Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

Additive Benefits of Twice Forest Bathing Trips in Elderly Patients with Chronic Heart Failure

Chronic heart failure （CHF）, a clinical syndrome resulting from the consequences of various cardiovascular diseases （CVDs）, is increasingly becoming a global cause of morbidity and mortality. We had earlier demonstrated that a 4-day forest bathing trip can provide an adjunctive therapeutic influence on patients with CHF. To further investigate the duration of the impact and the optimal frequency of forest bathing trips in patients with CHF, we recruited those subjects who had experienced the first forest bathing trip again after 4 weeks and randomly categorized them into two groups, namely, the urban control group （city） and the forest bathing group （forest）. After a second 4-day forest bathing trip, we observed a steady decline in the brain natriuretic peptide levels, a biomarker of heart failure, and an attenuated inflammatory response as well as oxidative stress. Thus, this exploratory study demonstrated the additive benefits of twice forest bathing trips in elderly patients with CHF, which could further pave the way for analyzing the effects of such interventions in CVDs.

Effect of adjuvant levosimendan therapy on neuroendocrine hormones and cytokines in elderly patients with chronic heart failure

Objective: To discuss the effect of adjuvant levosimendan therapy on neuroendocrine hormones and cytokines in elderly patients with chronic heart failure. Methods: A total of 100 elderly patients with chronic heart failure who were treated in the hospital between March 2014 and March 2017 were divided into control group and levosimendan group by random number table, each with 50 cases. Control group received clinical routine therapy for chronic heart failure, and levosimendan group received routine therapy combined with adjuvant levosimendan therapy. The differences in serum levels of RAAS indexes, thyroid hormones, myocardial damage indexes and endothelial function indexes were compared between the two groups before and after treatment. Results: At T0, there was no statistically significant difference in serum levels of RAAS indexes, thyroid hormones, myocardial damage indexes and endothelial function indexes between the two groups. At T1, serum RAAS indexes PRA, AngⅡ and ALD levels of levosimendan group were lower than those of control group;serum thyroid hormones TT3, TT4, FT3 and FT4 levels of levosimendan group were higher than those of control group;serum myocardial damage indexes cTnⅠ, H-FABP and NT-proBNP levels of levosimendan group were lower than those of control group;serum endothelial function index NO level of levosimendan group was higher than that of control group while ET-1 level was lower than that of control group. Conclusion: Adjuvant levosimendan therapy for elderly patients with chronic heart failure can effectively adjust the secretion of neuroendocrine hormones and reduce the myocardial and vascular endothelial damage.

A new clinical entity: multi-etiological heart failure in the elderly and its therapeutic implication

Heart failure (HF) is a major health problem for the geriatric population. In the United States, most of the 5 millions patients with HF are elderly.1 Seventy-five percent of HF hospitalizations occurred in patients older than 65 years and 50% in patients 75 years and older.1 In the Framingham population, the prevalence of HF increased eightfold among men from the fifth decade of life to the seventh decade.2 However, despite of considerable improvement in the treatment, the mortality of HF patients remained relatively constant between 1948 and 1997.

Cardiac resynchronization therapy in the elderly heart failure patient

Ms. BP is an 83 year old white female with a long history of congestive heart failure (HF). She is now symptomatic with minimal exertion, has a left ventricular ejection fraction (LVEF) of 20%. Her CHF is due to hypertension (HTN) plus coronary artery disease (CAD) and she is on angiotensin converting enzyme inhibitor (ACEI), furosemide, digoxin,spironolactone, low dose beta blocker and nitrates. Her beta-natriuretic peptide (BNP) in clinic is 3030 pg/ml, heart rate (HR) 100, blood pressure (BP) 89/43.

Multifactor heart failure in the elderly:a proposal for cooperative research

Chronic heart failure (CHF) is a clinical syndrome as a common pathway at the end stage of cardiac diseases of different etiologies, and it is currently the only cardiovascular disease with an increasing prevalence in the developed countries. In the United States, the prevalence of CHF at age 50 years is 1.0%, whereas it reaches 7.5% at age 80years. In the United Kingdom, the prevalence of CHF is5.0% at age 60-70 years, and 10-20% at age 80 years. The situation is similar in Italy and Portugal. Despite being a developing country in Asia, China has experienced rapid progress in acquiring medical knowledge and advancing techniques in recent years. Due to the markedly declined mortality of acute myocardial infarction (AMI) as well as the aging of Chinese population, about four million Chinese have CHF with a prevalence of 0.9%, most of whom are 60 years of age and older.……

