单中心急性心力衰竭登记研究5年随访及预后分析

发布时间：2018-04-28 05:11

本文选题：心力衰竭 + 登记研究　；参考：《北京协和医学院》2017年硕士论文

【摘要】：研究背景:心力衰竭(简称心衰)是各种心脏疾病的严重和终末阶段,有高发病率,高再住院率和高死亡率的特点。急诊科在急性心衰患者的治疗中有关键作用。我国目前尚无针对急诊科内急性心衰患者的大型登记研究,对急性心衰患者的远期预后和长期治疗情况研究不足。北京地区急性心力衰竭登记研究是我国第一个针对急诊室内急性心衰患者的多中心、前瞻性队列研究。在研究人口学资料、流行病学特点同时,对急性心衰患者进行长时间随访,了解患者的生存情况、治疗情况、疾病转归等,并进一步分析影响预后的危险因素。研究目的:观察阜外医院急诊室急性心衰患者的5年预后情况及治疗现状。比较各因素下5年预后的差异,探讨影响急性心衰患者5年预后的危险因素。研究方法:对“北京地区急性心衰登记研究”中阜外医院急诊室纳入的1032例急性心衰患者进行5年随访,通过电话随访、查询门诊记录、公安系统查询等多种方法,收集患者5年生存情况及治疗情况,总结5年死亡率及治疗现状,并应用SPSS进行统计学分析,对比各因素下5年预后的差异,探讨影响5年预后的危险因素。研究结果:研究中阜外医院急诊室自2011年3月15日至2012年4月27日共纳入1032例急性心衰患者。平均年龄56.9±15.6岁,女性占总体人群的38%。随访患者至第5年(第60个月),5年失访率4%,总体人群1年死亡率25.2%,3年死亡率38.9%,5年死亡率42.8%。5年存活患者药物治疗现状方面,可改善预后的神经内分泌阻滞剂药物的使用频率分别为:β受体阻滞剂45.2%,ACEI类17.1%,ARB类10.2%,螺内酯26.9%。KM生存分析有明显统计学差异的因素有年龄、BMI、心功能NYHA分级、慢性肾功能不全、NT-proBNP、神经内分泌阻滞剂、地高辛、利尿剂等,地高辛、利尿剂在校正混杂因素后远期预后无明显差异。不同EF分组,初发心衰或慢性失代偿心衰5年预后无明显差异。经多元COX回归分析,高龄、低BMI、高NYHA分级(2级以上)、低动脉收缩压、高血肌酐、高血NT-proBNP水平是急性心衰患者5年全因死亡的危险因素。研究结论:急性心衰患者5年预后较差。目前急性心衰患者的药物治疗现状与指南指导的药物治疗之间仍有差距。高龄、低BMI、高NYHA分级(2级以上)、低动脉收缩压、高血肌酐、高血NT-proBNP水平是急性心衰患者5年全因死亡的危险因素。
[Abstract]:Background: heart failure (HF) is a serious and terminal stage of various heart diseases, with high morbidity, high rehospitalization rate and high mortality. Emergency department plays a key role in the treatment of patients with acute heart failure. At present, there is no large-scale research on the patients with acute heart failure in emergency department in China, and the long-term prognosis and long-term treatment of patients with acute heart failure are not well studied. The Beijing area acute heart failure registration study is the first multicenter prospective cohort study of acute heart failure patients in emergency rooms in China. In the course of studying demographic data and epidemiological characteristics, the patients with acute heart failure were followed up for a long time to understand the survival, treatment and outcome of the disease, and to further analyze the risk factors affecting the prognosis. Objective: to observe the 5-year prognosis and treatment status of patients with acute heart failure in emergency room of Fuwei Hospital. To compare the 5-year prognosis of patients with acute heart failure (AHF) and to explore the risk factors affecting the 5-year prognosis of patients with acute heart failure (AHF). Methods: 1032 patients with acute heart failure included in the emergency department of Fuwei Hospital were followed up for 5 years in the "Research on the Registration of Acute Heart failure in Beijing area". By telephone follow-up, the records of outpatient service and public security system were queried. The 5-year survival and treatment were collected, the 5-year mortality and treatment status were summarized, and SPSS was used to carry out statistical analysis to compare the differences of 5-year prognosis between different factors, and to explore the risk factors affecting 5-year prognosis. Results: from March 15, 2011 to April 27, 2012, 1032 patients with acute heart failure were enrolled in the emergency department of Zhongfuwei Hospital. The average age was 56.9 卤15.6 years, and the female accounted for 38% of the total population. The patients were followed up to the fifth year (the 60th month, the lost visit rate was 4, the overall mortality rate was 25.2%, the 3-year mortality rate was 38.9%, and the 5-year mortality rate was 42.8.5 years). The frequency of use of neuroendocrine blockers to improve the prognosis were: 尾 receptor blockers 45.2 and ACEI 17.1ARB 10.2.The significant differences in survival analysis of spironolactone 26.9%.KM were age BMIand cardiac function NYHA grade. NT-proBNPs, neuroendocrine blockers, digoxin, diuretics, digoxin and diuretics had no significant difference in long-term prognosis after adjusting for mixed factors. In different EF groups, there was no significant difference in 5 years prognosis between primary heart failure and chronic decompensated heart failure. Multivariate COX regression analysis showed that old age, low BMI, high NYHA grade or above, low systolic blood pressure, high serum creatinine and high NT-proBNP level were the risk factors of death in patients with acute heart failure for 5 years. Conclusion: the prognosis of patients with acute heart failure in 5 years is poor. There is still a gap between the current status of drug therapy in patients with acute heart failure and the drug treatment guidelines. Old age, low BMI, high NYHA grade > 2, low systolic blood pressure, high serum creatinine and high blood NT-proBNP level were the risk factors of 5-year mortality in patients with acute heart failure.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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