老年慢性心力衰竭患者认知功能对自我护理行为影响的研究

摘要/Abstract

摘要： 目的探讨老年（≥60岁）CHF患者认知功能对自我护理行为的影响。方法便利选取2021年11月至2022年4月天津市某三级甲等医院心血管内科住院的老年CHF患者103例作为研究对象,采用自行设计的一般资料调查表、蒙特利尔认知评估量表、中文版欧洲心力衰竭自我护理行为量表、抑郁自评量表、社会支持评定量表进行调查。结果 103例老年CHF患者的认知功能总分为13-30分,平均（24.17±3.11）分;自我护理行为总分为23-55分,平均（40.24±4.87）分。多元线性回归分析显示,影响老年CHF患者自我护理行为的因素有社会支持、抑郁和认知功能（P<0.05）。其中,CHF患者的社会支持水平越低,自我护理行为水平越低（β=-0.367,P=0.001）;抑郁得分越高,自我护理行为水平越差（β=0.229,P=0.02）;老年CHF患者的认知功能越差,自我护理行为水平越低（β=-0.218,P=0.046）。结论老年CHF患者的自我护理行为受社会支持、抑郁和认知功能的影响。因此,在临床工作中,医务人员应加强老年CHF患者社会支持、抑郁和认知功能的评估,及早识别社会支持水平低、抑郁和认知功能障碍的老年CHF患者并采取针对性的干预措施,以提高其自我护理行为。

关键词: 慢性心力衰竭, 认知功能, 自我护理行为, 影响因素

杨慧锋, 王研, 牛伟华. 老年慢性心力衰竭患者认知功能对自我护理行为影响的研究[J]. 心血管病防治知识, 2023, 13(27): 37-42.

