Objective To survey the prevalence of coexisting chronic obstructive pulmonary disease ( COPD) and chronic heart failure in Chengdu communities. Methods A cross-sectional study was performed in the population aged over 40 years in eight communities of Chengdu city. The subjects were selected by stratified cluster random sampling. Using the same protocol and questionnaire, all participants underwent medical history taking, physical examination and spirometry. Results Of 354 participating patients with a diagnosis of COPD, 74 ( 20. 90% ) cases were complicated with chronic heart failure. The prevalence of chronic heart failure in COPD in male was significantly higher than that in female ( 22. 69%vs. 18. 12% , P lt; 0. 05) . The major causes of chronic heart failure were hypertension ( 31. 64% ) , ischaemic heart disease ( 18. 93% ) , chronic pulonary heart disease ( 17. 51% ) and diabetes ( 11. 86% ) .Conclusions The prevalence of coexisting COPD and chronic heart failure in Chengdu city is significantly higher than the average level of the whole country, which warrant more attention in prevention and treatment of COPD in communities.
【摘要】 目的 观察慢性心力衰竭营养支持治疗的疗效。 方法 将2007年1月〖CD3/5〗2009年10月期间收治的56例慢性心力衰竭住院患者随机分为常规治疗组及强化营养支持治疗组,每组28例患者。其中,强化治疗组是在常规治疗的基础上,给与强化营养支持治疗。比较两组治疗前后6 min步行距离、NYHA心功能评级及射血分数。 结果 治疗后,患者6 min步行距离、心功能评级强化营养治疗组优于常规治疗组。左心室射血分数两组无差异。 结论 对慢性心力衰竭患者,营养支持治疗是重要的治疗手段。【Abstract】 Objective To study the efficacy of nutritional support treatment for chronic heart failure. Methods 56 patients with chronic heart failure hospitalized patients were randomly divided into conventional therapy group and enhanced nutritional support therapy group, 28 patients in each group. Where enhenced therapy group is on the basis of conventional therapy to give extra enhanced intensive nutrition support treatment. Before and after treatment were compared sixminutes walking distance, NYHA cardiac function class, ejection fraction, mortality. Results After treatment, patients with sixminutes walking distance, cardiac function class,enhanced nutritional support therapy group is better than conventional treatment group. Left ventricular ejection fraction was no difference. Conclusion Patients with chronic heart failure, nutritional support treatment is an important treatment.
ObjectiveTo investigate the role of mindfulness-based stress reduction in improving anxiety and depression in elderly patients with chronic heart failure.MethodsFrom August 2016 to August 2018, a total of 196 elderly patients with chronic heart failure were randomly divided into the treatment group and the control group, with 98 cases in each group. The control group received routine care. The treatment group received routine care plus mindfulness-based stress reduction in two 60-minute sessions a week for 8 weeks. The level of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) was detected by electrochemiluminescence immunoassay, and left ventricular ejection fraction (LVEF) was measured by echocardiography before intervention and at week 8 of intervention; the effective rate was calculated. Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and General Well-Being scale (GWB) were used to assess the degree of anxiety, depression, and well-being of patients before intervention and at week 8 of intervention.ResultsThe serum NT-proBNP levels at week 8 of intervention in the two groups were lower than those before intervention, and the LVEFs were higher than those before intervention (P<0.05). The treatment group showed significant changes when compared with the control group (P<0.05). The effective rate of the treatment group was higher than that of the control group (89.80% vs. 69.39%, P<0.05). Before intervention, the SAS scores in the treatment group and the control group were 56.61±8.25 and 55.98±6.32, respectively, the SDS scores were 59.98±7.21 and 58.86±6.17, respectively, and the GWB scores were 53.19±12.38 and 54.06±10.93, respectively; at week 8 of intervention, the SAS scores in the treatment group and the control group were 40.56±8.17 and 46.25±5.43, respectively, the SDS scores were 42.85±5.77 and 48.34±8.01, respectively, and the GWB scores were 76.17±9.63 and 68.58±13.30, respectively. At week 8 of intervention, the SAS and SDS scores of the two groups were both lower than those before intervention, and the GWB scores were higher than those before intervention (P<0.05). The treatment group showed significant changes when compared with the control group (P<0.05).ConclusionMindfulness-based stress reduction can improve the anxiety and depression of elderly patients with chronic heart failure, improve their well-being and promote the recovery of heart function.
