| 摘要: |
| 目的探讨老年综合评估（CGA）在老年高血压患者中的应用。方法选择457例老年（≥65岁）高血压患者，分析高血压病程、分级、血压控制达标否、脉压差与老年综合征的关系。结果高血压患者检出老年综合征4.0（2.5，5.0）种，体位性低血压、共病（患病种类≥5种）、多重用药（服用药物≥5种）、改良巴氏指数评定表（MBI）≤95分、简易智能状态检查量表（MMSE）≤24分、简版老年抑郁量表15项（GDS-15）≥6分、简易营养评价法简表（MNA-SF）≤11分、Tinetti平衡与步态量表（POMA）≤24分、听力障碍、视力障碍等发生率分别为19.7%、69.4%、55.8%、39.2%、28.7%、14.7%、23.0%、43.1%、49.5%和53.0%。病程＞10年组共病率明显高于≤10年组（P＜0.05）；不同高血压分级患者在体位性低血压、GDS-15≥6分、听力障碍方面比较差异均有统计学意义（均P＜0.05）。血压控制达标组体位性低血压发生率明显低于未达标组（P＜0.05）；脉压差≤60mmHg组体位性低血压、多重用药、MBI≤95分、MMSE≤24分、听力障碍的发生率均低于＞60mmHg组（均P＜0.05）。结论老年高血压患者各种老年综合征发生率均较高；随着高血压病程的延长，易出现多种共病，且血压未达标者易出现体位性低血压，脉压差＞60mmHg者易出现体位性低血压、日常生活活动能力下降、认知功能下降和听力障碍。建议尽早应用CGA，根据结果进行有效干预，最大程度地维持和改善老年患者的功能状况以及生活质量。 |
| 关键词: 老年综合评估 高血压 应用 |
| DOI：10.12056/j.issn.1006-2785.2017.39.6.2017-433 |
| 分类号: |
| 基金项目:国家卫生和计划生育委员会科研基金项目（WKJ2013-2-001）；2015浙江省医学重点创新学科（老年逆龄医学）项目；2017年浙江省医药卫生科技项目（2017KY174） |
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| Application of comprehensive geriatric assessment in elderly hypertensive patients |
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LU Peiying, SHEN Shanshan, CHEN Xujiao
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Zhejiang Hospital
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| Abstract: |
| Objective To assess the application of comprehensive geriatric assessment (CGA) in elderly hypertensive patients. Methods A total of 457 elderly hypertensive patients aged 65 years or above were admitted, and the associations of hypertension-related parameters, including durations, stages, blood pressure control and pulse pressure (PP), with geriatric syndromes were analyzed. Results The median of geriatric syndromes was 4.0(2.5-5.0) in hypertensive patients. Among these patients, the prevalence of orthostatic hypotension(OH), comorbidities(≥5 diseases), polypharmacy (≥5 drugs), Modified Barthel Index(MBI) ≤95, Min-Mental State Examination (MMSE)≤24, 15-item Geriatric Depression Scale (GDS-15) ≥6, Mini Nutritional Assessment Short Form (MNA-SF) ≤11, Tinetti Performance Oriented Mobility Assessment (POMA) ≤24, hearing and visual impairment was 19.7%, 69.4%, 55.8%, 39.2%, 28.7%, 14.7%, 23.0%, 43.1%, 49.5% and 53.0%, respectively. Patients with ＞10
years durations had higher percentage of comorbidities than those with ≤10 years duration (P＜0.05). There were significantly differences in the incidences of OH, GDS-15≥6 and hearing impairment in patients with different hypertension grades (all P＜ 0.05). The incidence of OH was lower in well-controlled hypertension patients than that of poorly-controlled hypertensive patients (P＜0.05). Compared with patients with PP>60mmHg, those with PP≤60mmHg had lower incidence of OH, polypharmacy, MBI≤ 95, MMSE ≤24 and hearing impairment (all P＜0.05). Conclusion The elderly hypertensive patients have higher incidence of geriatric syndromes. Patients with longer durations are more prone to have comorbidities. Poorly-controlled hypertension patients
are at greater risk of OH. Furthermore, the incidence of OH, decreased activities of daily living, cognitive decline and hearing impairment is associated with PP ＞60mmHg in hypertensive patients. Therefore, early application of CGA may guide clinical practice to improve the quality of life in elderly hypertensive patients. |
| Key words: Comprehensive geriatric assessment Hypertension Application |
