心理护理干预对老年慢性心力衰竭病人情绪及心功能影响的研究

[目的]探讨心理护理干预对老年慢性心力衰竭病人焦虑、抑郁情绪及心功能的影响。[方法]选择确诊的老年慢性心力衰竭病人98例,随机分为干预组（48例）和对照组（50例）,对干预组实施心理护理和行为指导,两组病人均在住院后及出院前填写焦虑（SAS）、抑郁（sDs）自评量表并进行6min步行运动试验。[结果]干预后病人焦虑、抑郁评分干预组显著低于对照组（P〈0．01）,6min步行距离明显长于对照组（P〈0．01）。[结论]心理护理干预可有效控制慢性心力衰竭病人焦虑、抑郁情绪,促进心功能改善。     

院外护理干预对慢性心力衰竭病人心功能改善水平的影响

[目的]探讨院外护理干预对慢性心力衰竭病人心功能改善水平的影响.[方法]240例慢性心力衰竭病人随机分为两组,待病情稳定出院后,干预组在常规药物治疗的基础上增加护理干预,对照组给予药物治疗,6个月后观察两组病人心功能改善情况.[结果]两组心功能改善水平及6 min步行试验比较差异有统计学意义(P<0.01).[结论]院外护理干预有助于改善慢性心力衰竭病人心功能水平.     

认知行为干预对心力衰竭病人自我护理行为及生活质量的影响

[目的]观察认知行为干预对心力衰竭病人负性情绪、自我护理行为及生活质量的影响。[方法]将140例心力衰竭病人按随机数字表法分为观察组和对照组,每组70例。对照组予以常规护理,观察组予以常规护理+认知行为干预,测定两组病人干预前后6 min步行距离,以评价其心功能,采用焦虑自评量表(SAS)评估两组病人干预前后的焦虑程度,采用抑郁自评量表(SDS)对病人负性情绪予以评估,采用明尼苏达心力衰竭生活质量量表(MLWHFQ)对病人的生活质量予以评价,采用欧洲心力衰竭自我护理行为量表(EHFScBS)评价病人的自护能力。[结果]干预后观察组心功能优于对照组(P0.05);观察组6 min步行距离长于对照组,SAS、SDS评分以及MLWHFQ、EHFScBS评分低于对照组(P0.05)。[结论]对心力衰竭病人实施认知行为干预,可改善其心功能,缓解其焦虑、抑郁等负性情绪,提高其自护能力与生活质量。     

以家庭为中心的优质护理对慢性心力衰竭伴抑郁障碍患者临床疗效及生活质量的影响

目的 探讨以家庭为中心的优质护理对慢性心力衰竭伴抑郁障碍患者心功能、焦虑抑郁症状及生活质量的影响。方法 将150例慢性心力衰竭伴抑郁障碍患者按随机数字表法分为对照组和研究组,各75例。对照组给予常规护理,研究组在对照组基础上给予以家庭为中心的优质护理,观察6个月。比较干预前后两组6 min步行距离及汉密顿焦虑量表、汉密顿抑郁量表、明尼苏达心力衰竭生活质量问卷评分。结果 干预后两组6 min步行距离显著长于干预前(P<0.01),观察组显著长于对照组(P<0.01)。干预后两组汉密顿焦虑量表、汉密顿抑郁量表、明尼苏达心力衰竭生活质量问卷评分均较干预前显著降低(P<0.01),观察组显著低于对照组(P<0.01)。结论 以家庭为中心的优质护理能够显著改善慢性心力衰竭伴抑郁障碍患者的心功能,缓解焦虑抑郁症状,提高其生活质量。     

运动康复护理应用于慢性心力衰竭病人的效果评价

[目的]探讨运动康复护理应用于慢性心力衰竭病人的效果。[方法]根据随机数字表法将2016年2月—2017年12月收治的102例慢性心力衰竭病人分为观察组和对照组各51例,对照组给予常规护理干预,观察组在常规护理干预基础上给予运动康复护理干预。比较两组病人干预前后心率(HR)、左室射血分数(LVEF)、6 min步行距离水平,干预前后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和健康调查简表(SF-36)对病人的心理状况、生活质量进行评估。[结果]观察组干预后HR低于对照组,LVEF、6 min步行距离高于对照组(均P0.05)。观察组干预后SAS、SDS评分低于对照组(均P0.05)。观察组干预后各项生活质量评分均明显高于对照组(均P0.05)。[结论]运动康复护理能有效改善慢性心力衰竭病人的心功能与运动耐力,同时消除心理不良情绪,提高其生活质量。     

