论文部分内容阅读
目的对老年慢性心力衰竭患者进行营养风险筛查,探讨个体化营养支持对其心功能的影响。方法选取2015年1-12月在青岛市市立医院干部保健科因慢性心力衰竭(CHF)急性发作[心功能分级(NYHA)Ⅲ~IV级]而住院的96例老年患者为研究对象,所有患者均行营养风险筛查(NRS2002)方法评分,≥3分者共71例,采用随机、单盲法将患者分为个体化营养支持组(IN组,24例)、肠内营养组(EN组,23例)和肠外营养组(PN组,24例),3组患者均给予营养支持治疗10 d和抗心衰常规治疗,3组治疗前后均进行血清白蛋白(ALB)、前白蛋白(PA)、C反应蛋白(CRP)、B型钠尿肽(BNP)及左心室射血分数(LVEF)测定。用SPSS 17.0软件进行配对t检验,独立样本t检验和χ2检验。结果心功能Ⅲ级患者中营养风险发生率为72.0%(36/50),心功能Ⅳ级患者中营养风险发生率为76.1%(35/46)。不同心功能分级组营养风险的发生率,差异无统计学意义(P>0.05)。≥80岁组营养风险的发生率(86.7%)明显高于<80岁组(62.7%),差异有统计学意义(P<0.05)。3组治疗后,ALB、PA、LVEF均有不同程度升高,CRP、BNP均有不同程度降低,差异均有统计学意义(P<0.05,P<0.01)。治疗后,IN组的PA与EN组比较明显升高,而CRP、BNP与PN组比较明显下降,LVEF与PN组比较明显升高,差异均有统计学意义(P<0.05)。IN组、EN组和PN组不良反应发生率分别为8.3%、21.7%和25.0%,IN组无严重不良反应发生。结论老年CHF患者在常规治疗心衰的同时给予营养风险筛查,对高营养风险患者及时给予个体化营养支持治疗,可改善老年CHF患者的心功能和营养状态,更好地维持电解质平衡,改善预后。
Objective To screen nutritional risk in elderly patients with chronic heart failure and explore the influence of individualized nutritional support on their cardiac function. Methods A total of 96 elderly patients hospitalized in the Department of Health Care of Qingdao Municipal Hospital from January 2015 to January 2015 were enrolled for the acute episode of chronic heart failure (NYHA Ⅲ ~ Ⅳ). All the patients All patients were enrolled in nutrition risk screening (NRS2002) method, with a score of ≥3 in 71 cases. Patients were divided into individualized nutritional support group (IN group, 24 cases), enteral nutrition group (EN group , 23 cases) and parenteral nutrition group (PN group, 24 cases). All three groups were given nutrition supportive therapy for 10 days and anti-heart failure routine treatment. Serum albumin (ALB), prealbumin (PA), C-reactive protein (CRP), B-type natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) Paired t-test with SPSS 17.0 software, independent sample t-test and χ2 test. Results The incidence of nutritional risk in patients with grade Ⅲ cardiac function was 72.0% (36/50). The incidence of nutritional risk in patients with grade Ⅳ cardiac function was 76.1% (35/46). The incidence of nutritional risk in different cardiac function classification group had no statistical significance (P> 0.05). The incidence of nutritional risk ≥80 years old group (86.7%) was significantly higher than that of <80 years old group (62.7%), the difference was statistically significant (P <0.05). The levels of ALB, PA and LVEF in all three groups increased to different extents, while CRP and BNP all decreased to some extent (all P <0.05, P <0.01). After treatment, the levels of PA and EN in IN group were significantly higher than those in EN group, while the levels of CRP and BNP in PN group were significantly decreased. LVEF and PN group were significantly higher than those in PN group (P <0.05). The incidence of adverse reactions in IN group, EN group and PN group were 8.3%, 21.7% and 25.0%, respectively. No serious adverse reactions occurred in IN group. CONCLUSIONS: Elderly patients with CHF are routinely diagnosed with heart failure and nutritional risk screening, and patients with high nutritional risk in a timely manner to give personalized nutrition support treatment can improve heart function and nutritional status of elderly CHF patients to better maintain electrolyte balance and improve Prognosis.