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一例老年急性失代偿性心力衰竭患者的多方面评估病例

A Case of Multifaceted Assessment in an Elderly Patient With Acute Decompensated Heart Failure.

作者信息

Sako Hideto, Miyazaki Midori, Suematsu Yasunori, Koyoshi Rie, Shiga Yuhei, Kuwano Takashi, Kitajima Ken, Iwata Atsushi, Yorinaga Katsura, Fujimi Kanta, Miura Shin-Ichiro

机构信息

Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.

Division of Medical Safety Management, Fukuoka University Hospital, Fukuoka, Japan.

出版信息

Cardiol Res. 2017 Dec;8(6):339-343. doi: 10.14740/cr640w. Epub 2017 Dec 22.

Abstract

Heart failure (HF) is a common health problem worldwide, including in Japan. Unfortunately, patient outcomes remain poor, with a 5-year survival rate of approximately 50%. Therefore, we need to assess the precise conditions, including cardiac function, in patients with HF, particularly in the elderly. We performed a multifaceted assessment in an elderly patient with HF on admission and at discharge using eight different evaluations (the mean life expectancy using the Seattle Heart Failure Model (SHFM), the severity of dementia, nutrition, medication adherence, biomarker (the level of brain natriuretic peptide in blood), sociality, performance and comorbidity). Each parameter was scored on a 5-point scale (excellent = 5 points; good = 4 points; fair (average) = 3 points; poor = 2 points; failure = 1 point; maximum total points of 40) (ukuoka niversity Heart ailure coring System, FUFS). An 86-year-old male patient who complained of dyspnea and lower-leg edema was admitted to our university hospital due to acute decompensated HF. After treatment, his symptoms improved, as did his cardiothoracic ratio, plural effusion and pulmonary congestion, and he exhibited compensated HF. His total score improved from 28 to 32 points, and his mean life expectancy using SHFM increased from 4.9 to 5.4 years. We evaluated the precise conditions using a multifaceted assessment strategy in an elderly patient with HF. The strategy was useful for evaluate the patient's condition in this case.

摘要

心力衰竭(HF)是全球范围内常见的健康问题,在日本也不例外。不幸的是,患者的预后仍然很差,5年生存率约为50%。因此,我们需要评估HF患者的精确状况,包括心脏功能,尤其是老年患者。我们对一名老年HF患者在入院时和出院时进行了多方面评估,采用了八种不同的评估方法(使用西雅图心力衰竭模型(SHFM)计算平均预期寿命、痴呆严重程度、营养状况、药物依从性、生物标志物(血液中脑钠肽水平)、社交能力、身体机能和合并症)。每个参数按5分制评分(优秀 = 5分;良好 = 4分;中等(平均) = 3分;差 = 2分;极差 = 1分;总分最高40分)(九州大学心力衰竭评分系统,FUFS)。一名86岁男性患者因急性失代偿性HF入住我校医院,主诉呼吸困难和下肢水肿。经过治疗,他的症状有所改善,心胸比率、胸腔积液和肺淤血也有所改善,表现为代偿性HF。他的总分从28分提高到32分,使用SHFM计算的平均预期寿命从4.9年增加到5.4年。我们在一名老年HF患者中使用多方面评估策略评估精确状况。该策略在本病例中对评估患者状况很有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70c9/5755668/19e17c2459c7/cr-08-339-g001.jpg

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