老年非瓣膜性心房颤动住院患者衰弱现状及影响因素分析

doi:10.3761/j.issn.0254-1769.2021.07.009

摘要/Abstract

摘要：

目的调查老年非瓣膜性心房颤动住院患者的衰弱现状及其影响因素。方法采用便利抽样法,选取2020年3月—10月在温州市某三级甲等医院心血管内科住院的183例老年非瓣膜性心房颤动患者,采用一般资料调查表、FRAIL衰弱问卷、Barthel指数评定量表、Padua风险评估表进行调查。采用Logistic回归分析老年非瓣膜性心房颤动住院患者衰弱的影响因素。结果老年非瓣膜性心房颤动住院患者衰弱前期和衰弱的发生率分别为39.9%和28.4%,仅有31.7%患者无衰弱。Logistic回归结果显示,年龄、性别、左心室射血分数、左心房内径、Barthel指数得分和Padua得分是老年非瓣膜性心房颤动患者衰弱的影响因素（P<0.05）。结论老年非瓣膜性心房颤动患者合并衰弱的发生率高。高龄、左心室射血分数低、左心房内径增大等非瓣膜性心房颤动患者更易出现衰弱。

关键词: 衰弱, 心房颤动, 非瓣膜性, 老年人, 护理

Abstract:

Objective To investigate the current status of frailty in elderly hospitalized patients with non-valvular atrial fibrillation（NVAF） and to analyze the influencing factors. Methods The convenience sampling method was used to select 183 elderly patients aged 60 years and older who were diagnosed with NVAF and hospitalized in the Department of Cardiovascular Medicine of a tertiary hospital in Wenzhou from March 2020 to October 2020.The general patient data,laboratory parameters,cardiac ultrasound parameters,and health data were collected by the General Information Questionnaire,Frail Frailty Questionnaire,Barthel Index,Activity of Daily Living Scale（ADL）and Padua score for risks of deep vein thrombosis in medical inpatients. Statistical methods including single factor and multifactor analysis were conducted for influencing factors of frailty in the elderly patients with atrial fibrillation. Results The pre-frailty and frailty rates in 183 elderly patients with NVAF were 39.9% and 28.4%,respectively,and only 31.7% were non-frailty. The results of ordered multiple Logistic regression showed that age,sex,cardiac ejection fraction,left atrial internal diameter,and ADL were influential factors in the frailty of elderly patients with NVAF（P<0.05）. Conclusion Elderly patients with NVAF have a high incidence of frailty and a large proportion of patients are in the pre-frailty. Age,sex,cardiac ejection fraction,left atrial internal diameter,ADL and the deep vein thrombosis risk are influential factors in frailty. Frailty screening and management should be carried out as early as possible during hospitalization for elderly patients with NVAF to improve their ADL and quality of life.

Key words: Frailty, Atrial Fibrillation, Non-Valvular, Aged, Nursing Care

黄赛燕,宗晓梅,李彬,董超群,丁婷婷,卢中秋. 老年非瓣膜性心房颤动住院患者衰弱现状及影响因素分析[J]. 中华护理杂志, 2021, 56(7): 1009-1014.

HUANG Saiyan,ZONG Xiaomei,LI Bin,DONG Chaoqun,DING Tingting,LU Zhongqiu. The current status and influencing factors analysis of frailty in the elderly hospitalized patients with non-valvular atrial fibrillation[J]. Chinese Journal of Nursing, 2021, 56(7): 1009-1014.

图/表 3

表1 老年非瓣膜性心房颤动患者衰弱的单因素分析（n=183）

Table 1 One-way analysis of general information（n=183）

表2 老年非瓣膜性心房颤动患者衰弱的Logistic回归分析

Table 2 Sequential multiple Logistic regression analysis of the factors influencing declination in elderly patients with atrial fibrillation