Objective To explore the effect of motivational interviewing (MI) on medication compliance and self-management behaviors of patients with chronic heart failure (CHF). Methods Between April 2013 and May 2015, 200 cases of CHF were randomly divided into control group (n=98) and MI group (n=102). Patients in the control group received routine nursing measures only. On the basis of routine nursing measures, patients in the MI group received MI program throughout the whole process inside and outside the hospital. The main contents of MI were medication compliance and self-management, to find the existing problems in patients’ daily living and make solutions with the patients. At the time of admission and 6 months after discharge, the Compliance Scale for Drug Treatment of Hypertension and the Self-management Scale for Patients with Heart Failure were conducted to asses the medication compliance and self-management behaviors of the two groups. Results Six months after discharge, the compliance level in the MI group was improved than that on admission with a significant difference (P<0.05), while the medication compliance in the control group was not improved significantly compared with that on admission (P>0.05). In the aspect of self-management, there was no significant difference in the control group between 6 months after discharge and on admission time (P>0.05); while the scores of diet management, drug management, symptom management, and psychological and social adjustment in the MI group (12.9±2.5, 16.1±2.8, 17.3±3.1, 17.0±2.4, respectively) were higer than those on admission (9.9±1.9, 13.3±2.7, 13.7±2.6, 12.8±2.2, respectively), with statistically significant differences (P<0.05). Conclusion MI can prompt CHF patients to improve medication compliance and the ability of self-management, and adopt a more healthy lifestyle.
ObjectiveTo explore the relationship between the proportion of hospitalization expenses and the rationality of expense structure in patients with chronic heart failure (CHF), providing reference for early warning of unreasonable hospitalization expense structure and reasonable control of patients’ hospitalization expenses.MethodsPatients with CHF between 2020 and 2023 in Shanghai Pudong New Area Guangming Hospital of Traditional Chinese Medicine were used as the study data. Percentile algorithm was used to judge the rationality of the hospitalization expense structure. Multivariate logistic regression model was used to analyze the correlation between the proportion and rationality of expense structure. Restricted cubic spline model was to analyze the threshold response relationship. ResultsA total of 762 patients were included. The medicine expenses remained the primary component of hospitalization expenses for patients with CHF, and combined expenses of examination and laboratory tests exceeded 80% of the total hospitalization expenses. The incidence of unreasonable hospitalization expense structure in patients with CHF was about 10%. The proportion of traditional Chinese medicine, western medicine, examination and laboratory tests, age, admission mode and clinical pathway were the influencing factors of unreasonable hospitalization expense structure in patients with CHF. After coordinating the relevant variables, when the proportion of examination and laboratory tests was <35%, the risk of unreasonable hospitalization expense structure decreased with the increase of the proportion [odds ratio=0.887, 95% confidence interval (0.805, 0.977), P<0.01]. While the proportion of western medicine expenses was >30%, the proportion of traditional Chinese medicine expenses was >13%, and the proportion of examination and laboratory tests was>35%, the risk of unreasonable hospitalization expense structure increased with the increase of proportion (P<0.01). ConclusionsThere is a correlation between the expense proportion of medicine, examination and laboratory tests and unreasonable hospitalization expense structure. The consumptive expenses should be reasonably controlled.