基于微信的延续性护理在老年慢性心力衰竭患者中的应用

目的:探讨基于微信的延续性护理在老年慢性心力衰竭患者中的应用效果。方法:将2019年7月1日～2020年7月31日收治的88例老年慢性心力衰竭患者随机分为常规组和实验组各44例。常规组采用基础护理措施,实验组在常规组基础上采用基于微信的延续性护理。比较两组干预前后心力衰竭自我护理行为评价量表(EHFSCB-9)、汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、6 min步行距离、生活质量调查量表(DSQL)评分及患者再住院发生情况。结果:干预后实验组EHFSCB-9评分低于常规组(P0.01),且两组组内干预后EHFSCB-9评分低于干预前(P0.05);干预后实验组HAMA、HAMD评分均低于常规组(P0.01),且两组组内干预后HAMA、HAMD评分均低于干预前(P0.05);干预后实验组6 min步行距离长度高于常规组(P0.01),且两组组内干预后6 min步行距离长度长于干预前(P0.05);干预后实验组DSQL各项评分均高于常规组(P0.01),且两组组内干预后DSQL各项评分均高于干预前(P0.05);实验组再住院率低于常规组(P0.05)。结论:对老年慢性心力衰竭患者开展微信延续性护理,可提升其自我管理能力,改善焦虑、抑郁等负性情绪,提高心功能及生活质量,降低患者再住院率。     

综合护理干预对慢性心力衰竭患者生活质量、负性情绪及心功能的影响

目的探讨综合护理干预对慢性心力衰竭(CHF)患者生活质量、负性情绪及心功能影响。方法 112例CHF患者随机分为观察组和对照组,各56例。对照组实施常规护理,观察组在对照组基础上采用综合护理干预。运用明尼苏达心力衰竭生活质量调查表(Li HFe)评估患者生活质量改善情况,焦虑自评量表(SAS)和抑郁自评量表(SDS)评价患者心理状态,以6 min步行距离(6 MWD)评估患者心功能。结果干预后,2组Li HFe量表总评分,SAS和SDS评分较干预前显著降低(P0.05或P0.01),且观察组干预后评分显著低于对照组(P0.05或P0.01)。干预后,2组6MWD均较干预前显著增加(P0.01),且干预组6MWD增加幅度高于对照组(P0.01)。结论综合护理干预能够有效缓解CHF患者的负性情绪,提高生活质量,促进心功能康复。     

焦点解决短程治疗在老年慢性心力衰竭病人中的应用

[目的]探讨焦点解决短程治疗(SFBT)在老年慢性心力衰竭(CHF)病人中的应用效果。[方法]选取2017年1月—2018年12月我科收治的108例老年CHF病人作为研究对象。采用随机数字表法将病人随机分为SFBT组和对照组,每组54例。对照组给予常规健康教育及心理护理,SFBT组在对照组基础上实施SFBT。比较两组病人抑郁、幸福度、自我感受负担、心功能、护理满意度。[结果]干预4周后,两组汉密尔顿抑郁量表(HAMD)评分、抑郁自评量表(SDS)评分、自我感受负担量表(SPBS)评分均较干预前降低(P0.05),纽芬兰纪念大学幸福度量表(MUNSH)评分较干预前显著增高(P0.05);且SFBT组与对照组比较,HAMD评分、SDS评分、SPBS评分更低(P0.05),MUNSH评分更高(P0.05)。干预4周后,两组病人6 min步行距离延长(P0.05);且SFBT组与对照组比较步行距离更长(P0.05)。干预4周后,对照组的满意度为(93.91±0.34)%,SFBT组为(95.94±0.45)%,两组比较差异有统计学意义(P0.01)。[结论]在常规健康教育及心理护理基础上实施SFBT可显著改善CHF病人抑郁状态及自我感受负担,增加6 min步行距离,提高病人幸福指数及满意度。     

心理干预在老年慢性疾病病人中的应用探讨

[目的]观察心理干预在老年慢性疾病病人治疗中的作用.[方法]160例老年慢性疾病的病人随机分为两组,观察组82例,对照组78例,在常规治疗基础上,观察组进行心理护理干预,对照组采用传统护理方法.观察两组病人治疗后抑郁程度及医患依从性情况.[结果]观察组较对照组病人的抑郁情绪明显改善,医患配合良好率明显提高.[结论]心理干预有利于老年慢性疾病病人的康复.     