表3 受试者工作曲线下面积

Table 3 Table of area under ROC curve for different factors

参考文献 28

[1]	中华医学会老年医学分会. 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志, 2017, 36(3):251-256.
	Geriatric Medicine Branch of Chinese Medical Assoc. Chinese experts consensus on assessment and intervention for elderly patients with frailty[J]. Chin J Geriatr, 2017, 36(3):251-256.
[2]	Cesari M, Prince M, Thiyagarajan JA, et al. Frailty:an emerging public health priority[J]. J Am Med Dir Assoc, 2016, 17(3):188-192. DOI URL
[3]	蒋小琴, 秦明照. 衰弱评估在老年心房颤动患者管理中的应用[J]. 中华老年医学杂志, 2019, 38(6):708-712.
	Jiang XQ, Qin MZ. Application of frailty assessment in the management of elderly adults with atrial fibrillation[J]. Chin J Geriatr, 2019, 38(6):708-712.
[4]	Fumagalli S, Said SAM, Laroche C, et al. Age-related differences in presentation,treatment,and outcome of patients with atrial fibrillation in Europe:the EORP-AF general pilot registry(EUR observational research programme-atrial fibrillation)[J]. JACC Clin Electrophysiol, 2015, 1(4):326-334. DOI PMID
[5]	Polidoro A, Stefanelli F, Ciacciarelli M, et al. Frailty in patients affected by atrial fibrillation[J]. Arch Gerontol Geriatr, 2013, 57(3):325-327. DOI URL
[6]	Sławuta A, Jacek P, Mazur G, et al. Quality of life and frailty syndrome in patients with atrial fibrillation[J]. Clin Interv Aging, 2020, 15:783-795. DOI URL
[7]	Lip GYH, Keshishian AV, Kang AL, et al. Oral anticoagulants for nonvalvular atrial fibrillation in frail elderly patients:insights from the ARISTOPHANES study[J]. J Intern Med, 2021, 289(1):42-52. DOI URL
[8]	Yang PS, Sung JH, Jang E, et al. Application of the simple atrial fibrillation better care pathway for integrated care management in frail patients with atrial fibrillation:a nationwide cohort study[J]. J Arrhythm, 2020, 36(4):668-677. DOI URL
[9]	《老年人心房颤动诊治中国专家建议》写作组. 老年人非瓣膜性心房颤动诊治中国专家建议(2016)[J]. 中华老年医学杂志, 2016, 35(9):915-927.
	Writing Committee for Expert Consensus on the Mana Chinese Geriatric Society Editorial Board of Chinese Journal of Geriatrics. Expert consensus on the management of atrial fibrillation in elderly population(2016)[J]. Chin J Geriatr, 2016, 35(9):915-928.
[10]	卫尹, 曹艳佩, 杨晓莉, 等. 老年住院患者衰弱风险筛查工具的汉化及信效度研究[J]. 中国实用护理杂志, 2018, 34(20):1526-1530.
	Wei Y, Cao YP, Yang XL, et al. Reliability and validity of the Chinese version of Fatigue,Resistance,Ambulation,Illness,and Loss for Elder Inpatients[J]. Chin J Practic Nurs, 2018, 34(20):1526-1530.
[11]	侯晓琳, 高静, 吴晨曦, 等. 养老机构老年人衰弱现状及分析[J]. 中华护理杂志, 2018, 53(1):88-93.
	Hou XL, Gao J, Wu CX, et al. Prevalence and factors associated with frailty among institutional older adults[J]. Chin J Nurs, 2018, 53(1):88-93.
[12]	内科住院患者静脉血栓栓塞症预防的中国专家建议写作组, 中华医学会呼吸病学分会, 中华医学会老年医学分会, 等. 内科住院患者静脉血栓栓塞症预防中国专家建议(2015)[J]. 中华老年医学杂志, 2015, 34(4):345-352.
	Writing Committee for Expert Consensus on prevention of venous thromboembolism in internal medicine inpatients, respiratory branch of Chinese Medical Assoc, Geriatric Medicine Branch of Chinese Medical Assoc, et al. The recommendations of the prevention for venous thromboembolism in medical inpatients[J]. Chin J Geriat, 2015, 34(4):345-352.
[13]	陈小兰, 潘磊, 王勇. Padua血栓评估模型筛选住院患者深静脉血栓形成的有效性研究[J]. 中华内科杂志, 2018, 57(7):514-517. DOI PMID
	Chen XL, Pan L, Wang Y. Validity of Padua risk assessment scale for assessing the risk of deep venous thrombosis in hospitalized patients[J]. Chin J Intern Med, 2018, 57(7):514-517. DOI PMID
[14]	田鹏, 杨宁, 郝秋奎, 等. 中国老年衰弱患病率的系统评价[J]. 中国循证医学杂志, 2019, 19(6):656-664.