慢性心力衰竭发生率和死亡率均较高，夜间睡眠中反复发生的呼吸暂停和缺氧是促进心力衰竭恶化的因素之一。中枢性睡眠呼吸暂停（central sleep apnea ,CSA）为起源于脑干呼吸控制中枢障碍的呼吸暂停，表现为呼吸减弱或停止。在普通人群中CSA患病率很低，但在慢性心力衰竭患者中则很高，且常常以陈-施呼吸（Cheyne-Stokes respiration，CSR），即CSR-CSA形式出现。CSA可进一步加重心力衰竭，因此越来越受到重视[1]。
Objective To assess the effectiveness and safety of meglumine adenosine cyclophosphate (MAC) for chronic heart failure. Methods The databases such as Cochrane Central Register of Controlled Trials (Issue 3, 2011), MEDLINE (1950 to March 2011), EMbase (1980 to March 2011), CNKI (1995 to March 2011), and VIP (1989 to March 2011) were searched, and the relevant journals and conference proceedings were also manually retrieved. Then the studies were screened according to predefined inclusion and exclusion criteria, and their quality was evaluated. Meta-analyses were performed by using RevMan 5.0 software. Results Seventeen randomized controlled trials (RCTs) involving 1 281 patients were included. All of the included RCTs were Grade C in methodological quality. The results of meta-analyses showed that MAC plus routine treatment was superior to routine treatment in improving the left ventricular ejection fraction (WMD=5.75, 95%CI 3.61 to 7.89), stroke volume (SV) (WMD=5.55, 95%CI 3.71 to 7.38), E/A (WMD=0.09, 95%CI 0.05 to 0.14) and 6 min walk test (WMD=43.52, 95%CI 21.00 to 66.04). But MAC plus routine treatment was similar to routine treatment in regulating cardiac index (CO) (WMD=0.20, 95%CI –0.31 to 0.71) and heart rate (WMD=0.64, 95%CI –7.49 to 8.77). No significant adverse effects or allergic reactions were reported. Conclusion The current evidence shows that MAC may improve the left ventricular ejection fraction, stroke volume, E/A and 6 min walk test. Due to a high risk of selection bias and detection bias in the included studies, the evidence is insufficient to determine the effectiveness of MCA. Further large-scale trials are required to define the role of MAC in the treatment of chronic heart failure.
ObjectivesTo systematically assess the efficacy and safety of nitrates for patients with chronic heart failure. MethodWe searched PubMed, EMbase, Web of Science, The Cochrane Library (Issue 1, 2016), CBM, CNKI, VIP, and WanFang Data to collect randomized controlled trials (RCTs) and cross-over studies about nitrates in the treatment of heart failure from inception to January 4th 2016. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. ResultsTen trials were included involving 414 patients (195 patients in the nitrates group and 219 patients in the control group). The results of meta-analysis showed that, compared with the control group, the nitrates group could reduce arterial blood pressure (MD=-1.91, 95%CI -3.66 to -0.16, P=0.03), pulmonary wedge pressure vessels (PCWP) (MD=-2.00, 95%CI -3.84 to -0.15, P=0.03), increase cardiac index (CI) (MD=0.25, 95%CI 0.09 to 0.42, P=0.003), treadmill exercise time (MD=70.14, 95%CI 55.22 to 85.05, P < 0.000 01); but easily emerge side effects (OR=5.21, 95%CI 2.60 to 10.41, P < 0.000 01). ConclusionCurrent evidence indicates that nitrates treatment could improve the hemodynamic effect, enhance cardiac output and increase exercise tolerance in patients with heart failure.
Objective To evaluate the diagnostic value of brain natriuretic peptide (BNP) for cardiac dyspnea.Methods Plasma BNP levels were measured by radioimmunoassay in dyspnea patients with chronic heart failure (CHF) (n=52) or without CHF (n=30) and normal control group (n=28).Results The BNP level in dyspnea patients with CHF was significantly higher than that of dyspnea patients without CHF and normal control group [(649.80±141.72) pg/mL vs (59.08±18.60) pg/mL and (65.20±16.32) pg/mL，respectively,Plt;0.05].There was no significant difference of BNP level between dyspnea patients without CHF and normal group (Pgt;0.05).The plasma BNP level elevated with the worsening of heart failure (NYHA Classiffication).The BNP level in dyspnea patients with CHF was negatively correlated with left ventricle ejection fraction (r=－0.673，Plt;0.001).The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) is 0.91(0.88-0.98，Plt;0.001) with a sensitivity of 87.2% and a specificity of 86.8% at the cutoff value of 206 pg/mL.Conclusion Measurement of plasma BNP is a rapid diagnostic method for cardiac dyspnea.