急性心力衰竭急诊早期死亡风险预测临床研究  

Prediction of mortality of acute heart failure in emergency department

作　　者：杨铁城[1] 徐玢[1] 单凯[1] 陈必耀[1] 郭伟[1] 

机构地区：[1]首都医科大学附属北京天坛医院急诊科,北京100050

出　　处：《中国急救复苏与灾害医学杂志》2017年第4期301-304,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：北京市东城区科技计划项目（2016-3-006）;北京市科协金桥工程种子资金（ZZ16005）

摘　　要：目的确立急性心力衰竭（acute heart failure，AHF）的早期死亡风险预测因子。方法前瞻性入选2015年7月-2016年9月北京天坛医院急诊就诊AHF患者，收集患者临床资料，研究终点为7d死亡率。比较AHF患者死亡组与生存组临床资料的差异，分析AHF急诊早期死亡风险预测因子。结果共有520例AHF患者纳入本研究，随访7d，67例死亡，死亡率为12．9％。死亡组高龄（〉80岁）、既往慢性肾功能不全、脑血管病且改良Rankin卒中量表（modified rankinscale，MRS）〉2者明显多于生存组。与生存组相比，死亡组患者来诊时心率更快，收缩压（systolic pressure，SBP）水平更低，且SBP〈120mmHg更多见于死亡组。另外，死亡组患者动脉血氧分压（partialpressure of oxygen in arterial blood PaO2）〈60mmHg、心肌肌钙蛋白I（cardiac troponinI,cTnI）〉0．04ng／mL、Na＋〈135mEq／L、尿素氮（bloodureanitrogen，BUN）≥43mg/L、肌酐serumcreatinine，Scr）〉2．0mg／dl更多见于死亡组患者。Logistic回归分析结果显示，年龄〉80岁（P=0．011）、脑血管病病史（MRS〉2）（P=0．043）、SBP〈120mmHg（P〈0．001）、PaO2〈60mmHg（P=O．023）、BUNI〉43mg／dl（P〈0．001）、TNI〉0．04ng／mL（P=0．031）为AHF患者7d死亡的独立预测因子。结论年龄〉80岁、脑血管病病史（MRS〉2）、SBP〈120mmHg、PaO2〈60mmHg、BUN≥43mg／dl、TNI〉0．04ng／mL为AHF早期死亡的独立预测因子。Objective To analyze the predictor for early death of acute heart failure （AHF） in emergency department. Methods AHF Patients presented to the emergency department were prospectively recruited into the study. Data of clinical history, vital signs, electrocardiogram, chest X-ray, readily available laboratory tests and major treatment were collected. The primary end-point was 7-day mortality after initial presentation. Base-line demographic and clinical characteristics were compared between survival group and death group. Multivariate logistic regression was performed to determine the the predictor for early death of acute heart failure. Results 520 AHF patients were included in the study. 7-day mortality was 12.9%.Compared with survival group, age〉80 years,chronic renal failure and stoke history with MRS 〉2 were more frequently seen in death group.Also,more rapid heart rate, SBP 〈 120mmHg, PaO2 〈 60 mmHg, TNI〉0.04 ng/mL, Serum sodium concentration 〈 135mEq/L,BUN concentration≥43mg/dL,Serum creatinine （Scr）〉 2.0 mg/dl were more frequently presented in death group. Logistic regression analysis showed that age〉80 years （P = 0.011 ） s, stoke history with MRS 〉2 （P =0.043 ）, SBP 〈 120mmHg （P 〈 0.001 ）, PaO2 〈 60mmHg （P =0.023 ）, BUN≥ 43mg/dl （ P 〈 0.001 ） and TNI〉0.04ng/ml （P =0.031 ） were independent predictors for 7-day mortality. Conclusion For AHF patients presented to emergency department, age〉80 years, stoke history with MRS 〉2, SBP 〈 120 mmHg,PaO2 〈 60 mmHg,BUN ≥43 mg/dl and TNI〉0.04 ng/mL were independent predictors for early death.

关 键 词：急性心力衰竭 预后 风险因素 急诊 

分 类 号：R541.62[医药卫生—心血管疾病]