	Tian P, Yang N, Hao QK, et al. Epidemiological characteristics of frailty in Chinese elderly population:a systematic review[J]. Chin J Evid Med, 2019, 19(6):656-664.
[15]	顾朋颖, 胡世莲, 丁西平, 等. 老年人衰弱水平与心房颤动患者抗凝治疗的相关性研究[J]. 中华老年医学杂志, 2019, 38(10):1131-1136.
	Gu PY, Hu SL, Ding XP. et al. Correlation between frailty status and anticoagulation therapy in elderly patients with atrial fibrillation[J]. Chin J Geriat, 2019, 38(10):1131-1136.
[16]	Nguyen TN, Cumming RG, Hilmer SN. The impact of frailty on mortality,length of stay and re-hospitalisation in older patients with atrial fibrillation[J]. Heart Lung Circ, 2016, 25(6):551-557. DOI PMID
[17]	Molteni M, Polo FH, Primitz L, et al. The definition of valvular and non-valvular atrial fibrillation:results of a physicians’ survey[J]. Europ Soc Cardiol, 2014, 16(12):1720-1725.
[18]	Buckinx F, Reginster JY, Gillain S, et al. Prevalence of frailty in nursing home residents according to various diagnostic tools[J]. J Frailty Aging, 2017, 4(3):122-128.
[19]	焦静, 应巧燕, 刘华平, 等. 老年人衰弱状态筛查与评估工具研究进展[J]. 中华现代护理杂志, 2019, 25(18):2361-2364.
	Jiao J, Ying QY, Liu HP, et al. Research progress of frailty screening and assessment tools for the elderly[J]. Chin J Mod Nurs, 2019, 25(18):2361-2364.
[20]	Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability consistency across studies,predictive models,and value of gait speed alone compared with the short physical performance battery[J]. J Gerontol Biol Sci Med Sci, 2000, 55(4):M221-M231. DOI URL
[21]	宋雨, 李耘, 张亚欣, 等. 老年冠心病合并衰弱患者的心脏结构和功能的变化[J]. 山西医科大学学报, 2021(2):162-166.
	Song Y, Li Y, Zhang YX, et al. Changes of cardiac structure and function in elderly patients with coronary artery disease complicated with frailty[J]. Shanxi Med Univ, 2021(2):162-166.
[22]	黄学斌, 任小鹏, 解园星, 等. 慢性心力衰竭患者合并心房颤动的危险因素分析[J]. 中国循环杂志, 2015, 30(9):863-866.
	Huang XB, Ren XP, Xie YX, et al. Risk factor analysis in patients with chronic heart failure combining atrial fibrillation[J]. Chin Circul J, 2015,(9):863-866.
[23]	郭宥廷, 庄心宇, 刘荣宸, 等. 左房内径对非瓣膜性心房颤动患者缺血性卒中风险的预测价值研究[J]. 老年医学与保健, 2020, 26(2):195-199.
	Guo YT, Zhuang XY, Liu RC, et al. Predictive value of left atrial diameter on the risk of ischemic stroke in patients with non-valvular atrial fibrillation[J]. Geriat Heal Care, 2020, 26(2):195-199.
[24]	朱小刚, 韩凌, 陈欣, 等. 左室射血分数保留的心力衰竭患者心功能评价的相关因素分析[J]. 临床和实验医学杂志, 2017, 16(19):1918-1922.
	Zhu X, Han L, Chen X, et al. Analysis on relative factors for evaluation of cardiac function in patients with heart failure and preserved ejection fraction[J]. J Clin Experi Med, 2017, 16(19):1918-1922.
[25]	Hunter RJ, Berriman TJ, Diab I, et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure(the CAMTAF trial)[J]. Circ Arrhy Elec, 2014, 7(1):31-38.
[26]	赵旭, 王伟, 赵小静, 等. 慢性心力衰竭患者出入量管理的最佳证据总结[J]. 中华护理杂志, 2020, 55(3):456-461.
	Zhao X, Wang W, Zhao XJ, et al. Best evidence summary for management of output and input in chronic heart failure patients[J]. Chin J Nurs, 2020, 55(3):456-461.
[27]	杜宜修, 吴芳琴, 卢晓英, 等. 多学科团队延续性护理模式在心房颤动患者中的应用研究[J]. 中华护理杂志, 2020, 55(7):969-974.
	Du YX, Wu FQ, Lu XY. et al. The application effects of continuous nursing care in management of patients with atrial fibrillation by a nurse-led multidisciplinary team[J]. Chin J Nurs, 2020, 55(7):969-974.
[28]	龚江波, 于晓雯, 王士博, 等. 老年人静脉血栓栓塞症的危险因素[J]. 中华老年多器官疾病杂志, 2017, 16(6):468-472.
	Gong JB, Yu XW, Wang SB, et al. Risk factors for venous thromboembolism in the elderly[J]. Chin J Multip Organ Dis Eld, 2017, 16(6):468-472.