急性心力衰竭综合征不良预后负相关因素分析  

A analyse on negative risk factors for acute heart failure syndrome with poor outcomes

作　　者：彭佳华[1] 谭巧霞 肖玉光[1] 邓伟峰[1] 徐佐坤 

机构地区：[1]百色市人民医院急救中心,广西百色533000 [2]百色市右江区人民医院内二科,广西百色533000

出　　处：《中国中西医结合急救杂志》2014年第5期354-359,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广西百色市科技开发计划项目（百科计20130504）

摘　　要：目的：对急性心力衰竭综合征（AHFS）患者近期和远期不良事件发生的负相关因素进行分析，为急诊进行AHFS低危分层提供依据。方法采用回顾性队列研究方法，纳入广西百色市人民医院和百色市右江区人民医院共125例符合研究标准的AHFS患者，再按近期和远期随访结局分别分为结局不良组和相对低危组。采集患者入院首次病史、体征、辅助检查变量。随访入院至出院后30 d（近期）和1年（远期）不良结局发生情况，Cox回归分析30 d和1年不良结局发生的负相关因素。结果近期不良结局患者58例（46.4%），死亡30例（24.0%）；远期不良结局患者111例（88.8%），死亡39例（31.2%）。Cox多因素分析筛选出不良结局负相关因素7个，分别为无既往或现症心肌梗死〔近期：危险比（HR）＝0.36，95%可信区间（95%CI）＝0.20～0.65，P＝0.001〕、淋巴细胞比例0.20～0.40（近期：HR＝0.13，95%CI＝0.04～0.47，P＝0.002；远期：HR＝0.42，95%CI＝0.26～0.68，P＝0.001）、氧合指数（PaO2/FiO2）＞300 mmHg（1 mmHg＝0.133 kPa，近期：HR＝0.23，95%CI＝0.09～0.54，P＝0.001）、肾小球滤过率（eGFR）＞60 mL·min-1·1.73 m-2（近期：HR＝0.31，95%CI＝0.16～0.64，P＝0.002；远期：HR＝0.54，95%CI＝0.36～0.83，P＝0.004）、左室射血分数（LVEF）＞0.50（近期：HR＝0.29，95%CI＝0.10～0.85，P＝0.024）、V1导联P波终末电势（PtfV1）＞-0.04 mm·s（近期：HR＝0.29，95%CI＝0.14～0.60，P＝0.001）、平面QRS-T夹角＜90°（远期：HR＝0.46，95%CI＝0.27～0.77，P＝0.003）。结论本研究中纳入的AHFS患者近、远期预后差；具有非既往或现症心梗、淋巴细胞比例0.20～0.40、PaO2/FiO2＞300 mmHg、eGFR＞60 mL·min-1·1.73 m-2、PtfV1＞-0.04 mm·s、LVEF＞0.50、平面QRS-T夹角＜90°特征的患者可能有更好的近期和远期预后。ObjectiveTo assess negative risk factors associate with short-term and long-term poor outcome of acute heart failure syndromes（AHFS） and provide evidence to emergently proceed to AHFS low risk stratification.Methods A retrospective cohort study was conducted. 125 AHFS patients who met research criterion were enrolled from Guangxi Baise People＇s Hospital and Youjiang District People＇s Hospital of Baise City. The patients were divided into poor outcome and relatively low-risk groups by the results of short- and long-term follow-up of their outcomes. The patient＇s vital signs and disease history were collected at the first time after admission, and auxillary examination parameters were recorded. The poor outcomes occurring in the follow-up periods from the admission to after discharge for 30 days（short-term） and 1 year（long-term）were recorded, and Cox hazard regression was used to analyze the negative risk factor in the short- and long-term.Results There were 58 cases（46.4%）with poor outcome and 30 cases（24.0%）dead in short-term, and there were 111 cases（88.8%） with poor outcome and 39 cases（31.2%） dead in the long-term follow up. Seven negative risk factors were identified by Cox regression. They were no previous or de novo myocardial infarction〔short-term： hazard ratio（HR）=0.36, 95% confidence interval （95%CI）=0.20-0.65,P=0.001〕, lymphocyte ratio 0.20-0.40（short-term：HR=0.13, 95%CI=0.04-0.47, P=0.002; long-term：HR=0.42, 95%CI=0.26-0.68,P=0.001）,oxygenation index（PaO2/FiO2）〉300 mmHg （1 mmHg=0.133 kPa,short-term：HR=0.23, 95%CI=0.09-0.54,P=0.001）,estimated glomerular filtration rate （eGFR）〉60 mL·min-1·1.73 m-2（short-term：HR=0.31, 95%CI=0.16-0.64,P=0.002;long-term：HR=0.54, 95%CI=0.36-0.83,P=0.004）,left ventricular ejection fraction（LVEF）〉0.50（short-term：HR=0.29, 95%CI= 0.10-0.85,P=0.024）, P wave terminal force in lead V1（PtfV1）〉-0.04 mm·s（short-term：HR=0.29, 95%CI= 0.14-0.60,P=0.001）, planar QRS-T angle〈90°�

关 键 词：急性心力衰竭综合征 不良预后 负相关因素 

分 类 号：R395.6[哲学宗教—心理学]