运动干预对慢性心力衰竭病人运动耐量、心功能和生活质量的影响

[目的]探讨运动干预对慢性心力衰竭病人运动耐量、心功能和生活质量的影响。[方法]将60例心功能Ⅱ级~Ⅲ级的慢性心力衰竭病人按照所属2个不同病房分为干预组和对照组各30例,在入院24h内行6min步行距离、左室射血分数(LEVF)测定及明尼苏达心力衰竭病人生活质量量表(MHL)评分,然后两组均行常规抗心力衰竭药物治疗,但干预组每天行2次6min步行运动训练,4周后重复测量上述指标。[结果]两组病人干预前的6min步行距离、LEVF及MHL评分差异无统计学意义(P0.05)。干预组心功能Ⅱ级病人干预后6min步行距离、LEVF、MHL评分均显著高于对照组(P0.05);干预组心功能Ⅲ级病人干预后6min步行距离、MHL评分均显著高于对照组(P0.05),但两组LVEF比较差异无统计学意义(P0.05)。[结论]运动干预能有效改善慢性心力衰竭病人运动耐量、心功能和生活质量。     

心源性心力衰竭患者自我效能水平及其影响因素的调查

目的探讨心源性心力衰竭患者自我效能水平及其影响因素,为制订护理干预措施提供科学依据,从而提高患者的生活质量和整体护理质量。方法采用慢性心力衰竭自我效能量表、特定活动量表和社会支持量表,通过方便抽样法,对100例再人院心源性心力衰竭患者进行问卷调查。以自我效能总分及各因子得分为应变量,以一般资料、特定活动量表和社会支持量表的各项目为自变量进行多元线性逐步回归分析。结果心力衰竭患者自我效能平均得分（25．50±7．53）分,个人年收入、社会支持系统、病程及就医付费方式四个主要因素与心力衰竭患者的自我效能水平有关（t分别为3．061,4．359,6．175,2．072;P〈0．05）。其影响因素主要为住院次数、急性心力衰竭发作频率、支持系统。结论慢性心力衰竭患者的自我效能有待提高,护理人员应注重病程较长及社会支持系统不完善患者的自我效能的提高。     

左西孟旦对老年冠心病性心力衰竭患者心功能的影响

目的 探讨左西孟旦对老年冠心病性心力衰竭患者心功能的影响.方法 将90例老年冠心病性心力衰竭患者采用随机数字表法分为两组,各45例,均接受常规药物治疗,观察组在此基础上联合左西孟旦治疗.于治疗前和治疗后7d采用免疫荧光干式定量法测定患者血浆N末端脑利钠肽前体水平.采用彩色多普勒心动超声检测患者左室收缩末期容积、左室舒张末期容积和左室射血分数,比较两组患者的有效率.结果 治疗后两组血浆N末端脑利钠肽前体水平均较治疗前显著降低(P＜0.01),观察组较对照组下降更显著(P＜0.01).治疗后两组左室收缩末期容积、左室舒张末期容积均较治疗前显著降低(P＜0.01),观察组显著低于对照组(P＜0.01),两组左室射血分数均较治疗前显著升高(P＜0.01),观察组显著高于对照组(P＜0.01).观察组总有效率为97.8％,对照组为82.2％,观察组显著高于对照组(x2=6.05,P＜0.05).结论 左西孟旦能有效控制冠心病性心力衰竭患者血浆N末端脑利钠肽前体水平,改善老年冠心病性心力衰竭患者心功能,值得临床推广应用.     

