慢性心力衰竭患者症状负担现状调查及影响因素分析

目的 对慢性心力衰竭患者症状负担进行现状调查并分析其影响因素。方法 采用便利抽样法选取2022年1月至2023年1月徐州矿务集团总医院心内科收治的124例慢性心力衰竭患者为研究对象,采用中文版Memorial心力衰竭症状评估量表、临床衰弱量表、匹兹堡睡眠质量指数量表对其进行问卷调查。采用Pearson相关分析方法分析3个量表得分之间的相关性,采用多元线性回归进行影响因素分析。结果 量表评估结果显示,症状负担得分(23.38±6.72)分、衰弱得分(4.03±0.67)分、睡眠质量得分(12.33±5.41)分。Pearson相关分析结果显示,症状负担与衰弱呈正相关(r=0.437,P=0.004)、与睡眠质量得分呈负相关(r=-0.342,P=0.022),衰弱与睡眠质量得分呈负相关(r=-0.225,P=0.037)。多元线性回归分析结果显示,年龄、心功能分级、年住院次数、慢病数量、衰弱评分及睡眠质量是慢性心力衰竭患者症状负担的影响因素(P<0.05)。结论 慢性心力衰竭患者症状负担较重,临床工作人员应针对以上影响因素尽早识别出潜在高症状负担人群,同时加强对慢性心衰患者生活质量...     

慢性心力衰竭患者焦虑、抑郁症状的调查及相关因素分析

目的 了解慢性心力衰竭患者焦虑、抑郁症状的发生情况，分析各种因素与慢性心力衰竭患者焦虑、抑郁症状的关系。方法 采用自设问卷、焦虑自评量表（SAS）、抑郁自评量表（SDS）和社会支持评定量表（SSRS）对49例慢性心力衰竭患者进行调查。结果 慢性心力衰竭患者焦虑症状发生率71．43％，抑郁症状发生率51．02％；慢性心力衰竭患者的自理能力、心功能分级、合并症数目、社会支持情况4个因素对焦虑、抑郁症状的发生有统计学意义。结论 慢性心力衰竭患者多存在焦虑、抑郁的心理问题，其发生与自理能力、心功能分级、合并症数目和社会支持情况有一定的关系，应重视对患者的心理护理。     

慢性心力衰竭患者焦虑、抑郁症状的调查及相关因素分析

目的了解慢性心力衰竭患者焦虑、抑郁症状的发生情况,分析各种因素与慢性心力衰竭患者焦虑、抑郁症状的关系。方法采用自设问卷、焦虑自评量表(SAS)、抑郁自评量表(SDS)和社会支持评定量表(SSRS)对49例慢性心力衰竭患者进行调查。结果慢性心力衰竭患者焦虑症状发生率71.43%,抑郁症状发生率51.02%;慢性心力衰竭患者的自理能力、心功能分级、合并症数目、社会支持情况4个因素对焦虑、抑郁症状的发生有统计学意义。结论慢性心力衰竭患者多存在焦虑、抑郁的心理问题,其发生与自理能力、心功能分级、合并症数目和社会支持情况有一定的关系,应重视对患者的心理护理。     

护理干预对慢性心力衰竭患者心理状态和生活质量的影响

目的 观察护理干预对慢性心力衰竭(CHF)患者焦虑、抑郁症状和生活质量的影响.方法 将124例CHF患者随机分为观察组和对照组各62例,观察组采用系统化护理干预,对照组采用常规护理,比较观察2组护理前后焦虑、抑郁状况及生活质量.结果 观察组护理后不论是SAS、SDS评分还是躯体功能、角色功能、情绪功能、社会功能和生活质量评分,均较护理前明显改善,但对照组护理前后比较无显著差异;并且,观察组护理后焦虑、抑郁症状评分和生活质量评分均明显优于同期对照组水平.结论 对CHF患者采用护理干预,能够明显改善患者的焦虑、抑郁症状,提高其生活质量.     

