老年心力衰竭患者出院时血压水平与预后的关系  

Relation between blood pressure at discharge and outcome in elderly heart failure patients

作　　者：沈国英[1,2] 金智敏[1,2] 赵晓薇[1,2] 钟晔[1,2] 费萍燕[1,2] 张美玲[1,2] 贺茂荣 陈玲玲[1,2] 王继光[3] 

机构地区：[1]上海市松江区中心医院 [2]上海交通大学附属第一人民医院松江分院心内科,201600 [3]上海交通大学附属瑞金医院临床流行病学研究中心上海市高血压研究所

出　　处：《中华老年心脑血管病杂志》2015年第2期125-129,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 探讨老年慢性心力衰竭（CHF）患者出院时血压水平与长期预后的关系。方法 入选2010年1月~2011年12月上海市松江区中心医院心内科出院的LVEF〈50%的老年CHF患者116例,随访期以心源性死亡33例作为事件组,另外83例作为非事件组。记录入院时和出院时的血压及常规检查参数,按照心力衰竭指南治疗,并进行3年随访。终点事件为心源性死亡。进行单因素Cox和多因素Cox分析。结果 与非事件组比较,事件组患者出院时收缩压和舒张压降低[（108.7±10.5）/（68.5±8.4）mm Hg vs（130.3±14.2）/（74.4±10.2）mm Hg,1mm Hg=0.133kPa,P〈0.01];脉压降低[（40.2±10.4）mm Hg vs（55.8±13.8）mm Hg,P〈0.01]。单因素Cox分析显示,出院时收缩压〈100mm Hg、脉压〈45mm Hg是心源性死亡的危险因素;多因素Cox风险比例模型分析显示,出院时收缩压〈100mm Hg（RR=0.918,95%CI：0.859~0.981）和N末端钠尿肽前体升高（RR=6.148,95%CI：1.841~20.532）是影响心源性死亡事件发生的主要危险因素。结论 出院时收缩压〈100mm Hg是老年CHF患者死亡终点的独立预测指标。Objective To study the relation between blood pressure at discharge and long-term outcome in elderly CHF patients. Methods One hundred and sixteen elderly CHF patients with their LVEF〈50% when they were discharged from our hospital from January 2010 to December 2011 were randomy divided into cardiovascular event group （n= 33） and non-cardiovascular event group （n=83）. Their blood pressure and routine examination parameters were recorded at admission and discharge. The patients were treated according to the heart failure guidelines and followed up for 3 years. The endpoint event was cardiogenic death. The systolic and diastolic blood pressures in two groups were analyzed by univariate and multivariate Cox analysis. Results The systolic and diastolic blood pressure and pulse pressure were significantly lower in cardiovascular event group than in non cardiovascular event group at discarge （P〈0. 01）. Univariate Cox analysis showed that systolic blood pressure〈100 mm Hg （1 mm Hg=0. 133 kPa） and pulse pressure〈45 mm Hg were the risk factors for cardiognic death in elderly CHF patients. Multivariate Cox analysis showed that systolic blood pressure〈100 mm Hg and elevated serum NT probing level were the major risk factors for cardiognic death in elderly CHF patients at discharge（RR=0. 918,95 CI：0. 859--0. 981;RR=6. 408,95%oCI：1. 841- 20. 532）. Conclusion Systolic blood pressured 100 mm Hg is an independent predictor for death in elderly CHF patients.

关 键 词：心力衰竭 血压 利钠肽 脑 猝死 心脏 危险因素 

分 类 号：R541.6[医药卫生—心血管疾病]