Dependence of heart rate variability on heart period in disease and aging

The aim of this study was to compare the dependence of heart rate variability (HRV) on heart period (RR interval length) under different physiological and pathological states in order to detect changes in HR modulation. The dependence of HRV on the RR interval length in healthy elderly subjects, congestive heart failure (CHF) patients and one patient with a transplanted heart (T) was compared with healthy young subjects. Spectral powers, sample entropy (SampEn) and short-term fractal scaling exponent (alpha1) were determined from 24 h free-running recordings. For the same HR, HRV measures were different in different groups. In healthy subjects HRV measures depended on RR interval length and all spectral powers were highly correlated, although reduced in elderly subjects. SampEn at high HR was the most sensitive quantity to changes induced by aging. In disease, CHF and T, an achievable HR range was decreased, all spectral powers were reduced, but correlated, and the dependence of HRV measures on RR was lost. There was an evident difference in the dependence of nonlinear on linear measures between young subjects and all the other studied groups. In disease the reduction in autonomic control was associated with the decrease in short-range correlation and regularity in RR series. We have concluded that the analysis of HRV measures as functions of RR interval length can reveal important aspects of HR control that might be lost in averaging.     

Acromegalic heart disease: influence of treatment of the acromegaly on the heart

In a series of 256 patients with acromegaly, 10 had evidence of heart disease for which no explanation apart from the acromegaly could be found. Heart disease presented with effort dyspnoea, cardiac failure, palpitation, ECG changes or cardiomegaly. Initial chest radiographs showed cardiac enlargement in seven patients. Electrocardiograms were abnormal in nine patients with repolarisation disorders or intraventricular conduction defects. Rhythm disturbances were found in six. Echocardiograms were performed on six patients; all were abnormal showing left ventricular hypertrophy or impaired function. In five patients radionuclide ventriculography was also performed. Cardiac catheterisation was undertaken on seven patients; all showed either hypertrophy or dilatation of the left ventricle. Coronary arteries were widely dilated in two patients and in another there was dilation of the proximal segment only. In six of the 10 patients, acromegaly was cured by transsphenoidal surgery. This resulted in limited improvement of cardiac function in two patients only. Of the four patients who were not cured, three died and one was lost to the study. Four patients in total died and autopsies were obtained in two: one showed changes suggesting myocarditis and the other diffuse fibrosis. It is concluded that acromegaly may infrequently lead to heart disease, and that if recognised at an early stage progression may, in a proportion of patients, be arrested by successful treatment.     

经皮冠状动脉介入治疗对冠心病合并心力衰竭患者疗效评价

目的观察经皮冠状动脉介入治疗对冠心病患者左心室收缩和舒张功能的疗效。方法选择72例冠心病合并心力衰竭的患者,行经皮冠状动脉介入治疗,术前、术后1周和术后6个月分别行心脏超声检查左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室短轴缩短率(FS)、左室射血分数(LVEF)、舒张早期血流峰值速度(E)、舒张晚期血流峰值速度(A)以及E峰和A峰比值(E/A),比较术前和术后患者心功能变化情况。结果通过行介入治疗后,支架植入术后冠心病合并心力衰竭患者心功能较前有了明显的好转,术后6个月LVEF、FS、LVESD、LVEDD、E、A和E/A与术前相比均有明显改善(P<0.05和0.01),术后一周LVEF和FS与术前相比有改善(P<0.05)。术后6个月与术后一周相比LVEF、FS、LVESD和LVEDD有明显改善(P<0.05)。结论经皮冠状动脉介入治疗能够明显改善冠心病合并心力衰竭患者的心功能。     

Interventions on the heart and large vessels without prior heart catheterization

Between May 1983 and May 1987, 161 children of all age groups underwent surgery for congenital cardiac malformations without prior cardiac catheterization and angiocardiography. Their diagnoses were established by clinical investigation, electrocardiogram, chest X-ray and cross-sectional echocardiography only in all cases. The most common surgical procedures were ligation of a patent ductus arteriosus (n = 68), correction of aortic coarctation (n = 28), balloon atrial septostomy (n = 27), and closure of an atrial septal defect (n = 23). To prove the efficiency and accuracy of this method all patients with cardiac malformations surgically treated over the same time period, of the same age groups and with the same diagnoses, who had undergone routine preoperative cardiac catheterization and angiocardiography, were reviewed with regard to the attained results, which were compared with those of the non-invasive group. No patient in either group died postoperatively due to an incorrect or incomplete preoperative diagnosis. There were problems in the group diagnosed by echocardiography only in assessing the permeability of the tricuspid valve in cases of pulmonary atresia with a hypoplastic right ventricle and in assessing the operability of patients with a complete aterioventricular canal. A large group of congenital cardiac malformations can, however, be safely operated on the basis of non-invasive preoperative diagnoses only.     