远距离照护模式对慢性心力衰竭患者焦虑、抑郁及治疗依从性的影响

目的：探讨远距离照护模式对慢性心力衰竭患者焦虑、抑郁及治疗依从性的影响。方法选取2013年7月—2014年3月120例慢性心力衰竭患者作为研究对象,按照随机数字表法将患者随机分为对照组和研究组,每组各60例。出院后对照组实施常规护理,研究组在此基础上根据远距离照护模式进行护理。6个月后,通过焦虑自评量表（ SAS）和抑郁自评量表（ SDS）评定患者焦虑、抑郁的主观感受;依据治疗依从性评价标准评价患者的治疗依从性。结果远距离照护模式进行护理实施6个月后,研究组患者SAS、SDS得分分别为（39．27±8．31）,（40．54±5．51）分,分别优于对照组的（49．12±7．31）,（51．14±6．64）分,差异有统计学意义（t值分别为－16．26,－18．39;P＜0．05）。治疗后研究组不能依从5例,一般依从11例,完全依从44例,优于对照组,差异有统计学意义（ U＝11．217,P＜0．01）。结论远距离照护能够改善慢性心力衰竭患者焦虑、抑郁状态,提高患者治疗的依从性。     

基于症状管理策略的健康教育对慢性心力衰竭患者自我护理行为和生活质量的影响

目的探讨基于症状管理策略的健康教育对慢性心力衰竭患者自我护理行为和生活质量的影响。方法采用便利抽样法,选取2019年5月-2020年5月阜外华中心血管病医院收治的慢性心力衰竭患者300例为研究对象。根据随机数字表法将其分为对照组和观察组各150例,对照组给予常规健康宣教,观察组在对照组基础上应用基于症状管理策略的健康教育。干预前后采用自我护理能力测定量表(ESCA)、明尼芬达心力衰竭患者生活质量测评量表(MLHFQ)比较干预的效果。结果出院后3个月,观察组患者ESCA和MLHFQ总分及各维度得分均高于对照组,差异有统计学意义(P<0.05)。结论基于症状管理策略的健康教育能提高慢性心力衰竭患者自我护理能力和生活质量。     

The experience of fatigue among elderly women with chronic heart failure

Background

Fatigue is a common and distressing symptom in chronic heart failure (CHF). Most of the current methods for evaluating patients' symptoms fail to consider the meaning or importance that these symptoms have for the patient.

Aim

To illuminate the lived experience of fatigue among elderly women with CHF.

Method

Narrative interviews were conducted with 10 women with CHF, aged 73-89 years. Interviews were analysed with qualitative content analysis.

Results

The findings are presented in two themes and five subthemes. The first theme, ‘living with the loss of physical energy’, was based on three subthemes describing the experience of fatigue: ‘experiencing a substantial presence of feebleness and unfamiliar bodily sensations’, ’experiencing unpredictable variations in physical ability’, and ‘needing help from others in daily life’. The second theme, ‘striving for independence while being aware of deteriorating health’, describes how the women managed their life situation; it was based on two subthemes: ‘acknowledging one's remaining abilities’, and ‘being forced to adjust and struggle for independence’.

Conclusions

Fatigue was experienced as loss of physical energy, leading to discrepancies between intention and capacity. The will to reduce dependency on others involved a daily struggle against fatigue.     

Symptom distress and quality of life in patients with advanced congestive heart failure

Little is known about the burden of illness associated with advanced congestive heart failure (CHF). Understanding the needs of this population requires further information about symptoms and other factors related to quality of life. We studied a convenience sample of 103 community-dwelling patients with New York Heart Association Class III/IV CHF. The primary outcome, quality of life, was measured with the Multidimensional Index of Life Quality. Potential correlates of quality of life included overall symptom burden (Memorial Symptom Assessment Scale, MSAS), including global symptom distress (MSAS Global Distress Index, GDI); psychological state (Mental Health Inventory-5); functional status (Sickness Impact Profile); spirituality (Functional Assessment of Chronic Illness Therapy-Spirituality Scale); and co-morbid conditions (Charlson Comorbidity Index). Patients had a mean age of 67.1 years (SD=12.1); were mostly white (72.8%), male (71.8%), and married (51.5%); and had a mean ejection fraction of 22.3% (SD=6.8). The most prevalent symptoms were lack of energy (66%), dry mouth (62%), shortness of breath (56%), and drowsiness (52%). Pain was reported by about one-third of patients. For each of these symptoms, high symptom-related distress was reported by 14.1%-54.1%. Quality of life was moderately compromised (Multidimensional Index of Life Quality composite, median=56, possible range 12-84). Impairment in quality of life was strongly associated with global symptom distress (MSAS GDI; r=0.74, P<0.001); burden of comorbid conditions (r = -0.32, P=0.002), female sex (r=-0.22, P=0.03), functional impairment, particularly psychological impairment (r=-0.55, P<0.001), and poorer psychological well-being (r=0.68, P<0.001). In multivariate analyses, impairment in quality of life was significantly related to high symptom distress, poorer psychological well-being, and poor functional mobility (R2=0.67; P=0.002 for all). Distressful symptoms related to impaired quality of life included lack of energy (P=0.04), irritability (P=0.03), and drowsiness (P=0.02). Community-dwelling patients with advanced CHF experience numerous symptoms, significant symptom distress, and a compromised quality of life. Overall quality of life was strongly associated with symptom distress, psychological well-being and functional status. A focus on ameliorating prevalent physical symptoms and psychological distress, along with supportive measures that promote functional mobility, may lead to an improvement in the overall quality of life in this patient population.     

