心房颤动对老年急性肺血栓栓塞症患者院内不良结局的影响  

Impact of atrial fibrillation on in-hospital adverse outcomes in elderly patients with acute pulmonary thromboembolism

作　　者：王增智[1] 韩康宁 李杰[1] 张萌 高杨[1] 郭伟[1] 谢江[1] 张向峰[1] 万钧 刘双[1] Wang Zengzhi;Han Kangning;Li Jie;Zhang Meng;Gao Yang;Guo Wei;Xie Jiang;Zhang Xiangfeng;Wan Jun;Liu Shuang(Department of Respiratory and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;The 12th Ward,Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院呼吸与危重症医学科,北京100029 [2]首都医科大学附属北京安贞医院心内12病房,北京100029

出　　处：《中华老年医学杂志》2023年第7期760-765,共6页Chinese Journal of Geriatrics

摘　　要：目的分析既往存在心房颤动(AF)的老年急性肺血栓栓塞症(APE)患者的临床特点以及既往存在AF对老年APE患者院内不良结局的影响。方法回顾性分析首都医科大学附属北京安贞医院2008年1月1日至2021年12月31日住院且既往存在AF的老年APE患者,比较AF组和非AF组间患者的合并症、症状及体征、实验室检查和超声心动图指标、简化肺栓塞严重指数(sPESI)评分和院内不良结局。采用Logistic回归分析老年APE患者发生院内不良结局的危险因素。结果共纳入240例老年APE患者,其中AF组纳入120例,非AF组纳入120例。AF组和非AF组合并慢性心力衰竭比例分别为38.3%(46/120)和15.8%(19/120),合并下肢深静脉血栓(DVT)比例分别为36.7%(44/120)和65.8%(79/120),左心室射血分数分别为(59±10)%和(62±7)%,住院时间分别为(15±7)d和(11±4)d,差异均有统计学意义(χ^(2)=15.381、20.429,t=2.527、-4.710、均P<0.05)。AF组和非AF组院内不良结局的发生率分别为4.2%(5/120)和3.3%(4/120),差异无统计学意义(χ^(2)=0.000、P=1.000)。院内不良结局的总发生率为3.8%(9/240),Logistic多因素回归分析结果显示,乳酸升高是院内不良结局发生的独立危险因素(OR=2.753、95%CI:1.367~5.542、P=0.005),而AF(OR=2.880、95%CI:0.587~14.141、P=0.192)以及sPESI评分(OR=2.056、95%CI:0.904~4.673、P=0.086)与院内不良结局的发生无相关性。结论既往存在AF的老年APE患者DVT发生率更低,合并慢性心力衰竭比例更高,住院时间更长。乳酸升高是合并AF的老年APE患者院内不良结局发生的独立危险因素,而既往存在AF不能预测老年APE患者院内不良结局的发生。Objective To analyze the clinical characteristics of elderly acute pulmonary thromboembolism(APE)patients complicated with preexisting atrial fibrillation(AF)and the impact of preexisting AF on in-hospital adverse outcomes in elderly patients with APE.MethodsA retrospective analysis was performed on elderly APE patients with preexisting AF hospitalized in Beijing Anzhen Hospital,Capital Medical University between January 1,2008 and December 31,2021.We compared the comorbidities,symptoms,signs,laboratory test results and echocardiographic features,simplified pulmonary embolism severity index(sPESI)scores and adverse in-hospital outcomes between the preexisting AF group and the non-AF group.Logistic regression was used to analyze the risk factors of in-hospital adverse outcomes in elderly patients with APE.ResultsA total of 240 patients diagnosed with APE were enrolled.There were 120 patients in the AF group and 120 patients in the non-AF group.For patients in the AF group and the non-AF group,the proportions with chronic heart failure were 38.3%(46/120)and 15.8%(19/120),the proportions with lower extremity deep vein thrombosis(DVT)were 36.7%(44/120)and 65.8%(79/120),the left ventricular ejection fractions(LVEF)were(59±10)%and(62±7)%,and hospital stays were(15±7)and(11±4)days,respectively,and the differences were statistically significant(χ^(2)=15.381,20.429,t=2.527,-4.710,all P<0.05).The incidences of in-hospital adverse outcomes in the AF group and the non-AF group were 4.2%(5/120)and 3.3%(4/120),respectively,with no significant difference(χ^(2)=0.000,P=1.000).The overall incidence of in-hospital adverse outcomes was 3.8%(9/240).Multivariate Logistic regression analysis showed that elevated lactic acid was an independent risk factor for in-hospital adverse outcomes(OR=2.753,95%CI:1.367-5.542,P=0.005).However,AF(OR=2.880,95%CI:0.587-14.141,P=0.192)and sPESI score(OR=2.056,95%CI:0.904-4.673,P=0.086)were not associated with in-hospital adverse outcomes.ConclusionsElderly APE patients with preexisting AF have a

关 键 词：肺栓塞 心房颤动 预后 

分 类 号：R563.5[医药卫生—呼吸系统] R541.75[医药卫生—内科学]