不同衰弱水平的老年急性失代偿心力衰竭患者住院期间不良事件分析  

Analysis of in-hospital adverse events in elderly patients with acute decompensated heart failure with different frailty levels

作　　者：康云鹏[1] 郭雯[1] 李江[1] 陈立颖[1] KANG Yunpeng;GUO Wen;LI Jiang;CHEN Liying(Cardiac Intensive Care Medical Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所、心内重症医学中心,100029

出　　处：《心肺血管病杂志》2023年第5期416-420,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医管局市属医院科研培育计划项目(PX2018026)。

摘　　要：目的:对处于不同衰弱水平的老年急性失代偿心力衰竭(acute decompensated heart failure,ADHF)患者临床特点和院内不良事件发生情况进行探讨。方法:回顾性分析2018年1月至2021年12月,住院治疗的年龄≥60岁的ADHF患者共252例,采用Fried表现型衰弱量表分为衰弱期及衰弱前期,对比分析两组患者的临床特点、躯体能力水平和院内不良事件发生情况,应用线性回归模型筛选导致院内不良事件发生的危险因素。结果:衰弱期年龄高于衰弱前期[(70.4±7.3)vs.(68.5±5.8)岁,P=0.024];衰弱期ADHF患者平衡评分[(3.1±0.8)vs.(3.3±0.6)分,P=0.030],4米步行测试评分[(2.2±0.8)vs.(2.5±0.6)分,P=0.008],椅子站立测试评分[(1.9±0.8)vs.(2.6±0.9)分,P<0.001]及简易机体功能总分[(7.3±2.3)vs.(8.4±2.1)分,P<0.001]低于衰弱前期;衰弱期整体不良事件发生率[42.2%vs.29.1%,P=0.041]和多器官功能障碍发生率[25.9%vs.15.4%,P=0.041]高于衰弱前期。二元Logistic回归分析显示:衰弱(OR=2.806,95%CI:1.236~6.372,P=0.014)是影响老年ADHF患者住院期间不良事件的主要危险因素。结论:衰弱期ADHF的老年患者住院期间整体不良事件发生率高,衰弱是导致院内不良事件发生的危险因素。Objective:This study was designed to investigate the clinical characteristics and the occurrence of in-hospital adverse events in elderly patients with acute decompensated heart failure(ADHF)at different frailty levels.Methods:A total of 252 ADHF patients aged≥60 years old who were hospitalized from January 2018 to December 2021 were retrospectively analyzed.They were divided into the frailty stage and pre-frailty stage using Fried phenotype frailty Scale.Clinicalcharacteristics,physical ability level and occurrence of in-hospital adverse events of the two groups were compared and analyzed.The linear regression model was used to screen the independent risk factors for adverse events in the hospital.Results:The age of frailty was significantly higher than pre-frailty group[(70.4±7.3)vs.(68.5±5.8),P=0.024].Balance score of ADHF patients in the frailty stage[(3.1±0.75)vs.(3.3±0.61)points,P=0.030],walking test score of 4m[(2.2±0.8)vs.(2.5±0.6)points,P=0.008],The score of chair standing test[(1.9±0.8)vs.(2.6±0.9)points,P<0.001]and the total score of simple body function[(7.3±2.3)vs.(8.4±2.1)points,P<0.001]were significantly lower than those in the pre-frailty stage.The overall incidence of adverse events in frailty[42.2%vs.29.1%,P=0.041]and multiple organ dysfunction[25.9%vs.15.4%,P=0.041]was higher than those in pre-frailty.Binary logistic regression analysis showed frailty(OR=2.806,95%CI:1.236-6.372,P=0.014)is a significant risk factor for adverse events in elderly patients with ADHF during hospitalization.Conclusions:The overall incidence of adverse events in elderly patients with ADHF in the frailty stage is high during hospitalization,and frailty is an independent risk factor for the occurrence of in-hospital adverse events.

关 键 词：急性失代偿心力衰竭 衰弱 老年 不良事件 

分 类 号：R54[医药卫生—心血管疾病]