曲美他嗪治疗冠心病心力衰竭临床评价

目的评价曲美他嗪治疗冠心病心力衰竭的临床疗效及安全性。方法选择114例冠心病心力衰竭患者随机分为治疗组50例和对照组64例。对照组给予常规抗心力衰竭治疗;治疗组在对照组常规治疗基础上加服曲美他嗪20mg,3次／d。2组疗程均为6个月。观察两组治疗前后临床疗效、左室舒张末内径（LVEDD）、左室射血分数（LVEF）、血清B型尿钠肽（BNP）、6min步行试验及药物不良反应等。结果治疗6个月后,治疗组的总有效率显著高于对照组（P〈0．05）;在LVEDd、LVEF、6min步行距离及BNP等方面改善的程度,治疗组均优于对照组（P〈0．05）;治疗组发生药物不良反应少而轻微。结论冠心病心力衰竭患者长期服用曲美他嗪可使心功能改善．安伞有效。     

Identification of symptom clusters among patients with heart failure: An international observational study

Background

Virtually all patients with heart failure experience multiple symptoms simultaneously, yet clinicians and researchers usually consider symptoms in isolation. Recognizing and responding early to escalating symptoms is essential to preventing hospitalizations in heart failure, yet patients have considerable difficulty recognizing symptoms. Identification of symptom clusters could improve symptom recognition, but cultural differences may be present that must be considered.

Objectives

To identify and compare symptom clusters in heart failure patients from the United States, Europe and Asia.

Design

Cross-sectional, observational study.

Settings

In- and out-patient settings in three regions of the world: Asia (i.e., China and Taiwan); Europe (i.e., the Netherlands and Sweden); and the United States.

Participants

A total of 720 patients with confirmed heart failure. Propensity scoring using New York Heart Association Classification was used to match participants from each of the three regions.

Methods

Symptoms were identified using the Minnesota Living with Heart Failure Questionnaire. To identify symptom clusters we used cluster analysis with the hierarchical cluster agglomerative approach. We used the Euclidean distance to measure the similarity of variables. Proximity between groups of variables was measured using Ward's method. The resulting clusters were displayed with dendrograms, which show the proximity of variables to each other on the basis of semi-partial R-squared scores.

Results

There was a core group of symptoms that formed two comparable clusters across the countries. Dyspnea, difficulty in walking or climbing, fatigue/increased need to rest, and fatigue/low energy were grouped into a cluster, which was labeled as a physical capacity symptom cluster. Worrying, feeling depressed, and cognitive problems were grouped into a cluster, which was labeled as an emotional/cognitive symptom cluster. The symptoms of edema and trouble sleeping were variable among the countries and fell into different clusters.

Conclusion

Despite the diversity in cultures studied, we found that symptoms clustered similarly among the cultural groups. Identification of similar symptoms clusters among patients with heart failure may improve symptom recognition in both patients and healthcare providers.     

