多组分运动护理干预在老年慢性心力衰竭合并衰弱患者中的应用

doi:10.3761/j.issn.0254-1769.2023.23.001

摘要/Abstract

摘要：

目的构建多组分运动护理干预方案，并探讨其对改善老年慢性心力衰竭患者衰弱、日常生活活动能力及生活质量的效果。方法基于文献分析、专家小组会议等形成多组分运动护理干预方案。2022年1月—9月，选取山东省某三级甲等医院心内科住院的71例老年慢性心力衰竭患者作为研究对象，采用抛硬币法随机分为试验组35例和对照组36例。试验组在常规护理的基础上实施多组分运动护理干预，对照组接受常规护理。于干预前及干预4、12周后，采用Tilburg衰弱量表、改良Barthel指数量表和简易生活质量量表对两组进行评估。结果共有62例患者完成干预，其中试验组31例，对照组31例。广义估计方程结果显示，两组衰弱、日常生活活动能力和生活质量的组间效应、时间效应及交互效应均具有统计学意义（P<0.05）。干预4、12周后，试验组Tilburg衰弱量表得分低于对照组（P<0.05），改良Barthel指数量表得分和简易生活质量量表得分均高于对照组（P<0.05）。结论多组分运动护理干预可有效改善老年慢性心力衰竭患者的衰弱状态，提高其日常生活活动能力和生活质量。

关键词: 心力衰竭, 老年, 衰弱, 运动干预, 康复护理

Abstract:

Objective To investigate the effects of a multi-component exercise nursing intervention on frailty，activities of daily living and quality of life in elderly patients with chronic heart failure. Methods Through literature analysis and expert meeting，the multi-component exercise nursing intervention program was formed. A total of 71 elderly patients with chronic heart failure who admitted from January 2022 to September 2022 in a tertiary A hospital in Shandong Province were randomly divided into an intervention group（35 cases） and a control group（36 cases）. The control group received usual care，while the intervention group received an additional multi-component exercise nursing training. 2 groups were evaluated by Tilburg frailty indicator scale，modified Barthel index scale and 12-item short form health survey scale before the intervention，4 weeks and 12 weeks after the intervention. Results A total of 62 patients（31 in the experimental group and 31 in the control group） completed the study. Generalized estimation equation results showed that the inter-group effect，time effect and interaction effect of frailty，activities of daily living and quality of life in the 2 groups were statistically significant（P<0.05）. At 4 weeks and 12 weeks after the intervention，the Tilburg Frailty Indicator scale scores in the intervention group were lower than that in the control group（P<0.05），and the scores of the modified Barthel index scale and 12-item short form health survey scale were significantly higher than those in the control group（P<0.05）. Conclusion The multi-component exercise nursing intervention can effectively improve frailty，activities of daily living and quality of life in elderly patients with chronic heart failure.

Key words: Heart Failure, Elderly, Frailty, Exercise Intervention, Rehabilitation Nursing

梁倩, 汪晓丽, 刘梦琪, 王九瑞, 栾晓嵘. 多组分运动护理干预在老年慢性心力衰竭合并衰弱患者中的应用[J]. 中华护理杂志, 2023, 58(23): 2821-2828.

LIANG Qian, WANG Xiaoli, LIU Mengqi, WANG Jiurui, LUAN Xiaorong. Effects of multi-component exercise nursing intervention on frailty in elderly patients with chronic heart failure[J]. Chinese Journal of Nursing, 2023, 58(23): 2821-2828.

图/表 5

表1 多组分运动处方

Table 1 Multi-component exercise prescription

表2 两组一般资料比较（n=71）

Table 2 General baseline data of the 2 groups of patients（n=71）

表3 两组Tilburg衰弱量表评分比较

Table 3 Comparison of TFI scores between the 2 groups before and after intervention

表4 两组改良Barthel指数量表得分比较（分，$\bar{x}±s$）

Table 4 Comparison of MBI scores between the 2 groups before and after intervention（scores，$\bar{x}±s$）

表5 两组简易生活质量量表评分比较（分，$\bar{x}±s$）

Table 5 Comparison of SF-12 scores between the 2 groups before and after intervention（scores，$\bar{x}±s$）

