急诊急性心力衰竭单元收治患者出院后6个月内再入院率和病死率分析  

Effect of emergency heart failure units on readmission and mortality within 6 months after discharge in patients with acute heart failure

作　　者：王朋飞 裴源源 石芳娥 朱继红[1] Wang Pengfei;Pei Yuanyuan;Shi Fang'e;Zhu Jihong(Department of Emergency,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院急诊科,北京100044

出　　处：《中华急诊医学杂志》2022年第7期886-894,共9页Chinese Journal of Emergency Medicine

摘　　要：目的目前急诊急性心力衰竭单元在国内逐渐开展,分析急诊急性心衰单元对于急性心力衰竭(acute heart failure,AHF)出院后6个月内的病死率和再入院率的影响。方法前瞻性收集2019年12月至2020年12月北京大学人民医院急诊科和心内科收治的AHF病例,排除合并恶性肿瘤者、慢性肾脏疾病分期4-5期、自动出院及病史资料不全的患者,从基线资料、既往病史、入院病情、辅助检查等方面收集资料,患者出院后通过临床数据中心门诊就诊病历或电话咨询等方式收集出院口服药物、再入院及死亡信息。根据患者治疗地点不同分为接受急诊急性心衰单元治疗的(急诊AHFU组)、接受急诊常规诊疗的(急诊AHFU外组)和接受心内科治疗的心内科组。应用SPSS 25.0软件进行组间比较,以P<0.05为差异有统计学意义。结果共入选238例AHF患者,院内死亡28例,随访出院患者共210例。排除随访过程中发生恶性肿瘤患者4例,失访6例。纳入急诊AHFU组40例,急诊AHFU外组67例,心内科组93例,根据患者预后分为预后不良组83例,预后良好组145例。入院时急诊AHFU组与急诊AHFU外组患者年龄、性别、生命体征、心功能基本一致,治疗时AHFU组患者使用无创正压通气比例更高(52.5%vs.32.8%,P<0.05);出院后急诊AHFU组血管紧张素转化酶抑制剂/血管紧张素受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂、P受体阻滞剂、利尿剂等口服药物使用率更高;患者的随诊也更规律(95.0%vs.79.1%,P<0.05);患者6个月内再入院率(15.0%vs.40.3%,P<0.05),急诊AHFU组患者6个月内再入院和病死率复合结果(17.5%vs.43.3%,P<0.05)□通过COX回归分析发现急诊AHFU诊疗组较急诊AHFU外组治疗后患者的再入院率减低(OR=2.882,95%CI:1.267~6.611,P=0.12)。AHFU组与心内科相比收缩压更高、心率更快、NT-proBNP水平、心功能NYHA Ⅳ级、Killip Ⅲ级的比例也更高(均P<0.05);治疗上急诊AHFU组无创机械Objective At present,emergency acute heart failure unit has been gradually carried out in China.This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure(AHF)within 6 months after discharge.Methods Patients with AHF admitted to Emergency Department and Department of Cardiology,Peking University People's Hospital between December 2019 and December 2020,were prospectively collected.Patients with complicated malignant tumor,stage 4-5 chronic kidney disease,automatic discharge,and incomplete medical history were excluded.The baseline data,past medical history,admission condition,and auxiliary examination were collected.After discharge,the information of oral drugs,hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation.Patients were divided into the emergency acute heart failure unit treatment group(emergency AHFU group),emergency routine treatment group(outside AHFU group)and cardiology treatment group according to the different treatment locations.SPSS 25.0 software was used for comparison between groups,and a P<0.05 was considered as statistically significant.Results A total of 238 patients with AHF were enrolled,28 patients died in hospital,and 210 patients were followed up.Four cases were excluded from malignant tumor during follow-up,and 6 cases were lost to follow-up.There were 40 cases in the emergency AHFU group,67 cases in the outside AHFU group,and 93 cases in the cardiology treatment group.According to the prognosis,the patients were divided into the poor prognosis group(n=83)and good prognosis group (n=145).The age,sex,vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission,and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher(52.5%vs.32,8%,P<0.05).The utilization rate of angiotensin converting enzyme inhibitors/a

关 键 词：急性心力衰竭 急诊心衰单元 再入院率 病死率 危险因素 

分 类 号：R541.6[医药卫生—心血管疾病]