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

中药复方联合运动康复对CHF大鼠心肌重构机制的定量试验研究

目的探讨中医药结合康复运动治疗慢性心衰(CHF)的可行性。方法建立CHF动物模型,施加不同治疗方案,6周后提取动物模型心肌,利用实时荧光定量PCR及蛋白印迹法分析标本。结果基质金属蛋白酶-1(MMP-1)在中药组、西药组、中药加运动组、运动组、对照组、模型组蛋白印迹法测量值分别为(90.387±6.606)、(83.197±4.919)、(56.01±2.097)、(147.205±5.923)、(51.938±6.919)、(180.232±3.047);中药组与西药组比较,差异有统计学意义(P<0.05),中药加运动组与西药组比较,差异有统计学意义(P<0.01)。结论心肌重构是CHF基本病理因素,中药治疗CHF心肌重构有效;通过实验提出CHF治疗中给予足量供氧,适量补充血容量、降低血液粘稠度及降脂治疗可能更加有效。

附子及其药对治疗慢性心力衰竭研究进展

慢性心力衰竭(CHF)是多种心血管疾病的终末阶段。中医认为CHF多属本虚标实,病机关键是心肾阳虚。心气虚日久累及心阳,心阳虚贯穿整个病理过程;辨证可分为阳虚血瘀证、阳虚水泛证、心肾阳虚证、阳气虚脱证;治则重在益气温阳。附子为温阳要药,药性刚燥,走而不守,上助心阳以通脉,故在使用温阳法治疗CHF时,多取附子,回阳救逆,常配伍人参、黄芪、干姜、桂枝、甘草等增强补阳功效。本文查阅近年相关文献,重点综述附子及其常用药对治疗CHF的临床应用及机制研究进展,并分析现代医家治疗CHF的临证经验,以期为中医临床治疗CHF提供指导和帮助。

温阳化饮方治疗阳虚水泛型老年慢性心力衰竭的临床疗效观察

目的观察温阳化饮方(熟附子、桂枝、党参、白术、茯苓、葶苈子等)联合西药常规治疗,对阳虚水泛型老年慢性心力衰竭(Chronic heart failure,CHF)患者的临床疗效。方法选取2021年12月~2022年12月在汕头市澄海区人民医院接受治疗的120例阳虚水泛型老年CHF患者作为研究对象,随机分为对照组和观察组,每组60例。对照组给予西医常规治疗,观察组在对照组的治疗基础上增加温阳化饮方口服治疗,疗程为4周。观察2组患者治疗前后的指标:(1)中医证候评分;(2)血清N末端B型利钠肽原(NT-proBNP)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平;(3)左室射血分数(LVEF)、左室舒张末期内径(LVEDD);(4)6 min步行距离。比较2组患者的临床疗效及安全性。结果治疗后,(1)2组患者的中医证候评分均较治疗前明显降低(P<0.05),且观察组明显低于对照组(P<0.05)。(2)2组患者的血清hs-CRP、TNF-α、IL-6、NT-proBNP水平均较治疗前明显降低(P<0.05),且观察组明显低于对照组(P<0.05)。(3)2组患者的LVEF水平均较治疗前明显升高(P<0.05),LVEDD水平均较治疗前明显降低(P<0.05),且观察组的LVEF水平明显高于对照组(P<0.05),LVEDD水平明显低于对照组(P<0.05)。(4)2组患者的6 min步行距离均较治疗前明显增加(P<0.05),且观察组的增加幅度明显大于对照组(P<0.05)。(5)观察组的总有效率(96.67%)明显高于对照组(86.67%)(P<0.05);观察组的不良反应总发生率(1.67%)明显低于对照组(11.67%)(P<0.05)。结论温阳化饮方联合西药常规治疗能够有效降低阳虚水泛型老年CHF患者的中医证候评分,改善临床症状及心功能,减轻机体炎症反应,临床疗效优于单纯西药治疗,且安全性较好。

NT-proBNP在CHF患者中的诊断价值

目的:探究血浆氨基末端B型尿钠肽前体(NT-proBNP))在慢性充血性心力衰竭(CHF)患者中的诊断价值。方法:采用单克隆非均相免疫法在德灵自动化仪器上检测79例CHF患者和42例正常对照组血浆中NT-proBNP水平,并进行统计学分析。结果:CHF患者血浆NT-proBNP水平明显高于正常对照组(P<0.01),差异有统计学意义,且心衰组血浆NT-proBNP水平与病情严重程度呈正相关(P<0.01)。结论:血浆NT-proBNP水平可以作为CHF患者的实验室诊断指标,用于临床诊断、治疗及评估严重程度的辅助方法。