参考文献

[1] Zhang Y,Zhang J,Butler J,et al.Contemporary Epidemiology, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: Results From the China Heart Failure (China-HF) Registry[J]. J Card Fail,2017,23(12): 868-875.
[2] Virani S S,Alonso A,Aparicio H J,et al.Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association[J]. Circulation,2021,143(8): e254-e743.
[3] Lee K S,Lennie T A,Warden S,et al.A comprehensive symptom diary intervention to improve outcomes in patients with HF: a pilot study[J]. J Card Fail,2013,19(9): 647-654.
[4] Buck H G,Dickson V V,Fida R,et al.Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care[J]. Int J Nurs Stud,2015,52(11): 1714-1722.
[5] Abe R,Sakata Y,Nochioka K,et al.Gender differences in prognostic relevance of self-care behaviors on mortality and hospitalization in patients with heart failure - A report from the CHART-2 Study[J]. J Cardiol,2019,73(5): 370-378.
[6] Koirala B,Himmelfarb C D,Budhathoki C,et al.Factors affecting heart failure self-care: An integrative review[J]. Heart Lung,2018,47(6): 539-545.
[7] Sedlar N,Lainscak M,Martensson J,et al.Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies[J]. Eur J Cardiovasc Nurs,2017,16(4): 272-282.
[8] Cameron J,Gallagher R,Pressler S J.Detecting and Managing Cognitive Impairment to Improve Engagement in Heart Failure Self-Care[J]. Curr Heart Fail Rep,2017,14(1): 13-22.
[9] Choi S,Roy B,Kumar R,et al.Heart Failure Self-care Associated With Brain Injury in Executive Control Regions[J]. J Cardiovasc Nurs,2019,34(6): 433-439.
[10] Currie K,Rideout A,Lindsay G,et al.The Association Between Mild Cognitive Impairment and Self-care in Adults With Chronic Heart Failure: A Systematic Review and Narrative Synthesis[J]. J Cardiovasc Nurs,2015,30(5): 382-393.
[11] Adelborg K,Horváth-Puhó E,Ording A,et al.Heart failure and risk of dementia: a Danish nationwide population-based cohort study[J]. Eur J Heart Fail,2017,19(2): 253-260.
[12] Ampadu J,Morley J E.Heart failure and cognitive dysfunction[J]. Int J Cardiol,2015,178: 12-23.
[13] Rusanen M,Kivipelto M,Levalahti E,et al.Heart diseases and long-term risk of dementia and Alzheimer's disease: a population-based CAIDE study[J]. J Alzheimers Dis,2014,42(1): 183-191.
[14] Harkness K,Heckman G A,Akhtar-Danesh N,et al.Cognitive function and self-care management in older patients with heart failure[J]. Eur J Cardiovasc Nurs,2014,13(3): 277-284.
[15] Uchmanowicz I,Jankowska-Polańska B,Mazur G,et al.Cognitive deficits and self-care behaviors in elderly adults with heart failure[J]. Clin Interv Aging,2017,12: 1565-1572.
[16] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志,2018,46(10): 760-789.
[17] Nasreddine Z S,Phillips N A,Bedirian V,et al.The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc,2005,53(4): 695-699.
[18] 刘雪琴,张立秀. 蒙特利尔认知评估量表中文版的信效度研究[J]. 护理研究,2007,(31): 2906-2907.
[19] Jaarsma T,Stromberg A,Martensson J,et al.Development and testing of the European Heart Failure Self-Care Behaviour Scale[J]. Eur J Heart Fail,2003,5(3): 363-370.
[20] 钟克丹,王丽萍,王丽姿. 老年慢性心力衰竭患者自我护理行为的调查与分析[J]. 解放军护理杂志,2009,26(08): 22-24.
[21] Zung W W.A SELF-RATING DEPRESSION SCALE[J]. Arch Gen Psychiatry,1965,12: 63-70.
[22] 张作记. 行为医学量表手册[M/CD].北京:中华医学电子音像出版社,2005:223-224.
[23] 肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994(02): 98-100.
[24] Vellone E,Chialà O,Boyne J,et al.Cognitive impairment in patients with heart failure: an international study[J]. ESC Heart Fail,2020,7(1): 46-53.
[25] Kim E Y,Son Y J.Association between Anemia and Cognitive Impairment among Elderly Patients with Heart Failure[J]. Int J Environ Res Public Health,2019,16(16): 2933.
[26] Yang M,Sun D,Wang Y,et al.Cognitive Impairment in Heart Failure: Landscape, Challenges, and Future Directions[J]. Front Cardiovasc Med,2021,8: 831734.
[27] de la Torre J C. Hemodynamic Instability in Heart Failure Intensifies Age-Dependent Cognitive Decline[J]. J Alzheimers Dis,2020,76(1): 63-84.
[28] Dolansky M A,Hawkins M A W,Schaefer J T,et al. Association between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients with Heart Failure[J]. Circ Heart Fail,2016,9(12): e2475.
[29] Kim J S,Hwang S Y,Shim J L,et al.Cognitive Function and Self-Care in Patients with Chronic Heart Failure[J]. Korean Circ J,2015,45(4): 310-316.
[30] Harkness K,Heckman G A,Akhtar-Danesh N,et al.Cognitive function and self-care management in older patients with heart failure[J]. Eur J Cardiovasc Nurs,2014,13(3): 277-284.
[31] Kamrani A A,Foroughan M,Taraghi Z,et al.Self care behaviors among elderly with chronic heart failure and related factors[J]. Pak J Biol Sci,2014,17(11): 1161-1169.
[32] Lovell J,Pham T,Noaman S Q,et al.Self-management of heart failure in dementia and cognitive impairment: a systematic review[J]. BMC Cardiovasc Disord,2019,19(1): 99.
[33] Cameron J,Gallagher R,Pressler S J.Detecting and Managing Cognitive Impairment to Improve Engagement in Heart Failure Self-Care[J]. Curr Heart Fail Rep,2017,14(1): 13-22.
[34] Currie K,Rideout A,Lindsay G,et al.The Association Between Mild Cognitive Impairment and Self-care in Adults With Chronic Heart Failure: A Systematic Review and Narrative Synthesis[J]. J Cardiovasc Nurs,2015,30(5): 382-393.
[35] Freedland K E,Skala J A,Steinmeyer B C,et al.Effects of Depression on Heart Failure Self-Care[J]. J Card Fail,2021,27(5): 522-532.
[36] Hajduk A M,Lemon S C,Mcmanus D D,et al.Cognitive impairment and self-care in heart failure[J]. Clin Epidemiol,2013,5: 407-416.
[37] Dickson V V,Tkacs N,Riegel B.Cognitive influences on self-care decision making in persons with heart failure[J]. Am Heart J,2007,154(3): 424-431.
[38] Davis K K,Himmelfarb C R,Szanton S L,et al.Predictors of heart failure self-care in patients who screened positive for mild cognitive impairment[J]. J Cardiovasc Nurs,2015,30(2): 152-160.
[39] Lee K S,Choi J O,Jeon E S,et al.Distinct Factors Associated With Better Self-care in Heart Failure Patients With and Without Mild Cognitive Impairment[J]. J Cardiovasc Nurs,2019,34(6): 440-447.