参考文献 29

[1]	王斗, 丛雪, 周雅静, 等. 衰弱老年人管理循证指南的质量评价[J]. 中华护理杂志, 2020, 55(2):237-242. DOI
	Wang D, Cong X, Zhou YJ, et al. Quality evaluation of evidence-based guidelines for the management of frail elderly[J]. Chin J Nurs, 2020, 55(2):237-242. DOI
[2]	Zheng PP, Yao SM, He W, et al. Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients[J]. BMC Geriatr, 2021, 21(1):125. DOI
[3]	Yang Y, Liu YF, Zhang ZY, et al. Frailty and predictive factors in Chinese hospitalized patients with heart failure:a structural equation model analysis[J]. Eur J Cardiovasc Nurs, 2023, 22(4):400-411.
[4]	Dent E, Morley JE, Cruz-Jentoft AJ, et al. International clinical practice guidelines for sarcopenia(ICFSR):screening,diagnosis and management[J]. J Nutr Health Aging, 2018, 22(10):1148-1161. DOI PMID
[5]	黄宏燕, 戴曦, 胡蓉, 等. 多组分运动对老年衰弱患者营养状况和肌肉功能的影响[J]. 中国实用护理杂志, 2022, 38(7):530-536.
	Huang HY, Dai X, Hu R, et al. Effects of multicomponent training on nutritional status and muscle function in frail elderly adults[J]. Chin J Prac Nurs, 2022, 38(7):530-536.
[6]	Cho J, Choi Y, Sajgalik P, et al. Exercise as a therapeutic strategy for sarcopenia in heart failure:insights into underlying mechanisms[J]. Cells, 2020, 9(10):2284. DOI URL
[7]	中华护理学会老年护理专业委员会, 中国康复医学会心血管疾病预防与康复专业委员会, 中国老年保健协会脏器康复专业委员会, 等. 心脏康复护理专家共识[J]. 中华护理杂志, 2022, 57(16):1937-1941.
	Geriatric Nursing Committee of Chinese Nursing Association,Committee of Cardiac Rehabilitation and Prevention of Chinese Association of Rehabilitation Medicine, Organ Rehabilitation Committee of Chinese Elder Health Care Association, et al. Chinese expert consensus on cardiac rehabilitation nursing care[J]. Chin J Nurs, 2022, 57(16):1937-1941.
[8]	岳敏, 寇京莉, 周凤月, 等. 多组分运动干预对老年稳定性冠心病患者合并衰弱状态的影响[J]. 实用医院临床杂志, 2022, 19(2):111-114.
	Yue M, Kou JL, Zhou FY, et al. The effect of multi-component exercise intervention on elderly patients with stable coronary heart disease complicated with frailty[J]. Pract J Clin Med, 2022, 19(2):111-114.
[9]	张爽, 陈影, 孙娜雅, 等. 综合运动训练对老年糖尿病患者衰弱和躯体功能的影响[J]. 中华护理杂志, 2020, 55(10):1445-1451. DOI
	Zhang S, Chen Y, Sun NY, et al. Effects of multi-component exercise training on frailty and physical function in elderly diabetic patients in communities[J]. Chin J Nurs, 2020, 55(10):1445-1451. DOI
[10]	Jonathan, Afilalo, Md M, et al. Frailty assessment in the cardiovascular care of older adults[J]. J Am Coll Cardiol, 2014, 63(8):747-762. DOI PMID
[11]	Dent E, Morley JE, Cruz-Jentoft AJ, et al. Physical Frailty:ICFSR international clinical practice guidelines for identification and management[J]. J Nutr Health Aging, 2019, 23(9):771-787. DOI PMID
[12]	Dent E, Lien C, Lim WS, et al. The Asia-Pacific clinical practice guidelines for the management of frailty[J]. J Am Med Dir Assoc, 2017, 18(7):564-575. DOI PMID
[13]	Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure:JACC expert panel[J]. J Am Coll Cardiol, 2021, 77(11):1454-1469. DOI PMID
[14]	Kitzman DW, Whellan DJ, Duncan P, et al. Physical rehabilitation for older patients hospitalized for heart failure[J]. N Engl J Med, 2021, 385(3):203-216. DOI URL
[15]	Reeves GR, Whellan DJ, O’Connor CM, et al. A novel rehabilitation intervention for older patients with acute decompensated heart failure:the REHAB-HF pilot study[J]. JACC Heart Fail, 2017, 5(5):359-366. DOI URL
