慢性心力衰竭患者出院后1年预后及影响因素分析  

One year follow up of hospital discharged heart failure patients:the prognosis and influencing factors

作　　者：缪培智[1] 郑宏超[1] 周京敏 MIAO Peizhi;ZHENG Hongchao;ZHOU Jingmin(Department of Cardiology,Xuhui District Central Hospital,Shanghai,20031,China;Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市徐汇区中心医院心内科,上海200031 [2]复旦大学附属中山医院心内科,上海200032

出　　处：《内科理论与实践》2020年第2期85-88,共4页Journal of Internal Medicine Concepts & Practice

基　　金：上海市医学重点专科建设计划(项目编号:ZK2019A18)。

摘　　要：目的:探讨慢性心力衰竭(心衰)患者出院后1年内的心血管死亡以及再住院情况,并分析预后影响因素。方法:随访2016年1月到2018年12月上海市徐汇区中心医院所有诊断心衰的出院患者,记录患者出院后药物治疗、再住院和死亡情况。采用逐步Cox回归分析,分析影响慢性心衰患者预后的因素。结果:共入选194例患者,男性102例(52.6%),冠心病150例(77.3%),高血压病78例(40.2%),糖尿病96例(49.5%),心肌病35例(18.0%)。射血分数降低的心衰(heart failure with reduced ejection fraction,HFrEF)81例(41.8%),射血分数保留的心衰(heart failure with preserved ejection fraction,HFpEF)113例(58.2%)。纽约心脏协会(New York Heart Association,NYHA)心功能Ⅱ级40例,Ⅲ级92例,Ⅳ级62例。随访中位时间12(11~18)个月。出院后3、6、9和12个月因心衰的再住院率分别为3.6%、9.8%、17.0%和18.6%;全因死亡率分别为1.0%、2.6%、3.1%和6.7%;Cox分析表明,左心室射血分数(left ventricular ejection fraction,LVEF)、血红蛋白浓度和氨基末端脑钠肽前体(N-terminal probrain natriuretic peptide,NT-proBNP)水平是影响心衰患者1年内再住院或死亡的主要因素[相对危险度(relative risk,RR)分别为2.356、1.975、2.218,95%可信区间(confidence interval,CI)分别为1.321~4.353、1.382~2.287、1.374~4.523]。结论:心衰患者出院后1年因心衰的再住院率、全因死亡率分别为18.6%、6.70%。LVEF、血红蛋白浓度和NT-proBNP水平是影响心衰患者1年内再住院或死亡的主要因素。Objective To investigate the prognosis and its influencing factors in chronic heart failure(CHF)patients after discharging from hospital.Methods All the discharged heart failure patients from January 2016 through December2018 were followed,and treatment regimen,rehospitalization and mortality were recorded.The prognosis related factors were explored by Cox regression analysis.Results Totally 194 patients,with New York Heart Association(NYHA)cardiac function classⅡ(40/194),Ⅲ(92/194)andⅣ(62/194),were enrolled in the study,including 102(52.6%)males.Many patients had combined conditions,including coronary heart disease(150/194,77.3%),hypertension(78/194,40.2%),diabetes mellitus(96/194,49.5%)and cardiomyopathy(35/194,18.0%).Eighty-one patients(41.8%)had heart failure with reduced ejection fraction(HFrEF).The median follow-up time was 12(11-18)months.Results the rehospitalization rates at 3,6,9 and 12 months after discharge were 3.6%,9.8%,17.0%and 18.6%respectively,and the all-cause mortality was1.0%,2.6%,3.1%and 6.7%for the same time point.Cox analysis showed that left ventricular ejection fraction(LVEF),hemoglobin concentration and N-terminal brain natriuretic peptide(NT-proBNP)were closely associated with rehospitalization or mortality[relative risk(RR)=2.356,1.975,2.218,95%confidence interval(CI):1.321-4.353,1.382-2.287,1.374-4.523]of patients with heart failure during the follow-up.Conclusions The hospital discharged CHF patients have gradually increased risk for rehospitalization and death within one year of discharge.The LVEF,hemoglobin concentration and NT-proBNP were main factors affecting rehospitalization or mortality.

关 键 词：心力衰竭 再住院率 死亡率 影响因素 

分 类 号：R541.6[医药卫生—心血管疾病]