螺内酯对充血性心力衰竭患者心率变异性的影响

目的　探讨醛固酮受体拮抗剂螺内酯对充血性心力衰竭 (congestiveheartfailure,CHF)患者心脏自主神经活动的影响。方法　比较 3 2例CHF患者在螺内酯治疗前、第 4周及 16周时心率变异性 (heartreatvariability ,HRV)各项指标和心功能变化。结果　螺内酯 ( 40mg/d)治疗 4周时 ,左室收缩功能无显著变化 ( P >0 .0 5 ) ,治疗 16周时 ,左室收缩功能明显改善 ( P <0 .0 5 ) ;治疗前、治疗 4周和 16周时 ,代表心率总变异程度的全部正常R R间期标准差 (standarddeviationofallnormalsinusR Rintervalsover 2 4hours,SDNN)分别为 ( 98.5± 3 2 .0 )、( 115 .4± 3 5 .6)和( 118.1± 3 5 .0 )ms,差异有统计学意义 (P <0 .0 5 ) ;代表迷走神经功能的正常相邻R R间期差值的均方根 (rootmeansquareofthesuccessivenormalsinusR Rintervaldifference ,rMSSD)分别为 ( 2 8.3± 14.6)、( 3 5 .3± 13 .3 )和 ( 3 8.1±13 .9)ms ,差异有统计学意义 (P <0 .0 1)。结论　螺内酯可以提高CHF患者心脏迷走神经张力 ,使HRV得到改善     

Long-term effects of cardiac resynchronization therapy on heart rate and heart rate variability

Congestive heart failure is characterized by significant autonomic dysfunction. Development of left bundle branch block in congestive heart failure is a predictor of worse outcome. There are several lines of evidence that cardiac resynchronization therapy (CRT), by biventricular stimulation in patients with severe heart failure and left bundle branch block, improves autonomic functions which can be quantified by measuring heart rate variability. The aim of the present study was to assess the effect of CRT on autonomic functions quantified by heart rate variability and mean heart rate (HR) in patients with advanced heart failure and left bundle branch block in short and long-term follow-up. A total of 35 patients with systolic heart failure and left bundle branch block (mean-age 60 +/- 11 years; 24 male and 11 female; mean left ventricular ejection fraction [EF]: 22.3 +/- 3%) were enrolled. Clinical assessment and echocardiographic examination were performed at baseline and every three months. Continuous electrocardiographic monitorization by 24-hour Holter recordings was performed pre-implantation, 3 months and 2 years after implantation. Mean HR and one of the time-domain parameters of heart rate variability, standard deviation of the R-R intervals (SDNN) were measured. CRT was associated with a decrease in the mean duration of QRS, and an increase in diastolic filling time, the rate with which the left ventricular pressure rises (dP/dt), and left ventricular ejection fraction. Decrease in mean heart rate and increase in SDNN were statistically significant in the third month and second year recordings when compared to baseline recording (p values were < 0.001 for both). In conclusion, CRT with biventricular pacing provides sustained improvement in autonomic function in patients with advanced heart failure and left bundle branch block.     

冠心病患者心率变异性分析

目的 分析冠心病人的心率变异性的变化.方法 利用动态心电图监测40例冠心病人(28例ST段下移者为Ⅰ组,12例无ST段下移者为Ⅱ组)和30例正常人(对照组)的心率变异指数和心率,进行心率变异性变化的分析.结果 和正常人比较,冠心病人(Ⅰ组和Ⅱ组)HRVI降低非常明显(P<0.01,P<0.01).最大心率数变慢(P<0.01,P<0.05),最小心率教、平均心率数变快(P<0.05,P<0.05).冠心病Ⅰ组HKVI明显低于对照组(P<0.05).结论 冠心病HRV明显低于正常人.