[16]	Hanon O, Belmin J, Benetos A, et al. Consensus of experts from the French Society of Geriatrics and Gerontology on the management of heart failure in very old subjects[J]. Arch Cardiovasc Dis, 2021, 114(3):246-259. DOI PMID
[17]	中国康复医学会心血管病专业委员会, 中国老年学学会心脑血管病专业委员会. 慢性稳定性心力衰竭运动康复中国专家共识[J]. 中华心血管病杂志, 2014, 42(9):714-720.
	Cardiovascular Rehabilitation Branch-Chinese Association of Rehabilitation Medicine,China Committee of Cardio-Cerebral-Vascular Diseases of GSC. China expert consensus on exercise rehabilitation of chronic stable heart failure[J]. Chin J Cardiol, 2014, 42(9):714-720.
[18]	中国康复医学会心血管病预防与康复专业委员会. 慢性心力衰竭心脏康复中国专家共识[J]. 中华内科杂志, 2020, 59(12):942-952.
	Professional Committee of Cardiovascular Prevention and Rehabilitation of Chinese Rehabilitation Medical Association. Expert consensus on cardiac rehabilitation for chronic heart failure in China[J]. Chin J Intern Med, 2020, 59(12):942-952.
[19]	Heydari A, Khorashadizadeh F. Pender’s health promotion model in medical research[J]. J Pak Med Assoc, 2014, 64(9):1067-1074. PMID
[20]	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
	Chinese Society of Cardiology,Chinese Medical Doctor Association Heart Failure Professional Committee, Editorial Committee of the Chinese Journal of Cardiovascular Disease. China guidelines for diagnosis and treatment of heart failure 2018[J]. Chin J Cardiol, 2018, 46(10):760-789.
[21]	Gobbens RJ, van Assen MA, Luijkx KG, et al. The Tilburg frailty indicator:psychometric properties[J]. J Am Med Dir Assoc, 2010, 11(5):344-355. DOI URL
[22]	奚兴, 郭桂芳, 孙静. 中文版Tilburg衰弱评估量表的信效度研究[J]. 护理学报, 2013, 20(16):1-5.
	Xi X, Guo GF, Sun J. Reliability and validity of Chinese version of Tilburg frailty indicator[J]. J Nurs, 2013, 20(16):1-5.
[23]	Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel index for stroke rehabilitation[J]. J Clin Epidemiol, 1989, 42(8):703-709. DOI PMID
[24]	李奎成, 唐丹, 刘晓艳, 等. 国内Barthel指数和改良Barthel指数应用的回顾性研究[J]. 中国康复医学杂志, 2009, 24(8):737-740.
	Li KC, Tang D, Liu XY, et al. Review of the application of Barthel Index and Modified Barthel Index in Mainland China[J]. Chin J Rehabil Med, 2009, 24(8):737-740.
[25]	Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey:construction of scales and preliminary tests of reliability and validity[J]. Med Care, 1996, 34(3):220-233. DOI PMID
[26]	Shou J, Ren LM, Wang HT, et al. Reliability and validity of 12-item Short-Form health survey(SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai[J]. Aging Clin Exp Res, 2016, 28(2):339-346. DOI URL
[27]	宋晓月. 居家运动对伴有衰弱的高血压患者干预效果研究[D]. 郑州: 郑州大学, 2018.
	Song XY. Study on intervention effect of home exercise on hypertension patients with weakness[D]. Zhengzhou: Zhengzhou University, 2018.
[28]	肖伽, 李冬英, 胡晓莹, 等. 高强度间歇与中强度持续训练对患者心脏康复效果的Meta分析[J]. 中华护理杂志, 2020, 55(1):134-140. DOI
	Xiao J, Li DY, Hu XY, et al. Effects of high intensity interval training and moderate continuous training on cardiac rehabilitation:a meta-analysis[J]. Chin J Nurs, 2020, 55(1):134-140.
[29]	项琳, 吴疆. 多元运动干预对老年心血管疾病患者衰弱状态和运动功能的影响[J]. 护理实践与研究, 2022, 19(14):2063-2068.
	Xiang L, Wu J. Effects of multi-exercise intervention on frailty and motor function in elderly patients with cardiovascular disease[J]. Nurs Pract Res, 2022, 19(14):2063-2068.