老年冠心病合并慢性心力衰竭患者生活质量与日常生活能力及其相关性

Quality of life and daily living ability in elderly patients with coronary heart disease complicated with chronic heart failure and their correlation

【摘要】目的 调查老年冠心病(CHD)合并慢性心力衰竭(CHF)患者生活质量及日常生活能力并分析其相关性。方法 选择武汉大学中南医院2021年1月到2023年1月收治的120例因心力衰竭加重入院的老年CHD合并CHF患者为研究对象,分别在出院时、出院3个月及6个月,采用明尼苏达心力衰竭生活质量问卷(MLHFQ)及日常生活能力量表(ADL)调查其生活质量与日常生活能力。采用SPSS 22.0统计软件进行数据分析。根据数据类型分别采用重复测量方差分析、独立样本t检验、χ²检验或秩和检验进行组间比较。采用多因素logistic回归模型分析患者出院后6个月生活质量与日常生活能力的影响因素。采用Pearson相关性分析评估患者生活质量与日常生活能力的相关性。结果 120例患者中,91例完成调查。与出院时相比,患者出院3个月及6个月时MLHFQ量表及ADL量表得分均下降,差异有统计学意义(P<0.05)；出院6个月时两量表得分与出院3个月水平相当,差异无统计学意义(P>0.05)。多因素logistic回归分析提示,年龄≥80岁(OR=3.136,95%CI 1.251~7.864)、女性(OR=1.562,95%CI 1.197~2.039)、美国心脏学会(NYHA)分级Ⅲ~Ⅳ级(OR=1.714,95%CI1.123~2.618)、合并慢性病种类≥3种(OR=3.557,95%CI 1.692~7.477)及半年内再次住院(OR=3.466,95%CI 1.549~7.757)是影响老年CHD合并CHF患者出院后6个月生活质量的危险因素；中学及以上文化程度(OR=0.459,95%CI 0.283~0.743)及经常运动(OR=0.612,95%CI 0.434~0.862)是其保护因素。年龄≥80岁(OR=2.776,95%CI 1.120~6.879)及合并慢性病种类≥3种(OR=3.582,95%CI 1.800~7.127)是影响老年CHD合并CHF患者出院6个月时日常生活能力的危险因素；月收入≥3000元(OR=0.521,95%CI 0.343~0.791)及经常运动(OR=0.527,95%CI 0.340~0.816)是其保护因素。Pearson相关性分析提示,老年CHD合并CHF患者生活质量MLHFQ量表的躯体领域、情绪领域、其他领域以及量表总得分与其日常生活活动能力ADL量表总得分间均呈正相关(r=0.295,0.346,0.367,0.342；P<0.05)。 结论 老年CHD合并CHF患者出院后3个月时生活质量及日常生活能力较出院时明显提高,后趋于稳定,患者出院6个月时生活质量及日常活动能力之间具有显著相关性。开展健康教育督促患者养成定期运动习惯,积极控制基础性疾病在改善患者生活质量及日常生活能力中具有一定价值。

基金项目:国家重点研发项目(2022YFC2704105)；湖北省自然科学基金面上项目(2021CFB662)

【Abstract】Objective To investigate the quality of life and daily living ability in elderly patients with coronary heart disease (CHD) complicated with chronic heart failure (CHF) and analyze their correlation. Methods From January 2021 to January 2023,120 elderly patients with CHD and CHF admitted to Zhongnan Hospital of Wuhan University due to aggravation of heart failure were selected as the study subjects. At discharge and at three months and six months after discharge, the Minnesota living with heart failure questionnaire (MLHFQ) and activity of daily living scale (ADL) were used to investigate the quality of life and the daily living ability. SPSS 22.0 was used for data analysis. Repeated measure analysis of variance, independent sample t test, Chi-square test, or rank sum test was used for inter-group comparison according to the data type. Multivariate logistic regression model was used to analyze the influencing factors of quality of life and daily living ability of patients at six months after discharge. Pearson correlation analysis was used to assess the correlation between quality of life and daily living ability. Results Among the 120 patients, 91 completed the survey. Compared with at discharge, the scores on MLHFQ and ADL decreased at three and six months after discharge, and the difference was statistically significant (P<0.05). The scores on the two scales at six months after discharge were similar to those at three months after discharge, and the difference was not statistically significant (P>0.05). Multivariate logistic regression analysis showed that age≥80 years(OR=3.136, 95%CI 1.251-7.8645), female (OR=1.562, 95%CI 1.197-2.039), New York Heart Association (NYHA) grade Ⅲ-Ⅳ(OR=1.714, 95%CI 1.123-2.618), type of chronic diseases≥3 (OR=3.557, 95%CI 1.692-7.477) and re-hospitalization within half a year (OR=3.466, 95%CI 1.549-7.757) were the risk factors affecting the quality of life at 6 months after discharge in elderly patients with CHD complicated with CHF, and education level of middle school and above (OR=0.459, 95%CI 0.283-0.743) and regular exercise (OR=0.612, 95%CI 0.434-0.862) were protective factors. Age ≥ 80 years (OR=2.776,95%CI 1.120-6.879) and types of chronic diseases ≥3 (OR=3.582,95%CI 1.800-7.127) were risk factors and monthly income ≥ 3 000 yuan (OR=0.521,95%CI 0.343-0.791) and regular exercise (OR=0.527,95%CI 0.340-0.816) were protective factors of the daily living ability in the elderly CHD patients with CHF at six months after discharge. Pearson correlation analysis suggested that the scores of physical field, emotional field and other field and total score of MLHFQ scale were positively correlated with total score of daily living ability ADL scale in elderly CHD patients with CHF (r=0.295,0.346,0.367,0.342; P<0.05). Conclusion The quality of life and daily living ability in the elderly CHD patients with CHF at three months after discharge are significantly enhanced as compared with at discharge and then tend to be stable. There is a significant correlation between quality of life and daily living ability of patients at six months after discharge. Carrying out health education to urge patients to develop regular exercise habits and actively control the basic diseases has certain value on improving the quality of life and daily living ability of patients.

This work was supported by the National Key Research and Development Project (2022YFC2704105) and General Project of Hubei Provincial Natural Science Foundation (2021CFB662).