射血分数降低和射血分数保留的急性心力衰竭患者远期预后分析

发布时间：2018-08-02 19:15

【摘要】：背景射血分数降低的急性心力衰竭(AHFr EF)和射血分数保留的急性心力衰竭(AHFp EF)患者短期预后差异不显著,但远期随访资料缺乏。目的比较AHFr EF和AHFp EF患者出院后3年内再住院率和病死率,并探讨影响患者再住院的危险因素。方法选取2011—2012年于内蒙古医科大学附属医院急诊科和内蒙古自治区人民医院急诊科首次诊断为急性心力衰竭(AHF)的患者296例为研究对象,依据左心室射血分数(LVEF),将患者分为AHFr EF组(LVEF50%,n=171)和AHFp EF组(LVEF≥50%,n=125)。记录患者性别、年龄、吸烟史、合并症、急性冠脉综合征(ACS)、充血性心力衰竭(CHF)、影像学检查、B型利钠肽(BNP)水平,以及出院医嘱用药情况。出院后通过电话或门诊随访3年,观察终点为心脑血管源再住院或死亡。结果两组高血压、慢性阻塞性肺疾病(COPD)、ACS、CHF、左心室扩大检出率,以及BNP≥220 ng/L、出院医嘱口服β-受体阻滞剂(β-RB)比例比较,差异均有统计学意义(P0.05)。两组因ACS、脑卒中及恶性心律失常引起的再住院率比较,差异均无统计学意义(P0.05)。AHFr EF组因心力衰竭引起的再住院率高于AHFp EF组,且总再住院率高于AHFp EF组(P0.05)。多因素Cox比例风险回归模型分析显示,高血压〔HR=1.450,95%CI(1.036,2.030)〕和BNP≥220 ng/L〔HR=1.894,95%CI(1.327,2.702)〕是AHF患者再住院的独立危险因素(P0.05)。AHFr EF组1、2、3年生存率分别为98%、95%、85%,AHFp EF组1、2、3年生存率分别为98%、94%、86%。两组生存曲线比较,差异有统计学意义(χ2=6.656,P=0.010)。结论 AHFr EF患者3年内因心力衰竭引起的再住院率高于AHFp EF患者,3年生存率低于AHFp EF患者;高血压和高水平BNP是AHF患者再住院的独立危险因素。临床应加强对AHFr EF患者的随访,改善合并高血压患者的血压控制水平。
[Abstract]:Background there is no significant difference in short-term prognosis between patients with acute heart failure (AHFr EF) with low ejection fraction and (AHFp EF) with acute heart failure (AHFp EF) with retained ejection fraction, but the long-term follow-up data are lacking. Objective to compare the rate of rehospitalization and mortality of patients with AHFr EF and AHFp EF within 3 years after discharge, and to explore the risk factors affecting the rehospitalization of patients. Methods A total of 296 patients with acute heart failure (AHF) were selected from the emergency department of the affiliated Hospital of Inner Mongolia Medical University and the Emergency Department of the people's Hospital of Inner Mongolia Autonomous region from 2011 to 2012. According to left ventricular ejection fraction (LVEF), the patients were divided into AHFr EF group (LVEF50) and AHFp EF group (LVEF 鈮，

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