摘要
目的在国内首次将老年综合评估用于心脏康复及老年瓣膜病评估中,探讨老年综合评估在经导管主动脉瓣置换术(TAVR)患者心脏康复中的应用价值.方法应用老年综合评估指标初次评估43例拟行TAVR的患者,老年综合评估包括一般情况、认知功能、营养状态、活动能力、精神心理问题、虚弱程度、中医症状评分、左手及右手握力和5 m步行试验.患者完成第1次老年综合评估后,即启动心脏康复,包括术前预康复、术后住院期间及出院后康复指导,并采用中西医结合方法.心脏康复治疗后1个月常规随访,比较心脏康复前后各指标差异.结果 43例患者中,简易智能状态检查量表(MMSE)评分(25.44±2.26)分,轻度及以上认知功能障碍占60.47%;老年人微型营养评定量表评分(22.49±3.54)分,存在营养不良风险或营养不良占62.79%;Barthel指数评分(84.65±14.24)分,存在日常生活活动能力异常占93.02%;虚弱程度评分(2.89±0.99)分,明显虚弱占76.74%.33例患者心脏康复中,治疗后存在营养不良风险比例显著低于治疗前(24.2% vs 60.6%,P=0.006);虚弱程度评分[(1.50±0.97)分vs(3.17±1.00)分,P=0.000]和明显虚弱比例降低(33.3% vs 72.7%,P=0.003).患者心脏康复治疗后较治疗前MMSE评分和握力增加,焦虑抑郁量表焦虑分量表评分降低,差异虽无统计学意义(P>0.05),但各项均有不同程度改善.结论老年综合评估可作为TAVR患者心脏康复的指导依据,以提高活动能力、调节情绪、预防患者认知功能下降,改善虚弱程度,并可作为心脏康复的效果评价指标.
Objective To study the application of multidimensional geriatric assessment(MGA)in cardiac rehabilitation of elderly valvular heart disease(VHD)patients after transcatheter aortic valve replacement(TAVR).Methods The general condition,cognitive function,nutrition,activity, psychology,weakness score,left and right hand grip strength,5-min walking test in forty-three elderly VHD patients for TAVR were assessed according to the MGA indicators,followed by preoperative, postoperative,postdischarge cardiac rehabilitation.The patients were followed up at month 1 after cardiac rehabilitation.The cardiac rehabilitation indicators were compared before and after TAVR.Results The MMSE score,MNA score,Barthel Index score,and Fried Frailty Scale score were 25.44±2.26,22.49±3.54,84.65±14.24,2.89±0.99.The incidence of mildmoderate cognitive impairment,malnutririon,abnormal living ability,and significant weakness was 60.47%,62.79%,93.02%,76.74% respectively in forty-three elderly VHD patients.The incidence of malnutrition,significant weakness and the weakness score were significantly lower in thirty-three elderly VHD patients after TAVR than before TAVR(24.2% vs 60.6%,P =0.006;33.3% vs 72.7%,P =0.003;1.50±0.97 vs 3.17±1.00,P =0.000).No significant difference was detected in cardiac rehabilitation and other indications before and after treatment(P >0.05). Conclusion MGA can improve the activity,regulate the emotion,prevent the cognitive impairment in elderly VHD patients,and can thus be used as a predictor of the efficiency for their cardiac rehabilitation after TAVR.
作者
于子凯
许海燕
齐喜玲
张倩
赵振燕
叶蕴青
王墨扬
陈可冀
吴永健
Yu Zikai;Xu Haiyan;Qi Xiling;Zhang Qian;Zhao Zhenyan;Ye Yunqing;Wang Moyang;Chen Keji;Wu Yongjian(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2019年第7期691-694,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
中国医学科学院医学与健康科技创新工程协同创新团队项目(2017-12M-3-002)
关键词
经导管主动脉瓣置换
心脏瓣膜疾病
康复
生活质量
预后
transcatheter aortic valve replacement
heart valve diseases
rehabilitation
quality of life
prognosis
