老年冠心病合并心力衰竭患者症状群及对生活质量的影响研究

目的 研究老年冠心病合并心力衰竭患者症状群及对生活质量的影响。方法 以2021年1月至2022年6月入院确诊的老年冠心病合并心力衰竭患者为研究对象，获取其基本资料包括性别、年龄、文化程度、冠心病病程、心功能分级，借助中文版Memorial心力衰竭症状评估量表（MSAS-HF）调查患者症状出现及严重程度，并应用探索性因子分析方法探讨症状群类型及构成，采用基于中国文化改良明尼苏达心力衰竭生存质量量表（C-MLHF）评估生活质量，分析老年冠心病合并心力衰竭患者症状群及对生活质量的影响。结果 纳入有效研究对象1 228例，有效率96.01%。症状发生率高的是气短（71.99%）、平躺时呼吸困难（66.69%）、疲乏（64.50%）、心悸（61.89%）等，症状严重程度高的是平躺时呼吸困难（2.95±0.63）分]、气短（2.92±0.59）分]、睡眠困难（2.90±0.65）分]、疲乏（2.89±0.52）分]等。探索性因子分析得到5种症状群，分别为疲倦症状群（疲乏、出汗、易困）、呼吸困难症状群（呼吸困难、夜间睡眠憋醒、平躺时呼吸困难）、缺血症状群（心悸、头晕、胸痛、手脚麻木感）、淤血...

Study on symptom clusters and their influence on the quality of life in elderly patients with coronary heart disease complicated with heart failure

Objective To study symptom clusters and their influence on the quality of life in elderly patients with coronary heart disease complicated with heart failure. Methods Elderly patients with coronary heart disease complicated with heart failure who were admitted to the hospital from January 2021 to June 2022 were selected. The basic data including gender, age, education level, course of coronary heart disease, and cardiac function grading were obtained. The Chinese version of the Memorial Symptom Assessment Scale-Heart Failure （MSAS-HF） was used to investigate the occurrence and severity of symptoms. The exploratory factor analysis method was used to explore the types and composition of symptom clusters. The Minnesota Living with Heart Failure Questionnaire based on Chinese culture（C-MLHF） was used to evaluate the quality of life. The symptom clusters of elderly patients with coronary heart disease complicated with heart failure and their influence on the quality of life were analyzed. Results There were 1 228 effective subjects, with an effective rate of 96.01%. The high incidence of symptoms was short-winded （71.99%）, dyspnea when lying flat （66.69%）, fatigue （64.50%）, palpitation （61.89%）, etc. The high severity of symptoms was dyspnea when lying flat （2.95±0.63）, short-winded （2.92±0.59）, sleep difficulty （2.90±0.65）, fatigue （2.89±0.52）, etc. Five symptom clusters were obtained by exploratory factor analysis, which was fatigue symptoms （fatigue, sweating, and drowsiness）, dyspnea symptoms （dyspnea, oppressive wake, and dyspnea when lying flat）, ischemic symptoms （palpitation, dizziness, chest pain, and numbness of hands and feet）, congestion symptoms （short-winded, edema, and cough）, and psychological symptoms （anxiety, sadness, feeling nervous, and difficulty in concentrating）. The total score of C-MLHF was （62.87±11.05）, and the scores of the physical field, emotional field, and other fields were （42.36±8.90）, （11.54±5.16）, and （13.92±6.73）, respectively. The symptom clusters of elderly patients with coronary heart disease complicated with heart failure were positively correlated with quality of life （all P<0.05）. Fatigue symptoms （β'=0.267）, dyspnea symptoms （β'=0.173）, ischemic symptoms （β'=0.312）, congestion symptoms （β'=0.265）, and psychological symptoms （β'=0.277） were all influencing factors of quality of life in elderly patients with coronary heart disease complicated with heart failure. Conclusions Elderly patients with coronary heart disease complicated with heart failure have fatigue symptoms, dyspnea symptoms, ischemic symptoms, congestion symptoms, and psychological symptoms, which seriously affect the quality of life of patients. It is necessary to carry out targeted symptom management to reduce physical and mental discomfort and improve the quality of life of patients.