慢性心力衰竭患者躯体、认知、社会衰弱共存现状及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.03.008

摘要/Abstract

摘要：

目的探讨慢性心力衰竭（chronic heart failure，CHF）患者躯体、认知、社会衰弱共存现状及其影响因素，为制订针对性的干预措施提供参考。方法便利选取2021年11月—2022年12月于天津市某三级甲等综合医院心血管内科住院的CHF患者作为调查对象，采用自行设计的一般资料调查表、FRAIL衰弱风险筛查量表、蒙特利尔认知评估量表、社会衰弱量表、社会支持评定量表和抑郁自评量表对CHF患者进行调查，并采用单因素分析和二元Logistic回归分析其影响因素。结果共发放问卷275份，回收有效问卷269份。269例CHF患者在0、1、2、3个领域存在衰弱的比例分别为12例（4.5%）、67例（24.9%）、122例（45.4%）、68例（25.3%）。根据CHF患者是否存在躯体、认知、社会衰弱共存，分为共存组和非共存组。单因素分析显示，两组在文化程度、居住地、有无心血管疾病家族史、纽约心脏协会心功能分级、是否存在心房颤动、BMI、社会支持水平和抑郁程度等方面的比较，差异具有统计学意义（P<0.05）；二元Logistic回归分析显示，文化程度（OR=0.567，95%CI为0.397~0.810，P=0.002）、是否心房颤动（OR=1.904，95%CI为1.054~3.442，P=0.033）、抑郁自评量表得分（OR=1.038，95%CI为1.006~1.071，P=0.018）是CHF患者躯体、认知、社会衰弱共存的影响因素。结论 25.3%的CHF患者躯体、认知、社会衰弱共存，文化程度高是其保护因素，心房颤动及抑郁是其危险因素，医护人员应针对CHF患者躯体、认知、社会衰弱共存现状实施针对性的干预措施，降低其衰弱的发生，改善其生活质量。

关键词: 慢性心力衰竭, 衰弱, 影响因素分析, 护理

Abstract:

Objective To investigate the status and influencing factors of the coexistence of multiple frailty domains in patients with chronic heart failure（CHF），and to provide a reference for formulating targeted intervention measures. Methods The patients with CHF hospitalized in the cardiovascular department of a tertiary general hospital in Tianjin from November 2021 to December 2022 were conveniently selected as the study subjects. The self-designed general information questionnaire，FRAIL scale，Montreal Cognitive Assessment（MoCA） scale，HALFT Scale，Social Support Rating Scale and Self-Rating Depression Scale were used to investigate the coexistence of physical，cognitive and social frailty in CHF patients，and single factor analysis and binary logistic regression analysis were used to analyze the influencing factors. Results A total of 275 questionnaires were issued and 269 valid questionnaires were collected. Among 269 patients with CHF，12（4.5%），67（24.9%），122（45.4%） and 68（25.3%） patients had 0，1，2 and 3 frailty domains，respectively. According to the patients with CHF whether coexists physical，cognitive， social frailty，divided into coexistence and non-coexistence group. In univariate analysis，there were statistically significant differences in education，residence，family history of cardiovascular disease，NYHA cardiac function grade，atrial fibrillation，BMI，social support score and depression score（P<0.05）. Binary logistic regression analysis showed that high education level（OR=0.567，95%CI 0.397~0.810，P=0.002） was the protective factor for multiple frailty domains in CHF patients，and atrial fibrillation（OR=1.904，95%CI 1.054~3.442，P=0.033） and depression（OR=1.038， 95%CI 1.006~1.071，P=0.018） were risk factors. Conclusion The prevalence of the coexistence of multiple frailty domains in CHF patients is high. Education level，atrial fibrillation and depression are potential intervention targets for multiple frailty domains in CHF patients. Targeted intervention measures should be carried out to reduce the incidence of multiple frailty domains and to improve quality of life for CHF patients.

Key words: Chronic Heart Failure, Frailty, Root Cause Analysis, Nursing Care

王思沛, 王研, 牛伟华, 杨慧锋. 慢性心力衰竭患者躯体、认知、社会衰弱共存现状及影响因素研究[J]. 中华护理杂志, 2025, 60(3): 311-318.

WANG Sipei, WANG Yan, NIU Weihua, YANG Huifeng. The current status and influencing factors of the coexistence of multiple frailty domains in patients with chronic heart failure[J]. Chinese Journal of Nursing, 2025, 60(3): 311-318.

图/表 2

表1 慢性心力衰竭患者的一般资料及躯体、认知、社会衰弱共存的单因素分析

Table 1 Characteristics and univariate analysis of the coexistence of physical, cognitive, and social frailty in patients with CHF

表2 慢性心力衰竭患者躯体、认知、社会衰弱共存影响因素的二元Logistic回归分析（n=269）

Table 2 Binary Logistic regression analysis of influencing factors of the coexistence of physical， cognitive and social frailty in patients with CHF（n=269）

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