 2021,a convenient sampling method was used to select 310 elderly patients with heart failure from a tertiary grade A cardiovascular hospital in Henan province as the study subjects.They were investigated using the general information questionnaire and the Heart Failure Symptom Assessment Scale(HF-MSAS)on the day of discharge(T1)and at 1,3,6,9,12 months after discharge(T2-T6),respectively.Latent variable growth mixed model(LCGM)was used to identify the change trajectory of the physical symptom group in elderly patients with heart failure at six time points.Results:216 patients conducted the follow-up.Exploratory factor analysis both extracted rest-related symptom groups and digestive tract-related symptom groups at 6 time points.The rest related symptom group was fitted by LCGM to obtain"first ascending then descending group"and"first ascending then descending stable group".The relevant symptoms of the digestive tract were fitted to obtain"first rising then falling group""first rising then falling rising group""first rising then falling stable group".Conclusion:The physical symptoms of elderly patients with heart failure have different trajectory characteristics,and intervention time points can be selected based on the trajectory characteristics or targeted at patients with an upward trend in subgroup trajectory characteristics.