内源性大麻素与慢性心力衰竭患者心功能的相关性研究

目的：探讨内源性大麻素水平与慢性心力衰竭（CHF）患者心功能的相关性。方法纳入CHF患者（CHF组）260例,有共同心血管疾病但从未发生心力衰竭的患者（p-CHF组）130例及健康对照者（健康对照组）130名。心功能评价依据NYHA心功能分级以及M型超声测量患者LVEF、心排出量、左心室舒张期末径（LVEDD）及左心室收缩期末径（LVSDD）;使用高效液相色谱仪检测血浆花生四烯酸乙醇胺（AEA）及2-花生四烯酸甘油（2-AG）水平。结果 CHF组AEA、2-AG、脑利钠肽水平明显高于健康对照组及p-CHF组（P＜0.01）。单因素方差分析显示血浆AEA、2-AG水平在NHYA I级患者中最低,在NYHA IV级患者中最高,两两比较差异有统计学意义（P＜0.01）。秩相关分析显示,血浆AEA及2-AG水平均与NYHA心功能分级呈高度正相关（AEA：rs ＝0.84;P＜0.01;2-AG：rs ＝0.95;P＜0.01）。血浆AEA及2-AG水平均与血浆脑利钠肽浓度呈正相关（rAEA ＝0.83,P＜0.01;r2-AG＝0.97;P＜0.01）。血浆AEA水平与LVEF、心排出量、LVEDD及LVSDD均呈相关关系,其中与LVEF的相关性最好,相关系数为-0.63（P＜0.01）;血浆2-AG亦与上述各指标呈现良好相关性,其中与LVEF相关性最好,相关系数为-0.73（P＜0.01）。结论心力衰竭患者血浆AEA及2-AG水平均有所升高,其中以2-AG浓度升高明显;心力衰竭患者血浆AEA及2-AG浓度与患者心功能呈正相关;内源性大麻素系统（ECS）有望成为心力衰竭药物干预新靶点,可能具有广阔的应用前景。     

慢性心力衰竭32例的血清甲状腺素变化

目的　探讨慢性心力衰竭 (CHF)患者血清三碘甲状腺原氨酸 (T3 )值的变化。方法　对比分析32例CHF患者的血清T3 值和 30例健康对照组的血清T3 值。结果　Ⅱ级CHF患者血清T3 值为 (1 0±0 5 2 )ng/ml,Ⅲ级CHF患者血清T3 值为 (0 81± 0 4 7)ng/ml,Ⅳ级CHF患者血清T3 值为 (0 6 3± 0 5 7)ng/ml,健康对照组血清T3 值为 (2 0 3± 0 4 5 )ng/ml,各级CHF血清T3 值均有下降 ,与健康对照组比较 ,差异有显著意义 (P <0 0 5 )。结论　CHF患者的血清T3 水平有降低。     

心力衰竭患者的心率变异分析研究

目的探讨慢性心力衰竭(CHF)患者心率变异性(HRV)的变化,研究了HRV各指标与心功能程度(NYHA分级)、原发病、心衰类型的关系。方法选取CHF患者76例与正常对照组24例进行回顾性分析。结果正常对照组比较,CHF试验组SDNN,SDANN降低,差异有统计学意义。结论CHF患者HRV部分指标变化可作为判定CHF严重程度的参考指标。各项HRV指标变化大小可能与CHF患者的原发病无关,但部分似与心衰类型有关。     

慢性心力衰竭患者并发电解质紊乱的临床观察与分析

目的：观察心力衰竭患者入院前、后电解质紊乱发生的类型及发生率，探讨其原因，总结临床防治策略，指导临床治疗。方法： 对96例心功能Ⅲ-Ⅳ（NYHA分级）的慢性心力衰竭患者，于入院后当天及入院后第6 d进行电解质检测，观察电解质紊乱发生的情况及原因。结果： （1） 96例患者中共有17例存在不同类型的电解质紊乱，发生率为17.71%。（2）入院后第6 d进行电解质检测，入院时已存在电解质紊乱的17例患者经过纠正电解质紊乱治疗，16例完全恢复正常，1例低钠血症患者虽然血钠水平有所上升，但没有恢复至正常值水平，治愈率为94.12%；入院时电解质正常的79例患者新发电解质紊乱12例，发生率为15.19%。结论：心力衰竭患者在入院前、后电解质紊乱的发生率均较高，以低Na^＋血症、低K^＋血症最为常见。     

