心血管急症伴发晕厥患者发生死亡风险的临床研究  

Clinical study of correlation between syncope and risk of death in patients with cardiovascular emergencies

作　　者：马建斌[1] 王赟 王东[2] 黄燕[2] 刘宏利[1] 白丽[1] 许瑞佳[1] 陈永亮[1] 王琦[1] Ma Jianbin;Wang Yun;Wang Dong;Huang Yan;Liu Hongli;Bai Li;Xu Ruijia;Chen Yongliang;Wang Qi(Department of Emergency, General Hospital of Air Force of PLA, Beijing 100142;Department of Respiratory Disease, General Hospital of Air Force of PLA, Beijing 100142;PLA 95968 Army Hospital, Beijing 100195, Chin)

机构地区：[1]空军总医院急诊部,北京100142 [2]空军总医院呼吸科,北京100142 [3]95968部队医院,北京100195

出　　处：《中华急诊医学杂志》2018年第5期541-547,共7页Chinese Journal of Emergency Medicine

摘　　要：目的 探讨伴发晕厥是否增加急性心肌梗死（acute myocardial infarction，AMI）、心律失常（arrhythmia）、急性心力衰竭（acute heart failure, AHF）、肺动脉血栓栓塞症（pulmonary tbrombo embolism, PTE）、主动脉夹层（aortic dissection, AD）破裂等五种心血管急症患者的死亡风险及其实际的临床意义。方法 回顾性分析2010年6月至2016年6月空军总医院急诊诊治及收住院诊治的五种心血管急症患者共2 789例，以是否伴发晕厥为标准分为晕厥组和未晕厥组，对每一种心血管急症两组间性别构成、年龄以及病死率进行比较；将晕厥患者以是否死亡为标准分为死亡组和存活组，比较每一种心血管急症死亡组和存活组性别构成、年龄的差异；比较五种急症之间伴发晕厥患者的病死率的差异；采用CHM校正的卡方检验的方法，探讨在消除了疾病种类、年龄分档、性别的影响后整体晕厥组与未晕厥组病死率之间的差异。采用多重logistic回归分析性别、年龄、疾病病种、是否伴发晕厥对病死率的影响。结果 五种疾病伴发晕厥患者的病死率由大到小依次为：主动脉夹层（50%）〉肺栓塞（30.43%）〉急性心肌梗死（26.53%）〉急性心力衰竭（20.00%）〉心律失常（7.04%），且整体五种心血管急症伴发晕厥患者的病死率之间差异有统计学意义（P〈0.05）；AMI、心律失常晕厥组病死率（26.53%比11.20%；7.04%比0.36%）高于未晕厥组，差异有统计学意义（均P〈0.05）； CHM校正的卡方检验结果显示在消除了疾病种类、年龄分档、性别的影响后整体晕厥组与未晕厥组的病死率有统计学意义（χ^2=35.876, P〈0.01），且晕厥组的病死率高于未晕厥组。多重logistic回归分析显示，晕厥对是否死亡的影响具有统计学意义[晕厥：OR=3.876, 95%CI：2.362~6.359, P〈0.01]。结论 晕厥是心血管急症患者发生死亡的独立危险因素。Objective To explore the relationship between syncope and risk of death in patients with cardiovascular emergencies including acute myocardial infarction（AMI）, arrhythmia, acute heart failure（AHF）, pulmonary thromboembolism（PTE） and aortic dissection（AD） rupture. Methods Data from 2 789 patients with cardiovascular emergency admitted from June 2010 to June 2016 in the Emergency Department, Air Force General Hospital, PLA was retrospectively analyzed. Difference in gender, age and motality were compared between patients with syncope and those without syncope. Among five kinds of cardiovascular emergency events with syncope, difference in mortality were compared. Difference in mortality were also analyzed by the CHM corrected chi square test when difference of disease, gender and age were taken into consideration. Syncope, the type of cardiovascular emergency, gender and age were analyzed as potential risk/protective factors for death by the multiple logistic regression analysis. Results The mortalities of the five diseases accompanied with syncope were 50%, 30.43%, 26.53%, 20% and 7.04% respectively in arterial dissection, pulmonary embolism, acute myocardial infarction, acute heart failure and arrhythmia.There was a statistically significant difference in mortality among the five kinds of cardiovascular emergencies accompanied with syncope（P〈0.05）.The mortalities of patients with syncope were significantly higher than those without syncopein AMI patients （26.53% vs. 11.20%, P〈 0.05） and cardiac arrhythmias patients （7.04% vs. 0.36%, P〈0.05）.The results of the CHM corrected chi square test showed that there was significant difference in mortality between the syncope group and non-syncope group, when the differences in disease type, age and gender were adjusted （χ^2=35.876, P〈0.01）. The mortality of syncope group was higher than that of non-syncope group.When age, gender and disease type were considered as covariates, the multiple logistic regression analysis showed that syn

关 键 词：晕厥 死亡 急性心肌梗死 心律失常 急性心力衰竭 肺动脉血栓栓塞症 主动脉夹层破裂 

分 类 号：R54[医药卫生—心血管疾病]