多次急性发作心力衰竭患者特性及院内死亡分析  

Analysis on the Characteristics and In-hospital Mortality for Heart Failure Patients With Several Acute Exacerbation

作　　者：尹朝霞[1] 肖涛[1] 陈瑒[1] 蔡澍[1] 

机构地区：[1]首都医科大学附属复兴医院月坛社区卫生服务中心,北京100045

出　　处：《继续医学教育》2015年第12期68-71,共4页Continuing Medical Education

基　　金：首都卫生发展科研专项资助项目(首发2011-7001-04)

摘　　要：目的调查多次急性发作的不同类型心力衰竭（心衰）患者特性及院内心源性死亡情况。方法收集2008年1月~2013年9月首都医科大学附属复兴医院住院病例,以两次及以上因急性心衰住院患者为研究对象,根据左室射血分数（LVEF）分成三组不同类型心衰：LVEF≤40%、LVEF 40.1%~49.9%、LVEF≥50%,收集病史、临床资料,分析院内心源性死亡（心衰恶化、心律失常、心肌梗死、猝死）情况。结果共入选307名患者,男性162名（52.8%）,女性145名（47.2%）,平均年龄（75.9±10.2）岁,平均住院次数（2.3±0.7）次,LVEF≤40%者138人,LVEF 40.1%~49.9%者92人,LVEF≥50%者77人;LVEF≥50%者与LVEF 40.1%~49.9%者病史大致相同,LVEF≥50%者与LVEF≤40%者比较,年龄偏大（P〈0.001）,较少住院次数,较多未监测血压、吸烟、慢性阻塞性肺疾病（COPD）、房颤病史,较低脑钠肽（BNP）水平（P〈0.05）;LVEF 40.1%~49.9%者与LVEF≤40%者比较,年龄偏大（P〈0.001）,较少住院次数、糖尿病病史,较多未监测血压史,较低血红蛋白水平（P〈0.05）;三组间随着LVEF降低,男性增多（P=0.001）,心肌梗死病史增多、左室舒张末内径增大、尿酸增高（P〈0.001）。有39名患者院内死亡,LVEF≤40%者19人（10.1%）,LVEF 40.1%~49.9%者12人（9.8%）,LVEF≥50%者8人（7.8%）,三组间死亡率无统计学差异（χ2=0.5,P〉0.05）;住院次数、COPD、房颤、BNP是死亡的独立危险因素。结论不同类型心衰临床特性不完全相同,对于心衰反复住院者,即使LVEF保留者,院内心源性死亡率与LVEF降低性心衰者相同,应重视LVEF保留性心衰患者的管理。Objective To investigate characteristics and in-hospital cardiac mortality for different type of heart failure patients with several acute exacerbation. Methods Collecting the medical records in Fuxing hospital, Capital medical University between January 2008 to May 2013, Only the heart failure patients with two or more acute exacerbation were chosen. According to left ventricular ejection fraction（LVEF）, they were divided into three groups： patients with LVEF ≤ 40%, LVEF 40.1% to 49.9% and LVEF ≥ 50%. History,clinical data, and in-hospital cardiac mortality（deterioration of heart failure, arrhythmia, myocardial infarction, sudden death）were collected. Results A total 307 patients were recruited. 162 men（52.8%） and 145 women（47.2%）. The mean age was（75.9±10.2） year old, mean frequency of hospitalization was（2.3±0.7）, 138 patients with LVEF ≤ 40%,92 patients with LVEF 40.1% to 49.9% and 77 patients with LVEF ≥ 50%, history was almost similar between patients with LVEF ≥ 50% and LVEF 40.1% to 49.9%, compared with patients with LVEF ≤ 40%, patients with LVEF ≥ 50% were elderly（P0.001） and had less frequency of hospitalization as well as blood pressure monitoring, more history of smoking, chronic obstructive pulmonary diseases（COPD） and atrial fibrillation（Af）, lower levels of brain natriuretic peptide（BNP）（P0.05）, patients with LVEF40.1% to 49.9% were elderly（P0.001） and had less frequency of hospitalization as well as blood pressure monitoring, more history of diabetes, lower levels of hemoglobin（P0.05）, with the decreasing of LVEF, there were more males（P=0.001）,more myocardial infarction, larger of left ventricular diastolic diameters, higher levels of uric acids（P0.001）. 29 patients were died in hospital, 14 patients with LVEF ≤ 40%（10.1%）,9 patients with LVEF 40.1% to 49.9%（9.8%）, 6 patients with LVEF ≥ 50%（7.8%）, there was no statistical difference among the three groups（χ2=0.5, P0.05）, the independent factors fo

关 键 词：心力衰竭 射血分数保留性心力衰竭 射血分数下降性心力衰竭 急性发作 死亡 

分 类 号：R541.6[医药卫生—心血管疾病]