心力衰竭患者出院后再入院的影响因素研究

摘要

目的 探讨心力衰竭患者出院后再入院的影响因素,为心力衰竭的治疗和护理提供理论依据.方法 选取2010年1月-2015年2月黄冈市黄梅县人民医院心内科收治的心力衰竭患者360例,根据患者出院后6个月内是否再入院分为再入院者152例(再入院组)和未再入院者208例(未再入院组).记录两组患者年龄、性别、文化程度、工作状态及性质、心功能分级、心力衰竭分期、心力衰竭病程、服药依从性、有无抑郁、是否低钠限水饮食、氨基末端B型利钠肽前体(NT-proBNP)水平、有无规律有氧锻炼、心力衰竭类型和心力衰竭性质;随访截至2015-09-31,截尾事件为失访、末次随访或再入院.结果 两组患者性别、年龄、心功能分级、心力衰竭分期、服药依从性、有无抑郁、是否低钠限水饮食、NT-proBNP水平及有无规律有氧运动比较,差异有统计学意义(P<0.05);两组患者文化程度、工作状态及性质、心力衰竭病程、心力衰竭类型及性质比较,差异无统计学意义(P>0.05).多因素Logistic回归分析结果显示,服药依从性〔OR=4.323,95%CI(1.875,11.252)〕、抑郁〔OR=3.815,95%CI(2.103,9.347)〕、NT-proBNP〔OR=3.215,95%CI(1.104,10.779)〕是心力衰竭患者出院后6个月内再入院的危险因素,低钠限水饮食〔OR=0.443,95%CI(0.220,0.890)〕和规律有氧锻炼〔OR=0.263,95%CI(0.254,0.273)〕是心力衰竭患者出院后6个月内再入院的保护因素(P<0.05).结论 服药依从性、抑郁及NT-proBNP是心力衰竭患者出院后再入院的危险因素,低钠限水饮食、规律有氧锻炼是心力衰竭患者出院后再入院的保护因素.%Objective To investigate the influencing factors of rehospitalization in post-discharge patients with heart failure,to provide theoretical basis for the treatment and nursing of heart failure.Methods From January 2010 to February 2015,a total of 360 patients with heart failure were selected in the Department of Cardiology,the People′s Hospital of Huangmei County,Huanggang,and they were divided into A group(with rehospitalization,n=152)and B group(without rehospitalization,n=208)according to the rehospitalization situation after 6 months of discharge.Age,gender,educational level,working status and specification,cardiac functional grading,heart failure stage,course of heart failure,medication compliance,with depression or not,received low-sodium and limit-water diet,NT-proBNP,taking regular aerobic exercise or not,heart failure types and heart failure features of the two groups were recorded;patients of the two groups were followed up to 2015-09-31,the cut-off events includes loss to follow-up,final follow-up and rehospitalization.Results There were statistically significant differences of gender,age,cardiac functional grading,heart failure stage,medication compliance,with depression or not,received low-sodium and limit-water diet,NT-proBNP,taking regular aerobic exercise or not between the two groups(P<0.05),while no statistically significant differences of educational level,working status and specification,course of heart failure,heart failure types or heart failure features was found between the two groups(P>0.05).Multivariate Logistic regression analysis results showed that,medication compliance〔OR=4.323,95%CI(1.875,11.252)〕,depression〔OR=3.815,95%CI(2.103,9.347)〕and NT-proBNP〔OR=3.215,95%CI(1.104,10.779)〕were risk factors of rehospitalization in patients with heart failure after 6 months of discharge,while low-sodium and limit-water diet〔OR=0.443,95%CI(0.220,0.890)〕and regular aerobic exercise〔OR=0.263,95%CI(0.254,0.273)〕were protective factors(P<0.05).Conclusion Medication compliance,depression and NT-proBNP are risk factors of rehospitalization in patients with heart failure after 6 months of discharge,while low-sodium and limit-water diet and regular aerobic exercise are protective factors.