CHF患者血清TNF-α、可溶性Fas和sFasL联检的临床意义

目的:探讨慢性心力衰竭(CHF)患者治疗前后血清TNF-α、sFas和sFasL水平的变化及意义。方法:应用放免法对36例CHF患者进行了治疗前后血清TNF-α、sFas和sFasL的检测,并与35例正常健康人作比较。结果:在CHF治疗前,患者血清TNF-α、sFas和sFasL水平非常显著地高于正常人组(P<0.01),治疗后2周,则与正常人组比较无显著性差异(P>0.05)。结论:检测CHF患者血清TNF-α、sFas和sFasL水平的变化对了解病情、观察预后均有重要的临床价值。

美托洛尔对CHF患者血浆BNP和TNF-α的影响

目的:探讨慢性心力衰竭(CHF)患者口服美托洛尔后血浆脑钠肽(BNP)和肿瘤坏死因子-α(TNF-α)变化的临床意义。方法:观察32例CHF患者(以下简称CHF组)给予美托洛尔治疗12周前后血浆BNP和TNF-α浓度的变化,并与30例体检健康者(以下简称对照组)作比较。血浆BNP、TNF-α采用生物活性法测定。结果:CHF组基础血浆BNP和TNF-α浓度非常显著地高于对照组(P<0.01),服药12周后,CHF组血浆BNP和TNF-d浓度显著降低(P<0.05)。结论:CHF患者服用美托洛尔后血浆BNP和TNF-α浓度降低。

浅谈《伤寒》利水法在慢性心力衰竭治疗中的应用

水肿是慢性心力衰竭(CHF)常见的临床症状,利尿在现代医学治疗CHF过程中占据重要地位,然而利尿剂的长期使用会导致机体电解质的紊乱,甚至产生利尿剂抵抗,而CHF患者也时常出现反复水肿的情况,针对这一情况,在传统医学对水肿认识的基础上,着重以对《伤寒》条文及古今部分医家临床经验及研究进行浅述,从《伤寒》原文的层面探讨经方治疗CHF患者水肿症状的可行性,从而更加有效治疗不同病机的CHF患者,达到消除水肿症状、减少水肿复发的目的。通过研究,得到以下结论:对于以“咳喘”为主症的(寒饮伏肺型)CHF患者可辨证使用小青龙汤加减;因“脾阳不足,土不制水”可运用苓桂术甘汤加减治疗;因“肾阳不足,阳虚水泛”可运用真武汤加减治疗;因“三焦气机水道不利”可选用五苓散加减治疗;因“水热互结下焦出现小便不利或利尿剂抵抗”可选用猪苓汤加减治疗。

益气养阴方治疗气阴两虚型慢性心力衰竭临床观察

目的:观察益气养阴方治疗气阴两虚型慢性心力衰竭(chronic heart failure,CHF)的临床疗效。方法:选取2022年8月至2023年8月郑州市第九人民医院诊治的CHF患者80例,按照随机数字表法分为对照组和治疗组,每组40例。对照组给予常规抗心力衰竭治疗,治疗组在对照组治疗的基础上给予益气养阴方治疗。观察两组患者临床症状(下肢水肿、呼吸困难、全身乏力)消退时间、心率(heart rate,HR)、6min行走试验(6-minute walking test,6MWT)、明尼苏达州心功能不全生存质量量表(Minnesota living with heart failure questionnaire,MLHFQ)评分、左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左室收缩末期内径(left ventricular end systolic diameter,LVESD)及左室射血分数(left ventricular ejection fraction,LVEF)变化情况。结果:治疗组有效率为92.5%,对照组有效率为75.0%,治疗组有效率高于对照组,差异具有统计学意义(P<0.05);治疗组呼吸困难、乏力、下肢水肿等临床症状消退时间短于对照组,差异具有统计学意义(P<0.05);治疗组治疗后6MWT长于对照组,MLHFQ评分、心率低于对照组,差异具有统计学意义(P<0.05);治疗组治疗后LVEDD、LVESD低于对照组,LVEF高于对照组,差异具有统计学意义(P<0.05)。结论:益气养阴方能改善气阴两虚型慢性心力衰竭患者心功能,提高左心室舒张能力、生活质量。

温阳法治疗慢性心力衰竭研究进展

慢性心力衰竭病机以心气心阳衰之脏腑虚损为本,以感受六淫邪气久病成瘀血、痰湿、瘀毒等病理产物为实。综合各家经验,慢性心力衰竭辨证多以复合证为主,阳虚类证型最为常见。临床多采用温阳养心、温阳利水、温阳益气、温阳活血(通络)、益气温阳活血利水的内治法和艾灸、穴位贴敷、奄包热熨等外治法进行治疗,疗效确切。目前,温阳法治疗本病的研究局限于名老中医经验及临床个案报道,样本量有限,中心单一,缺乏治疗后临床随访以考量长期疗效,且各个医家对运用温阳法的组方用药不尽相同,方剂内含药物的作用机制未能完全明确。温阳法与其他治法组成的复合治法在治疗本病时也未有系统归纳和统一,故今后应展开多中心、大样本的中医药临床、动物及药理实验研究,注重追踪随访,对温阳类治法进行系统归纳,制定统一标准,并挖掘温阳类药物的作用机制,从而有力发挥温阳法治疗本病的优势。

