心源性呼吸困难的相关影响因素  

Factors related to cardiogenic dyspnea

作　　者：蒋艳敏[1] 杨君莉[1] 刘畅 李红娟 JIANG Yanmin;YANG Junli;LIU Chang(Department of Respiratory Medicine,The Third Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第三医院呼吸内二科,050011 [2]河北省石家庄市第三医院门诊办,050011

出　　处：《河北医药》2022年第23期3598-3601,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题(编号:20201370)。

摘　　要：目的 探究心源性呼吸困难的相关因素。方法 回顾性选取2016年7月至2019年11月97例接受医治的急性呼吸困难患者为研究对象,对其临床基本资料进行分析与整理。研究对象均进行肺部超声检查、超声心动图检查、胸部X线检查等,然后由内科医师根据患者肺部超声检查结果和NT-proBNP水平,并结合临床症状,将患者分为心源性呼吸困难组(60例)和非心源性呼吸困难组(37例)。分析2组患者的临床表现、对影响患者发生心源性呼吸困难的单因素进行分析,对影响患者发生心源性呼吸困难的相关危险因素进行多因素非条件Logistic回归分析。结果 心源性呼吸困难组患者肺部湿啰音、心脏增大、血性泡沫痰发生率高于非心源性呼吸困难组患者,肺部四凹征发生率低于非心源性呼吸困难组患者,差异有统计学意义(P<0.05);单因素分析结果显示,心源性呼吸困难组中患有冠心病的患者占比高于非心源性呼吸困难组,且LVEF水平低于非心源性呼吸困难,血清NT-proBNP、ULCs水平均高于非心源性呼吸困难组,差异有统计学意义(P<0.05);多因素非条件Logistic回归分析结果显示,冠心病、LVEF<50%、血清NT-proBNP≥900ng/L、ULCs≥20条均为患者发生心源性呼吸困难的危险因素,差异有统计学意义(OR=2.261,2.672,2.428,2.186,P<0.05)。结论 临床中可根据患者的临床表现、肺部体征、影像学检查等鉴别心源性呼吸困难;冠心病、LVEF<50%、血清NT-proBNP≥900 ng/L、ULCs≥20条均为患者发生心源性呼吸困难的危险因素,临床应通过治疗前对危险因素的严密检测,及时采取有效措施进行防治,进而避免患者严重并发症的发生,同时临床也可通过肺部超声和血清NT-proBNP检查更加准确诊断心源性呼吸困难。Objective To explore the factors related to cardiogenic dyspnea(CD). Methods the clinical data of 97 patients with acute dyspnea received medical treatment from July 2016 to November 2019 was retrospectively analyzed. All subjects received pulmonary ultrasonography, echocardiography and chest X-ray examination, then the patients were divided into the CD group(60 cases) and non-CD group(37 cases) by the physicians based on the results of pulmonary ultrasonography and N-terminal fragment brain natriuretic peptides(NT-pro-BNP) level by combining clinical symptoms of patients. The clinical features of these patients and non-cardiogenic dyspnea and single factor were assessed, and the related risk factors affecting the occurrence were subjected to multivariate unconditional Logistic regression analysis. Results The incidence of pulmonary rales, cardiac enlargement and bloody foamy sputum in the CD group was statistically higher than that of patients in the non-CD group, the incidence of lung four-concave sign in the CD group was statistically lower(P<0.05). The multivariate unconditional Logistic regression analysis showed that coronary heart disease(CHD), LVEF<50%, serum NT-pro-BNP≥900ng/L and ULCs≥20 were risk factors for CD, and the differences were statistically significant(P<0.05). Conclusion Clinically, CD can be differentiated by the patients’ clinical features, pulmonary signs, and imaging examinations;CHD, LVEF<50%, serum NT-pro-BNP≥900ng/L and ULCs≥20 are risk factors for CD. The risk factors should be strictly detected before treatment in clinical practices, and effective measures should be taken to prevent the occurrence of severe complications. Moreover, the further accurate diagnosis on CD is supported to be performed by pulmonary ultrasonography and serum NT-pro-BNP examination.

关 键 词：心源性 呼吸困难 相关影响因素 危险因素 

分 类 号：R441.8[医药卫生—诊断学]