危重型新型冠状病毒感染患者合并心力衰竭的临床特征分析  

Clinical characterization of critical COVID⁃19 patients combined with heart failure

作　　者：喻淑慧 朱睿瑶[2] 王璐[1] 邹捍东[1] 詹丽英[1] YU Shuhui;ZHU Ruiyao;WANG Lu;ZOU Handong;ZHAN Liying(Dept.Ⅰof Critical Care Medicine Division,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Infection Prevention and Control Office,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院重症医学科Ⅰ科,湖北武汉430060 [2]武汉大学人民医院感染预防与控制办公室,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2023年第12期1419-1423,1544,共6页Medical Journal of Wuhan University

基　　金：国家重点研发计划项目(编号:2021YFC2501800)。

摘　　要：目的:探讨危重型新型冠状病毒感染(COVID-19)患者合并心力衰竭的临床特点。方法:对武汉大学人民医院2022年12月7日至2023年1月10日收入的106例危重型COVID-19患者进行回顾性分析,根据心脏彩超结果中左心室射血分数(LVEF)分为射血分数降低(HFr+mEF)组(12例)和射血分数保留(HFpEF)组(94例),比较两组间患者临床特征及疗效评估。结果:①危重型COVID-19患者合并心力衰竭平均年龄在(68.3±15.3)岁,以男性(67.9%)为主,大多数患者有发热、咳嗽、胸闷及呼吸困难等症状。②HFr+mEF组患者大部分有心血管基础疾病(66.7%),发生胸闷的比例更高,为58.3%,初次就诊即存在呼吸衰竭(83.3%),使用有创机械通气比例更高(83.3%);33.3%患者进行血液透析治疗,病情更严重。③与HFr+mEF组比较,HFpEF组进行俯卧位通气、使用糖皮质激素、人血免疫球蛋白及抗凝药物比例更高。④Logistic回归分析显示,糖皮质激素及抗凝药物使用均为危重型COVID-19患者合并心力衰竭的独立危险因素,其中糖皮质激素更高(OR=9.82,95%CI:1.22~79.1)。结论:心脏射血分数降低的患者在感染新型冠状病毒后发生心力衰竭的比例更高,需要有创机械通气治疗。临床医师应根据患者临床症状,既往基础疾病以及心功能状态及时做出判断并调整治疗方案。Objective:To investigate the clinical features of heart failure in patients with critical COVID-19 combined with heart failure.Methods:A retrospective analysis was performed on 106 patients with critical COVID-19 admitted to Renmin Hospital of Wuhan University from December 7,2022,to January 10,2023.A total of 106 patients were divided into a reduced ejection fraction group(HFr+mEF,12 cases)and a preserved ejection fraction group(HFpEF,94 cases)according to the left ven-tricular ejection fraction(LVEF)in cardiac ultrasound results.The clinical features and efficacy were compared between the two groups.Results:①The mean age of patients with COVID-19 combined with heart failure was(68.3±15.3)years,67.9%were male(67.9%),and most patients had symptoms such as fever,cough,chest tightness,and dyspnea.②Most patients in the HFr+mEF group had underlying cardiovascular diseases(66.7%)and chest tightness(58.3%),and the presence of first-visit respiratory failure(83.3%)and the proportion of invasive mechanical ventilation(83.3%)were higher;33.3%of the patients were treated with hemodialysis,and their condition was more severe.③Compared with those in the HFr+mEF group,higher proportions of prone position ventilation and glucocorticoid,human immunoglobulin,or anti-coagulant medications were found in the HFpEF group.④Logistic regression analysis showed that both glucocorticoid and anticoagulant use were in-dependent risk factors for critical COVID-19 patients combined with heart failure(OR=9.82,95%CI:1.22-79.1).Conclusion:Patients with reduced cardiac ejection fraction have a higher rate of heart failure after infected with SARS-CoV-2 and require invasive mechanical ventilation.Clinicians should make timely judgment and adjust the treatment plan according to the patient's clinical symp-toms,previous underlying diseases and cardiac function status.

关 键 词：新型冠状病毒感染 临床特征 心力衰竭 

分 类 号：R563.1[医药卫生—呼吸系统]