Metabolic remodeling in chronic heart failure

Although the management of chronic heart failure (CHF) has made enormous progress over the past decades, CHF is still a tremendous medical and societal burden. Metabolic remodeling might play a crucial role in the pathophysiology of CHF. The characteristics and mechanisms of metabolic remodeling remained unclear, and the main hypothesis might include the changes in the availability of metabolic substrate and the decline of metabolic capability. In the early phases of the disease, metabolism shifts toward carbohydrate utilization from fatty acids (FAs) oxidation. Along with the progress of the disease, the increasing level of the hyperadrenergic state and insulin resistance cause the changes that shift back to a greater FA uptake and oxidation. In addition, a growing body of experimental and clinical evidence suggests that the improvement in the metabolic capability is likely to be more significant than the selection of the substrate.

Effects of Polysaccharides Extracted from Zhu Zi Shen(Rhizoma Panacis Majoris) on Oxidative Stress and Hemodynamics in Rats with Adriamycin-induced Chronic Heart Failure

Objective:To probe into the intervening action of polysaccharides of Zhu Zi Shen(Rhizoma Panacis Majoris)(PZZS) on oxidative stress and hemodynamics in rats with adriamycin-induced chronic congestive heart failure(CHF).Methods:After SD rats were successfully modeled with adriamycin,they were randomly divided into a normal control group,a model group,a PZZS group,and a captopril group,and were administrated respectively.At the end of experiment,the hemodynamic function,whole heart weight index,and the blood CK,SOD,MDA,NO,NOS were detected;and the myocardial morphological examinations were carried out.Results:Compared with the normal control group,the arterial systolic pressure(SBP),diastolic pressure(DBP),mean arterial pressure(MAP),heart rate(HR),left ventricular systolic peak(LVSP),and left ventricular pressure change rate(dp/dtmax) significantly decreased,and left ventricular end diastolic pressure(LVEDP),whole heart weight index,the blood CK,MDA,NO,NOS significantly increased in the model group.PZZS significantly improved the hemodynamic function,lowered the MDA and NO levels,and decreased the CK and NOS activities in the CHF rats.Conclusion:PZZS can improve the hemodynamic function,and alleviate the oxidative stress reaction in the CHF rat.

CHF患者治疗前后血浆BNP和血清SOD、IL-2检测的临床意义

目的:探讨了慢性心力衰竭(CHF)患者治疗前后血浆BNP和血清SOD、IL-2水平的变化及临床意义。方法:应用放射免疫分析对32例CHF患者进行了治疗前后血浆BNP和血清SOD、IL-2测定,并与35名正常健康人作比较。结果:CHF患者在治疗前血浆BNP水平非常显著地高于正常人组(P<0.01),而血清SOD、IL-2水平又非常显著地低于正常人组(P<0.01),经综合治疗2周后则与正常人组比较无显著性差异(P>0.05)。血浆BNP水平与SOD、IL-2水平呈显著负相关(r=-0.5788、-0.6136,P<0.01)。结论:血浆BNP和血清SOD、IL-2水平的变化参与了CHF患者的发生与发展。

复方丹参滴丸联合左西孟旦对老年CHF患者炎症因子及血管活性物质水平的影响

目的:分析复方丹参滴丸联合左西孟旦对老年慢性心力衰竭(CHF)患者炎症因子及血管活性物质水平的影响。方法:选取118例老年CHF患者,按照随机数字表法分为观察组和对照组,每组各59例。对照组采用左西孟坦治疗,观察组在对照组的基础上增加复方丹参滴丸治疗,比较两组疗效及心功能、炎症因子、血管活性物质水平和不良反应。结果:治疗后,观察组总有效率高于对照组,两组比较差异有统计学意义(P<0.05);两组左心室收缩末期内径、左心室舒张末期内径、血清C反应蛋白、肿瘤坏死因子-α、白介素-6、内皮素-1以及血管紧张素-Ⅱ水平均低于治疗前,且观察组低于对照组(P<0.05);两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论:复方丹参滴丸联合左西孟旦治疗老年CHF患者,可提高临床疗效,改善患者心功能水平,抑制血管活性物质生成,降低机体炎性损伤,且安全性高。