超声综合参数在慢性心力衰竭患者预后评估中的意义

目的 运用综合超声心动图多项参数的心力衰竭超声指数(HFEI)评价慢性心力衰竭(CHF)患者的整体心脏功能,并初步探讨HFEI在慢性心力衰竭患者CHF预后评估中的价值.方法 选择CHF患者118例和非CHF患者21例,运用HFEI评分,进行心功能分级;对CHF组患者进行随访,观察终点为全因死亡和因CHF恶化再入院.结果 CHF组HFEI明显高于对照组,并随纽约心功能分级增高而升高.死亡组与再入院组HFEI高于无事件生存组;HFEI为心力衰竭患者终点事件发生的独立预测因素.结论 HFEI可作为综合评价CHF患者心功能的可靠指标,并可用于CHF患者的预后评估     

The implications of physical activity in patients with chronic heart failure

The clinical syndrome of chronic heart failure is increasingly prevalent. It can be considered a multiorgan disorder that may exert a negative physical and psychological influence on a patient. Medication and surgical intervention have important roles to play and have certainly improved both morbidity and mortality in this field, but clearly these interventions alone are not enough. Excessive resource utilization for this group of patients has provided added impetus to research into non-pharmacological interventions. These encompass dietary and other lifestyle measures, including smoking cessation and exercise. Exercise has been shown to favourably affect the functional capacity and quality of life. There is also emerging evidence that it reduces mortality. In the absence of contraindications, regular endurance exercise coupled with strength training is undoubtedly beneficial. As with other cardiovascular research, there is a trend towards recruiting middle-aged males. This effectively means that practitioners need to be cautious when evaluating and/or implementing research evidence. By addressing the implications of physical activity for deconditioned patients with chronic heart failure, a holistic therapeutic regimen is fostered. This has been shown to improve the quality of life of patients and to enhance the quality of service delivered to this patient group.     

比索洛尔治疗老年慢性心力衰竭的临床研究

目的探讨比索洛尔治疗老年慢性心力衰竭的临床效果。方法将86例患者随机分为治疗组和对照组,每组各43例。对照组采用常规治疗,治疗组在对照组常规治疗的基础上加用比索洛尔,观察两组患者的治疗效果。结果治疗组治疗后的总有效率、再住院率优于对照组,差异有统计学意义（P〈0.05）。治疗组治疗后的心率（HR）、左室射血分数（LVEF）、运动耐量与对照组相比有明显改善（P〈0.01）。结论比索洛尔可改善老年慢性心力衰患者的临床症状、提高生活质量、降低再住院率。     

Perceived loneliness and social support in patients with chronic heart failure

Self-reported conditions have become increasingly important in patient care, and perceived loneliness and social relationships in patients with chronic heart failure (CHF) are not sufficiently investigated.

Aim

The aim was to investigate perceived loneliness and social support in patients with CHF. Further, to investigate whether loneliness and social support might be associated with gender, age, healthcare utilization and mortality.

Methods

One hundred and forty nine patients with CHF, hospitalised at least once during a 4-month period in 2006, completed a self-reported questionnaire including measurements about loneliness and social support. Healthcare utilization was assessed prospectively by frequency of readmissions and number of days hospitalised during 1 year.

Results

Loneliness was reported by 29 (20%) participants. They were more often women (p < 0.001) and younger (p = 0.024). Patients who perceived loneliness had fewer social contacts (p = 0.033), reported lower occurrence of emotional contacts (p = 0.004), were less satisfied with social contacts and close relationships (p < 0.001). Those reporting loneliness had more days hospitalised (p = 0.044), and more readmissions to hospital (p = 0.027), despite not having more severe CHF.

Conclusion

Loneliness is a health-related risk indicator in that patients with CHF who perceived loneliness have more healthcare utilization than those who do not report loneliness despite not having more severe CHF.     

慢性肾衰血液透析患者并发急性左心衰58例分析

目的探讨慢性肾衰血液透析患者并发急性左心衰的原因及防治措施。方法对58例慢性肾衰并发急性左心衰患者的临床资料进行回顾性分析。结果 58例急性左心衰患者经过序贯超滤透析临床症状均改善。结论高血压、容量负荷过重和贫血是诱发急性左心衰的主要原因,序贯超滤透析是治疗慢性肾衰血液透析患者合并急性左心衰的有效措施之一。