影响老年慢性心力衰竭住院患者营养不良相关因素及多指标联合预测指导下的精准营养管理

Factors influencing malnutrition in older inpatients with chronic heart failure and precise nutritional management guided by multi-index combined prediction

中文关键词: 老年    慢性心力衰竭    营养不良    相关因素    多元化管理模式    心功能

英文关键词: older adultschronic heart failuremalnutritionrelated factordiversified management modelcardiac function

中文摘要:

      目的 探讨老年慢性心力衰竭（CHF）住院患者发生营养不良的相关危险因素，并分析多元化营养管理模式在该类患者中的应用效果。方法 采用横断面联合前瞻性随机对照干预的混合研究设计，纳入2023年1月至2025年6月海安市人民医院收治的286例老年CHF住院患者为研究对象，采用心力衰竭专用微型营养评定（MNAHF）量表评估营养状况，将MNAHF评分<16分者纳入营养不良组（n=101）,MNAHF评分≥16分者纳入非营养不良组（n=185）。收集患者一般资料、临床指标、心功能分级等信息，采用单因素和多因素Logistic回归分析筛选老年CHF患者营养不良的独立危险因素;前瞻性干预阶段仅纳入营养不良组101例患者，采用随机数字表法将患者随机分为对照组（n=50，实施常规营养干预）和观察组（n=51，实施多元化营养管理模式），比较2组干预前后的营养指标、心功能指标、临床结局及生活质量。结果 286例老年CHF住院患者中营养不良发生率为35.32%;单因素分析显示，营养不良组与非营养不良组在基本人口学指标、患病情况及住院相关指标中的13个指标具有统计学差异（均P <0.05）;共线性分析及多因素Logistic回归分析证实，年龄、NYHA心功能Ⅲ～Ⅳ级、白蛋白、合并吞咽障碍、住院时间是老年CHF住院患者营养不良的独立危险因素（P均<0.05），且上述指标联合检测对营养不良的预测效能最优（曲线下面积=0.890，灵敏度77.23%，特异度87.57%）。干预后6个月，对照组与观察组的营养指标（白蛋白、血红蛋白、前白蛋白、体重指数）、心功能指标（左室射血分数、N末端脑钠肽前体）及生活质量（明尼苏达心力衰竭生活质量问卷评分）均较干预前显著改善（P均<0.05），且观察组各指标改善程度均显著优于对照组（P均<0.05）;随访6个月，观察组患者再住院发生率为7.84%（4/51），对照组为30.00%（15/50）;观察组再住院率显著低于对照组（χ²=4.11,P=0.043）。结论 老年CHF住院患者营养不良发生率高，多指标联合预测可实现早期高风险识别，指导分层、个体化、精准营养管理，显著改善营养与心功能、降低再住院率。

英文摘要:

      Objective To investigate the risk factors for malnutrition in older inpatients with chronic heart failure(CHF)and to evaluate the application effect of a diversified nutrition management model in these patients.Methods A mixed study design combing a cross-sectional survey and prospective randomized controlled intervention was adopted.A total of 286 older CHF inpatients admitted to People' s Hospital of Hai' an City from January 2023 to June 2025 were enrolled.Nutritional status was assessed using the mini-nutritional assessment special for heart failure(MNAHF)scale.Patients with a score＜16 were assigned to the malnutrition group(n=101),and those with a score≥16 were assigned to the non-malnutrition group(n=185).Demographic data,clinical indicators,and cardiac function classification were collected.Univariate analysis and multivariate Logistic regression were used to identify independent risk factors for malnutrition in older CHF patients.During the prospective intervention phase,only the 101 patients in the malnutrition group were included.They were divided into a control group(n=50,receiving routine nutritional intervention)and an observation group(n=51,receiving a diversified nutritional management model)using a random number table.Nutritional indicators,cardiac function indicators,clinical outcomes,and quality of life were compared between the two groups before and after the intervention.Results The overall incidence of malnutrition among the286 older CHF inpatients was35.32%.Univariate analysis showed that the malnutrition group and the non-malnutrition group differed significantly in 13 indicators among basic demographic,clinical,disease-related,and hospitalization-related variables(all P＜0.05).Collinearity analysis and multivariate Logistic regression analysis identified age,NYHA class Ⅲ～Ⅳ,albumin,concomitant swallowing dysfunction,and length of hospital stay as independent risk factors for malnutrition in older CHF inpatients(all P＜0.05).The combined detection of these indicators yielded the best predictive performance for malnutrition,with an AUC of 0.890,a sensitivity of 77.23%,and a specificity of 87.57%.At 6 months after intervention,both the control group and the observation group showed significant improvements in nutritional indicators(albumin,hemoglobin,prealbumin,and body mass index),cardiac function indicators(left ventricular ejection fraction and N-terminal pro-brain natriuretic peptide),and quality of life(Minnesota living with heart failure questionnaire score)compared with baseline(all P＜0.05).The degree of improvement in all indicators was significantly greater in the observation group than in the control group(all P＜0.05).During the 6-month follow-up,the re-hospitalization rate was 7.84%(4/51)in the observation group and 30.00%(15/50)in the control group;the difference was statistically significant(x2=4.11,P=0.043).Conclusion The incidence of malnutrition is high among older CHF inpatients.Multi-indicator combined prediction can facilitate early identification of high-risk patients,guide stratified,individualized and precise nutritional management,significantly improve nutrition status and cardiac function,and reduce the re-hospitalization rate.