老年高血压病人衰弱的危险因素及其与不良预后的关系

陈丽丽; 闻立伟

doi:10.13898/j.cnki.issn.1000-2200.2020.10.023

老年高血压病人衰弱的危险因素及其与不良预后的关系

Risk factors of frailty in elderly patients with hypertension, and their relationship with poor prognosis

摘要

摘要:
目的探讨老年高血压病人衰弱的危险因素及其与不良预后的关系。
方法选取420例老年高血压病人为研究对象，采用Fried量表进行衰弱评估，根据评估结果将所有病人分为衰弱组和非衰弱组，分析老年高血压病人衰弱的相关影响因素，采用多因素logistic分析衰弱的危险因素，随访病人的再入院情况，通过cox回归模型分析衰弱与老年高血压病人再入院的关系。
结果420例老年高血压病人中，衰弱组165例，占39.29%；非衰弱组255例，占60.71%，包括正常病人95例（22.62%）和衰弱前期病人160例（38.09%）；单因素分析结果显示，衰弱组与非衰弱组病人在年龄、MNA-SF评分、MMSE评分、合并症数量、骨质疏松、冠心病、脑血管病、慢性阻塞性肺疾病以及心功能不全方面差异均有统计学意义（P < 0.05~P < 0.01）；在性别、体质量指数、血压、吸烟史、饮酒史、糖尿病方面差异均无统计学意义（P>0.05）；二分类logistic回归分析显示年龄、营养不良、认知功能下降、骨质疏松以及心功能不全均为老年高血压病人发生衰弱的独立危险因素（P < 0.01）；衰弱组病人再入院率明显高于非衰弱组（51.52% vs 25.49%）（P < 0.01）；多因素cox模型进行回归分析，结果显示年龄、衰弱、贫血、合并症数量≥5种以及尿蛋白阳性均与病人再入院相关（P < 0.01）。
结论老年高血压合并衰弱病人的再入院风险要高于非衰弱病人，通过管理好衰弱发生的危险因素，并针对性的调整治疗方案，可提高病人的生活质量，改善预后。

Abstract:
ObjectiveTo explore the risk factors of frailty in elderly patients with hypertension, and their relationship with poor prognosis.
Methods The frailty assessment in 420 patients with hypertension were implemented using the Fried scale, and all patients were divided into the frailty group and non-frailty group according to the evaluation results.The related influencing factors of frailty in elderly hypertensive patients were analyzed, and the risk factors of frailty were analyzed using multivariate logistic analysis.The readmission of the patients was followed up, and the relationship between frailty and readmission in elderly patients with hypertension was analyzed by cox regression model.
ResultsAmong 420 elderly patients with hypertension, 165 cases were in the frailty group(accounting for 39.29%), and 255 patients in the non-frailty group(accounting for 60.71%).The non-frailty group included 95 normal patients(22.62%) and 160 pre-frailty patients(38.09%).The results of univariate analysis showed that the differences of the age, MNA-SF score, MMSE score, number of complications, osteoporosis, coronary heart disease, cerebrovascular disease, chronic obstructive pulmonary disease and cardiac insufficiency were statistically significant between the two groups(P < 0.05 to P < 0.01), and the differences of the gender, body mass index, blood pressure, smoking history, drinking history and diabetes were not statistically significant between the two groups(P>0.05).The results of the dichotomous logistic regression analysis showed that the age, malnutrition, cognitive decline, osteoporosis, and cardiac insufficiency were the independent risk factors of frailty in elderly hypertensive patients(P < 0.01).The rate of readmission in frailty group was significantly higher than that in non-frailty group(51.52% vs 25.49%)(P < 0.01).The results of multivariate cox model analysis showed that the age, weakness, anemia, ancomorbidities and positive urinary protein were associated with readmission of patients(P < 0.01).
ConclusionThe risk of readmission in elderly patients with hypertension complicated with frailty is higher than that in non-frailty patients.Managing the risk factors of frailty and adjusting the treatment plan can improve the quality of life and prognosis of patients.

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