左心衰竭合并肺动脉高压发生不同类型心律失常的危险因素分析  

Analysis of risk factors for different types of arrhythmias in patients with left heart failure and pulmonary hypertension

作　　者：祁小青 王沛 杨玉青 QI Xiaoqing;WANG Pei;YANG Yuqing(Department of Functional Examination,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China;Department of Cardiology,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京中医药大学附属医院功能检查科,南京210029 [2]南京中医药大学附属医院心血管科,南京210029

出　　处：《医学研究与战创伤救治》2025年第2期156-163,共8页Journal of Medical Research & Combat Trauma Care

基　　金：国家中医临床研究基地开放课题(JD2023SZ14)。

摘　　要：目的探讨左心衰竭合并肺动脉高压(PH-LHF)发生不同类型心律失常的危险因素。方法回顾性分析2022年1月至2023年12月在江苏省中医院心内科收治的789例左心衰竭患者的临床资料。根据肺动脉收缩压(PASP)将其分为non PH-LHF组(PASP<33 mm Hg,n=374)和PH-LHF组(PASP≥33 mm Hg,n=415),比较两组不同类型心律失常的发生率。根据有无心律失常,将患者分为心律失常组(n=334)和对照组(n=81),并采用单因素及多因素Logistic回归分析PH-LHF发生室上性快速型心律失常(SVT)、复杂室性心律失常(CVA)及缓慢型心律失常的危险因素。结果PH-LHF组发生SVT、CVA及缓慢型心律失常的比例分别为69.4%、19.0%、20.5%。多因素logistic回归分析结果显示年龄(OR=1.034)、RAD(OR=1.064)是PH-LHF合并上述任意心律失常的危险因素(P<0.05);年龄(OR=1.024)、高血压(OR=1.827)、LAD(OR=1.048)、RAD(OR=1.031)、RVD(OR=1.061)是其发生SVT的危险因素(P<0.05);冠心病(OR=2.679)、LVDd(OR=1.080)是其发生CVA的危险因素(P<0.05);RAD(OR=1.094)、E/e′(OR=1.069)是其发生缓慢型心律失常的危险因素(P<0.001)。结论PH-LHF容易发生SVT、CVA和缓慢型心律失常,其中高龄、高血压、冠心病、心房心室结构异常是常见的危险因素,临床应根据患者具体情况采取合理的心律失常管理策略。Objective This study aims to investigate the risk factors of different types of arrhythmias in patients with pulmonary hypertension and left heart failure(PH-LHF).Methods 789 patients with left heart failure admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2022 to December 2023 were divided into non PH-LHF group(PASP<33mm-Hg,n=374)and PH-LHF group(PASP≥33mmHg,n=415)according to their pulmonary artery systolic pressure(PASP).The incidence of different types of arrhythmias were compared between the two groups.According to the presence or absence of arrhythmias,the patients were divided into an arrhythmia group(n=334)and a control group(n=81).Univariate and multivariate Logistic regression analysis was used to analyze the risk factors of supraventricular tachyarrhythmia(SVT),complex ventricular arrhythmia(CVA)and bradyarrhythmia in PH-LHF.Results The proportions of SVT,CVA and bradyarrhythmia in PH-LHF group were 69.4%,19.0%and 20.5%,respectively.Multivariate logistic regression analysis showed that age(OR=1.034)and RAD(OR=1.064)were independent risk factors of PH-LHF with any of the above arrhythmias(P<0.05).Age(OR=1.024),hypertension(OR=1.827),LAD(OR=1.048),RAD(OR=1.031),RVD(OR=1.061)were risk factors of SVT(P<0.05).Coronary heart disease(OR=2.679)and LVDd(OR=1.080)were risk factors of CVA(P<0.05).RAD (OR=1. 094) and E/ e′(OR=1. 069) were risk factors of bradyarrhythmia (P<0. 001). Conclusion PH-LHF is prone to SVT, CVA and bradyarrhythmia. Old age, hypertension, coronary heart disease and abnormal atrial ventricular structure are common risk factors. Reasonable management strategies should be taken according to the specific conditions of patients.

关 键 词：左心衰竭 肺动脉高压 动态心电图 心律失常 

分 类 号：R541[医药卫生—心血管疾病]