老年急性心力衰竭住院患者近期预后的影响因素分析

Impact factors on short-term prognosis in senile inpatients with acute heart failure

摘要:

目的 对急性失代偿心力衰竭老年住院患者临床特点及检测指标进行分析，评估影响近期预后的危险因素。方法 回顾性地分析2012年1月至2012年12月首都医科大学宣武医院急诊病房收治的417例急性失代偿心力衰竭老年患者的临床资料，对基础疾病、并发症、NYHA分级、器官衰竭数目等因素以及氨基端B型利钠肽前体（NT-proBNP）水平及其变化趋势对预后的影响进行比较；采用logistic回归方法分析住院死亡的独立危险因素。结果 417例，年龄60～95（78.7±6.6）岁，男性190例，女性227例；其中≥80岁占50.6%；住院天数（12.4±8.6）d，≥2个器官功能障碍患者占86.8%。住院期间死亡74例，病死率为17.7%；随合并器官功能障碍数目增加，病死率显著增加（P＝0.001）。入院前NT-proBNP的水平及住院期间最高值在死亡组显著高于存活组（P＝0.001）；根据NT-proBNP水平的变化趋势分组，与入院前比较，NT-proBNP水平增高的患者组较该值下降或稳定的患者组住院病死率明显增高，分别为43.2%（35/81）与11.6%（39/336；P＝0.000）。logistic回归分析显示，影响住院期间死亡的独立危险因素依次为：合并器官功能障碍数目、合并呼吸衰竭、NYHA分级、NT-proBNP变化趋势、NT-proBNP住院期间最高水平、急性心肌梗死、低蛋白血症。结论 老年心力衰竭患者病因复杂，病情重，易合并器官功能障碍，预后差，应尽早明确诊断，尽早实施脏器保护。

Abstract:

Objective To investigate the clinical characteristics of acute decompensated heart failure in elderly inpatients and analyze the related clinical data in order to predict the factors influencing the short-term prognosis. Methods A total of 417 inpatients with acute decompensated heart failure admitted in our department from January to December of 2012 were enrolled in this study. There were 190 males and 227 females, with an age of (78.7±6.6)years, and 50.6% of them were over 80 years. Their clinical data, such as underlying diseases, complications, New York Heart Association (NYHA) classification, number of dysfunctioned organs, and serum level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) were collected and retrospectively analyzed. Logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results The length of hospital stay of the cohort was (12.4±8.6)d. The patients having more than 2 dysfunction organs accounted for 86.8%. There were 74 cases died in hospital, with a mortality of 17.7%. The mortality was increased with the increased number of dysfunctioned organs (P＝0.001). Serum level of NT-proBNP before hospitalization and the highest level during hospitalization were significantly higher in the death group than in the survival group (P＝0.001). The patients (43.2%, 35/81) with their serum NT-proBNP level in an increased trend after hospitalization had significantly higher mortality than those (11.6%, 39/336) with the level decreased or in a stable status (P＝0.000). Logistic regression analysis indicated that the independent predictors of mortality were the number of dysfunctioned organs, respiratory failure, NYHA grade, change trend of NT-proBNP, the highest level of NT-proBNP during hospitalization, acute myocardial infarction, and hypoproteinemia in turn. Conclusion Acute congestive heart failure in elderly patients is characterized with complicated causes, severe status, and is commonly associated with multiple organ dysfunction and poor prognosis. It is essential to diagnose the disease quickly and protect the organs function as early as possible.