高二氧化碳血症与老年急性心力衰竭患者预后的相关性分析  

Analysis of correlation between hypercapnia and prognosis of elderly patients with acute heart failure

作　　者：高元标 吴媛媛[2] Gao Yuanbiao;Wu Yuanyuan(Emergency Department,People's Hospital of Qionghai City,Qionghai,Hainan,571400,P.R.China;Department of Cardiothoracic Surgery,First Affiliated Hospital of Hainan Medical College,Haikou,Hainan,570102,P.R.China)

机构地区：[1]琼海市人民医院急诊科,海南琼海571400 [2]海南医学院第一附属医院心胸外科,海南海口570102

出　　处：《老年医学与保健》2022年第4期842-846,共5页Geriatrics & Health Care

摘　　要：目的 探讨老年急性心力衰竭(AHF)患者入院时高二氧化碳血症状态对其短期预后的影响,为治疗该病症提供依据。方法 回顾性纳入2019年4月—2021年4月琼海市人民医院急诊科就诊的151例老年AHF患者为研究对象,根据入院时血气分析中二氧化碳分压水平分为高二氧化碳血症组(n=83)和无高二氧化碳血症组(n=68)。随访患者入院1个月内的预后状态,再分为预后良好组(n=114)和预后不良组(n=37)。收集并比较2组的临床、实验室检查结果,并通过单因素和多因素分析明确高二氧化碳血症对老年AHF患者预后的影响。结果 同非高二氧化碳血症组相比,高二氧化碳血症组患者预后不良比例显著升高(P<0.05)。同预后良好组相比,预后不良组的年龄更大、糖尿病和慢性肾功能不全比例更高、NYHA心功能分级为Ⅲ-Ⅳ级比例更高、血氧饱和度和氧分压更低和高二氧化碳血症的比例更高(均P<0.05)。多因素分析发现,高龄(OR=1.53)、糖尿病(OR=1.74)、慢性肾功能不全(OR=1.43)、NYHA心功能分级为Ⅲ-Ⅳ级(OR=2.99)和高二氧化碳血症(OR=3.09)是老年AHF患者预后不良的危险因素,而血氧饱和度高(OR=0.88)是其保护性因素。多因素模型预测患者预后不良的曲线下面积为0.88,敏感性和特异性分别为86.84%和81.48%。结论 高二氧化碳血症可能是老年AHF患者预后不良的危险因素;积极处理高二氧化碳血症可能有助于改善患者的预后。Objective To explore the effects of hypercapnia on admission on the short-term prognosis of elderly patients with acute heart failure(AHF),and provide evidence for the treatment of the disease.Methods A total of 151 elderly patients with AHF who visited the Emergency Department of People’s Hospital of Qionghai City from April 2019 to April 2021 were retrospectively included.They were divided into hypercapnia group(n=83) and non-hypercapnia group(n=68) according to the level of carbon dioxide partial pressure in blood gas analysis at admission.The prognosis of the patients within one month after admission was followed up,and they were divided into good prognosis group(n=114) and poor prognosis group(n=37).The clinical and laboratory examination results of the two groups were collected and compared.The effect of hypercapnia on the prognosis of elderly patients with AHF was determined by univariate and multivariate analysis.Results Compared with the non-hypercapnia group,the proportion of poor prognosis in the hypercapnia group was significantly higher(P<0.05).Compared with the good prognosis group,the poor prognosis group had older age,higher proportion of diabetes and chronic renal insufficiency,higher proportion of NYHA cardiac function class Ⅲ-Ⅳ,lower blood oxygen saturation and oxygen partial pressure,and higher proportion of hypercapnia(all P<0.05).Multivariate analysis showed that old age(OR=1.53),diabetes mellitus(OR=1.74),chronic renal insufficiency(OR=1.43),NYHA cardiac function grade Ⅲ-Ⅳ(OR=2.99) and hypercapnia(OR=3.09) were the risk factors for poor prognosis of elderly AHF patients,while high blood oxygen saturation(OR=0.88) was a protective factor.The area under the curve of multivariate model for predicting poor prognosis was 0.88,and the sensitivity and specificity were 86.84% and 81.48%,respectively.Conclusion Hypercapnia may be a risk factor for poor prognosis in elderly patients with AHF.Active treatment of hypercapnia may help to improve the prognosis of the patients.

关 键 词：老年 急性心力衰竭 高二氧化碳血症 预后 

分 类 号：R541.6[医药卫生—心血管疾病]