出院过渡期老年心力衰竭患者相关症状及影响因素的纵向研究
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摘要
目的调查老年心力衰竭患者出院过渡期心衰相关症状,分析其变化趋势及影响因素。方法采用Memorial心力衰竭症状评估量表、心脏病患者抑郁量表、照护负担问卷和家属照护者照护能力问卷,对219例老年心衰患者及主要家庭照护者,于患者出院前1～2 d、出院后1个月和3个月进行调查。结果患者的心衰相关症状随着出院过渡期的延长呈恶化趋势,与出院前1～2 d相比,出院后1个月和3个月患者的心衰症状总分及各维度得分显著提高(P<0.01)。抑郁症状在出院后1个月得分最高(90.31±3.27),随着过渡时间的延长得分逐渐下降(P<0.01)。回归分析显示,出院过渡期患者心衰相关症状受患者服药种类、心功能分级和照护能力的影响;抑郁受患者年龄、病程和住院次数的影响(P<0.05,P<0.01)。结论老年心衰患者出院过渡期心衰相关症状较差且呈动态变化,受多种因素影响。护理人员应该制定针对性的过渡期护理计划,减轻患者症状负担。
Objective To investigate the symptoms of elderly heart failure patients during the transition from hospital to home,and to analyze the change trends and influencing factors. Methods A total of 219 elderly heart failure patients and their family caregivers were investigated using the Memorial Symptom Assessment Scale for Heart Failure(MSAS-HF), Cardiac Depression Scale(CDS), Zarit Burden Interview(ZBI) and the Family Caregiver Task Inventory(FCTI) at 1-2 d before discharge, 1 and 3 months after discharge. Results The symptoms of heart failure were aggravated during the transitional period. Compared with the baseline values at 1-2 d before discharge,the total MSAS-HF score and dimension scores were significantly increased at 1 and 3 months after discharge(P<0.01). The score of depression was highest at 1 month after discharge,being 90.31±3.27, and then it was decreased(P<0.01). Regression analysis indicated that heart failure symptoms were affected by the number of medications used per day, cardiac function grading and caregiving ability of the family caregivers; and depression was predicted by age, course of disease and counts of hospitalization(P<0.05, P<0.01). Conclusion Elderly heart failure patients had worse symptoms that were changed dynamically and affected by many factors during the transitional period, so nurses should conduct targeted transitional care to ameliorate their symptom burden.
Objective To investigate the symptoms of elderly heart failure patients during the transition from hospital to home,and to analyze the change trends and influencing factors. Methods A total of 219 elderly heart failure patients and their family caregivers were investigated using the Memorial Symptom Assessment Scale for Heart Failure(MSAS-HF), Cardiac Depression Scale(CDS), Zarit Burden Interview(ZBI) and the Family Caregiver Task Inventory(FCTI) at 1-2 d before discharge, 1 and 3 months after discharge. Results The symptoms of heart failure were aggravated during the transitional period. Compared with the baseline values at 1-2 d before discharge,the total MSAS-HF score and dimension scores were significantly increased at 1 and 3 months after discharge(P<0.01). The score of depression was highest at 1 month after discharge,being 90.31±3.27, and then it was decreased(P<0.01). Regression analysis indicated that heart failure symptoms were affected by the number of medications used per day, cardiac function grading and caregiving ability of the family caregivers; and depression was predicted by age, course of disease and counts of hospitalization(P<0.05, P<0.01). Conclusion Elderly heart failure patients had worse symptoms that were changed dynamically and affected by many factors during the transitional period, so nurses should conduct targeted transitional care to ameliorate their symptom burden.
引文
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[13] 施龙永.抑郁对心力衰竭患者因心因及全因死亡风险影响的Meta分析[J].护理学报,2016,23(14):60-64.
[14] Timonet-Andreu E, Canca-Sanchez J C, Sepulveda-Sanchez J, et al.Overestimation of hours dedicated to family caregi-ving of persons with heart failure[J].J Adv Nurs,2018,74(10):2312-2321.
[15] 贺捷,蒋维连.居家慢性心力衰竭患者家庭照顾者负担体验的质性研究[J].解放军护理杂志,2016,33(1):26-28,43.
[16] 孟静,吕蓉,郝玉芳,等.慢性心力衰竭患者服药依从性的质性研究[J].中华现代护理杂志,2015,21(20):2386-2389.
[17] Guzzo E, Teme A, Chimera K, et al.Quick inventory of depressive symptomatology self-report in the clinical practice of depressive patients[J].Vertex,2015,26(121):173-181.
[18] Johnson T J, Basu S, Pisani B A, et al.Depression predicts repeated heart failure hospitalizations[J].J Card Fail,2012,18(3):246-252.
[2] Alpert C M, Smith M A, Hummel S L, et al.Symptom burden in heart failure: assessment, impact on outcomes, and management[J].Heart Fail Rev,2017,22(1):25-39.
[3] 衣艳凤,袁越,宋红霞,等.心力衰竭患者症状群与生活质量的相关性研究[J].护理学报,2018,25(1):10-13.
[4] 郭金玉.心力衰竭患者症状经历的相关研究[D].北京:北京协和医学院,2013.
[5] Wang W, Thompson D R, Leicester D, et al.A psychometric evaluation of a Chinese version of the Cardiac Depression Scale[J].J Psychosom Res,2008,65(2):123-129.
[6] 王烈,杨小湜,侯哲,等.护理者负担量表中文版的应用与评价[J].中国公共卫生,2006,22(8):970-972.
[7] 王姗姗,薛小玲,杨小芳,等.中文版家属照顾者照顾能力量表在急性心肌梗死患者家属中的信效度研究[J].中华现代护理杂志,2015,21(6):645-649.
[8] 王泽泉,吴茂春,李漫漫,等.心力衰竭症状群的研究进展[J].护理学杂志,2017,32(3):110-112.
[9] 沈潞华.老年人心力衰竭[J].中华老年多器官疾病杂志,2014,13(9):641-642.
[10] Stamp K D, Machado M A, Allen N A.Transitional care programs improve outcomes for heart failure patients[J].J Cardiovasc Nurs,2014,29(2):140-154.
[11] Polikandrioti M, Goudevenos J, Michalis L, et al.Factors associated with depression and anxiety of hospitali-zed patients with heart failure[J].Hellenic J Cardiol,2015,56(1):26-35.
[12] Tew J D Jr. Post-hospitalization transitional care needs of depressed elderly patients: models for improvement[J].Curr Opin Psychiatry,2005,18(6):673-677.
[13] 施龙永.抑郁对心力衰竭患者因心因及全因死亡风险影响的Meta分析[J].护理学报,2016,23(14):60-64.
[14] Timonet-Andreu E, Canca-Sanchez J C, Sepulveda-Sanchez J, et al.Overestimation of hours dedicated to family caregi-ving of persons with heart failure[J].J Adv Nurs,2018,74(10):2312-2321.
[15] 贺捷,蒋维连.居家慢性心力衰竭患者家庭照顾者负担体验的质性研究[J].解放军护理杂志,2016,33(1):26-28,43.
[16] 孟静,吕蓉,郝玉芳,等.慢性心力衰竭患者服药依从性的质性研究[J].中华现代护理杂志,2015,21(20):2386-2389.
[17] Guzzo E, Teme A, Chimera K, et al.Quick inventory of depressive symptomatology self-report in the clinical practice of depressive patients[J].Vertex,2015,26(121):173-181.
[18] Johnson T J, Basu S, Pisani B A, et al.Depression predicts repeated heart failure hospitalizations[J].J Card Fail,2012,18(3):246-252.