老年病房患者体位性低血压的健康与功能决定因素：一项回顾性横断面队列研究
Health and Functional Determinants of Orthostatic Hypotension in Geriatric Ward Patients: A Retrospective Cross Sectional Cohort Study.
作者信息
Wojszel Z B, Kasiukiewicz A, Magnuszewski L
机构信息
Zyta B. Wojszel, M.D., Ph.D. Department of Geriatrics, Medical University of Bialystok, Fabryczna str. 27, 15-471 Bialystok, Poland, Phone:+48 85 869 4982, e-mail:
出版信息
J Nutr Health Aging. 2019;23(6):509-517. doi: 10.1007/s12603-019-1201-2.
OBJECTIVE
Orthostatic hypotension (OH) is a common problem in older people. Although it is indicated that OH can be a marker of frailty there are no studies that evaluate this relationship in hospitalized patients. The aim of the study was to assess the prevalence of OH in geriatric ward patients and its association with health and functional ability characteristics and patients' frailty status.
DESIGN AND SETTING
A retrospective cross-sectional cohort study was conducted among patients aged 60 or over hospitalized in the geriatric ward.
PARTICIPANTS
Patients' medical records were analyzed and those with Active Standing Test (AST) results were included in the study.
MEASUREMENTS
Orthostatic hypotension was defined by a drop in blood pressure of at least 20mmHg for systolic blood pressure and at least 10mmHg for diastolic blood pressure within 3minutes of standing up in AST. The database included sociodemographic characteristics, nutritional, functional and cognitive state, comorbidity and medical treatment. Frailty syndrome was diagnosed with Clinical Frailty Scale. Correlations with OH were counted and multivariable logistic regression models were built.
RESULTS
416 patients were hospitalized in the study period and 353 (84.9%) were included, 78 (22.1%) men and 298 (84.4%) 75+ year-old. AST was not available in patients significantly more dependent in ADL and more frail. OH was diagnosed in 57 (16.2%) patients, significantly more frequently in men (systolic- 45,5%, systolic-diastolic- 40,0%). The significant independent predictors of OH were lower diastolic blood pressure at admittance, nutritional risk in MNA-SF, Parkinson disease, α1-blockers, neuroleptics and memantine, and not the frailty syndrome diagnosed with Clinical Frailty Scale.
CONCLUSIONS
OH affects a significant percentage of patients in the geriatric ward, although this problem may be underestimated due to limitations in the performance of AST in very frail and functionally dependent patients.
目的
体位性低血压（OH）是老年人的常见问题。尽管有研究表明OH可能是虚弱的一个标志，但尚无研究评估住院患者中的这种关系。本研究的目的是评估老年病房患者中OH的患病率及其与健康、功能能力特征和患者虚弱状态的关联。
设计与背景
对老年病房中60岁及以上住院患者进行了一项回顾性横断面队列研究。
参与者
分析患者的病历，将有主动站立试验（AST）结果的患者纳入研究。
测量指标
OH的定义为在AST中站立3分钟内收缩压至少下降20mmHg，舒张压至少下降10mmHg。数据库包括社会人口学特征、营养、功能和认知状态、合并症及治疗情况。采用临床虚弱量表诊断虚弱综合征。计算与OH的相关性并建立多变量逻辑回归模型。
结果
研究期间共416例患者住院，353例（84.9%）被纳入研究，其中男性78例（22.1%），75岁及以上者298例（84.4%）。在日常生活活动依赖程度更高和更虚弱的患者中，AST结果不可用。57例（16.2%）患者被诊断为OH，男性患者中诊断频率显著更高（收缩压-45.5%，收缩压-舒张压-40.0%）。OH的显著独立预测因素为入院时舒张压较低、微型营养评定简表（MNA-SF）中的营养风险、帕金森病、α1受体阻滞剂、抗精神病药物和美金刚，而非临床虚弱量表诊断的虚弱综合征。
结论
OH影响老年病房中相当比例的患者，尽管由于AST在非常虚弱和功能依赖患者中的表现受限，这个问题可能被低估。
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