老年综合评估对老年慢性心力衰竭患者治疗结果的影响及相关因素

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摘要目的：探讨老年综合评估（CGA）对老年慢性心力衰竭（CHF）患者治疗结果的影响及其相关影响因素。方法：纳入2015年1月至2017年4月在奉化市人民医院住院治疗的280例老年CHF患者为研究对象，随机分为CGA组和对照组，每组各140例，对照组给予常规药物治疗，CGA组通过CGA评估，并制定个体化治疗方案并实施。观察2组临床疗效，并采用logistic回归模型分析影响治疗结果的因素。结果：2组患者的一般资料、心功能情况和原发疾病构成等基线比较差异均无统计学意义（P＞0.05）。CGA组治疗后的总有效率为80.71%，显著高于对照组的69.29%（P＜0.05）。多元logistic回归分析显示，心功能分级高、合并症数目多、日常生活能力弱、跌倒风险高、认知功能障碍及营养状况差对老年CHF的疗效有显著影响（P＜0.05）。结论：老年CHF患者预后的影响因素多且复杂，应用CGA将有利于评估预后危险因素，制订适当的个体化治疗方案，以提高老年CHF患者的疗效，改善预后。

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关键词 ：老年综合评估, 慢性心力衰竭, 治疗结果, 影响因素

Abstract：Objective: To investigate the impact of comprehensive geriatric assessment (CGA) on the treatment outcomes of chronic heart failure (CHF), and analyze the influential factors of clinical efficacy in elderly patients. Methods: Totally 280 hospitalized patients with CHF in Fenghua People’s Hospital from January 2015 to April 2017 were recruited as participants, who were randomly divided into CGA group and control group with 140 cases each. The control group was given routine drugs, and individualized treatment was given under the guidance of CGA in the CGA group. The clinical effects of two groups were observed, and the influential factors were analyzed by logistic regression model. Results: There was no significant difference between the two groups (P>0.05) in general characteristics, the features of heart function and primary diseases at these baseline data. The total effective rate in CGA group was significantly higher than that in the control group (80.71% vs. 69.29%, P<0.05). The multivariate logistic analysis showed that the higher grade of heart function classification, larger number of complications, poorer quality of daily life, higher fall-down risk, poorer cognitive dysfunction and nutritional status were all significantly associated with the efficacy of elderly CHF (P<0.05). Conclusion: The influential factors for the prognosis of elderly CHF are numerous and complicated. The application of CGA will improve the clinical efficacy and prognosis by means of assessment of influential factors and appropriate individualized treatment under the direction of CGA.

Key words： geriatric comprehensive assessment chronic heart failure treatment outcome influential factors

收稿日期: 2017-08-07

基金资助:奉化市科技计划项目（20162712）。

作者简介: 刘晓芳（1976-），女，山西屯留人，副主任医师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I3/211

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