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[射血分数保留的心力衰竭患者的生活质量与弯腰呼吸症状]

[Quality of life in patients with heart failure with preserved ejection fraction and the bendopnea symptom].

作者信息

Dragunov D O, Sokolova A V, Arutyunov G P, Gasanova A D, Latyshev T V

机构信息

Pirogov Russian National Research Medical University.

Municipal Outpatient Hospital #6 of the Moscow Healthcare Department.

出版信息

Kardiologiia. 2019 Jul 24;59(6S):24-32. doi: 10.18087/cardio.2507.

Abstract

The study of quality of life (QOL) in patients with CHF with preserved LVEF (left ventricular ejection fraction) and a symptom of bendopnea with different levels of salt intake. Materials and methods. The study included 66 patients. The main symptoms of CHF were edema in 54.5% of cases, dyspnea in 77% of cases, ascites was detected in only 2 patients, an enlarged liver in 7 patients. Abdominal obesity was detected in 53 patients. Quality of life was assessed by the SF‑36 questionnaire, the level of salt intake was assessed by the Charlton: SaltScreener questionnaire. Results. On average, the time of occurrence of the bendopnea was 22.5±9.3 seconds, the minimum was 5 seconds. The absence of the effect of abdominal obesity on the risk of bendopnea (relative risk 1.18 [0.76; 1.83]) was revealed. According to the SF‑36 questionnaire, a decrease in physical health indicators (median 31.3 points [20.7; 42.3]) and psychological health (average score 43.2±21.7) was found. In patients with bendopnea, QOL was reduced due to both physical and mental health, unlike patients without bendopnea: physical functioning (Physical Functioning - PF) 24.8±16.1 against 47±28.9 points, p=0.001 ; role‑based functioning due to physical condition (Role‑Physical Functioning - RP), 0 [0; 25] vs. 37.5 [0; 100] points, p=0.008; general health (General Health - GH) 29.9±15.8 against 50±14.2 points, p=0.0005, social functioning (Social Functioning - SF) 56 ± 38 against 78.9 ± 17.8 points ; p = 0.004. Multidimensional regression analysis revealed the relationship between the time of occurrence of the symptom bendopnea and the level of salt intake, physical and psychological activity (r2=0.25; p<0.009). The time of onset of the symptom of bendopnea in patients with CHF decompensation was significantly longer (18.9±8.7 vs. 26.2±8.5 seconds, p=0.003). The presence of diseases such as hypertension, COPD, IHD, atrial fibrillation, cerebrovascular disease did not significantly affect QOL (p> 0.05), while the presence of bronchial asthma or chronic kidney disease significantly reduced QOL of patients (p<0.05). Conclusion. The presence of the symptom bendopnea significantly reduces the quality of life of patients with CHF with preserved LVEF (left ventricular ejection fraction).

摘要

对左心室射血分数(LVEF)保留且有端坐呼吸症状的慢性心力衰竭(CHF)患者在不同盐摄入量水平下的生活质量(QOL)进行研究。材料与方法。该研究纳入了66例患者。CHF的主要症状中,54.5%的病例出现水肿,77%的病例出现呼吸困难,仅2例检测到腹水,7例肝脏肿大。53例检测到腹部肥胖。生活质量通过SF-36问卷进行评估,盐摄入量水平通过查尔顿:盐筛查问卷进行评估。结果。平均而言,端坐呼吸出现的时间为22.5±9.3秒,最短为5秒。研究发现腹部肥胖对端坐呼吸风险无影响(相对风险1.18 [0.76;1.83])。根据SF-36问卷,发现身体健康指标下降(中位数31.3分[20.7;42.3])以及心理健康下降(平均得分43.2±21.7)。与无端坐呼吸的患者不同,有端坐呼吸的患者由于身体和心理健康问题导致生活质量下降:身体功能(Physical Functioning - PF)24.8±16.1分对比47±28.9分,p = 0.001;因身体状况导致的基于角色的功能(Role-Physical Functioning - RP),0 [0;25]分对比37.5 [0;100]分,p = 0.008;总体健康(General Health - GH)29.9±15.8分对比50±14.2分,p = 0.0005,社会功能(Social Functioning - SF)56±38分对比78.9±17.8分;p = 0.004。多维度回归分析揭示了端坐呼吸症状出现时间与盐摄入量水平、身体和心理活动之间的关系(r2 = 0.25;p <0.009)。CHF失代偿患者端坐呼吸症状的发作时间显著更长(18.9±8.7秒对比26.2±8.5秒,p = 0.003)。高血压、慢性阻塞性肺疾病(COPD)、缺血性心脏病(IHD)、心房颤动、脑血管疾病等疾病的存在对生活质量无显著影响(p>0.05),而支气管哮喘或慢性肾脏病的存在显著降低了患者的生活质量(p <0.05)。结论。端坐呼吸症状的存在显著降低了左心室射血分数保留的CHF患者的生活质量。

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