CAJ | 학술논문

目的探讨内科危重症患者心力衰竭患病率、心力衰竭特点以及危险因素。方法连续收集2006年10月至2010年6月入住北京安贞医院急诊内科重症监护病房(ICU)患者887例,54.2％为男性,年龄(69.83±13.57)岁。回顾性分析内科ICU患者心力衰竭患病率,应用多普勒超声心动图资料评价心力衰竭特点。调查心力衰竭基础心脏病因与危险因素,多元Logistic 回归探讨心力衰竭独立危险因素。结果 (1)在887例ICU患者中,≥65岁老年患者占74.1％,53％患者存在器官功能不全;(2)本组内科ICU患者心力衰竭患病率为22.8％(202例),完成超声心动图检测的187例心力衰竭患者中,62.5％(117例)左室射血分数＞50％;(3)基础心脏病因分析显示,冠心病居心力衰竭基础病因首位(52.5％),其次为瓣膜性心脏病(17.8％),27.2％心力衰竭患者未发现明确器质性心脏疾病;(4) Logistic多元回归分析显示,冠心病(OR=7.364,95％ CI:4.979～10.890,P＜0.01)、瓣膜性心脏病(OR=18.023,95％ CI:9.280～35.002,P＜0.01)、糖尿病(OR=2.154,95％CI:1.227 ～3.784,P=0.0076)、呼吸衰竭(OR=1.527,95％CI:1.045～2.229,P=0.0285)以及肾脏功能不全(OR=2.638,95％ CI:1.621 ～4.294,P=0.0001)显著增加内科ICU患者心力衰竭发病风险。结论心力衰竭已经成为危重症临床实践不容忽视的问题,其发病受到多因素影响。警惕左室射血分数正常的心力衰竭,对危重症临床实践具有重要意义。
목적 탐토내과위중증환자심력쇠갈환병솔、심력쇠갈특점이급위험인소。방법 련속수집2006년10월지2010년6월입주북경안정의원급진내과중증감호병방(ICU)환자887례,54.2％위남성,년령(69.83±13.57)세。회고성분석내과ICU환자심력쇠갈환병솔,응용다보륵초성심동도자료평개심력쇠갈특점。조사심력쇠갈기출심장병인여위험인소,다원Logistic 회귀탐토심력쇠갈독립위험인소。결과 (1)재887례ICU환자중,≥65세노년환자점74.1％,53％환자존재기관공능불전;(2)본조내과ICU환자심력쇠갈환병솔위22.8％(202례),완성초성심동도검측적187례심력쇠갈환자중,62.5％(117례)좌실사혈분수＞50％;(3)기출심장병인분석현시,관심병거심력쇠갈기출병인수위(52.5％),기차위판막성심장병(17.8％),27.2％심력쇠갈환자미발현명학기질성심장질병;(4) Logistic다원회귀분석현시,관심병(OR=7.364,95％ CI:4.979～10.890,P＜0.01)、판막성심장병(OR=18.023,95％ CI:9.280～35.002,P＜0.01)、당뇨병(OR=2.154,95％CI:1.227 ～3.784,P=0.0076)、호흡쇠갈(OR=1.527,95％CI:1.045～2.229,P=0.0285)이급신장공능불전(OR=2.638,95％ CI:1.621 ～4.294,P=0.0001)현저증가내과ICU환자심력쇠갈발병풍험。결론 심력쇠갈이경성위위중증림상실천불용홀시적문제,기발병수도다인소영향。경척좌실사혈분수정상적심력쇠갈,대위중증림상실천구유중요의의。
Objective To investigate the prevalence and the characteristics of heart failure (HF) in medical intensive care unit (ICU) so as to explore the factors contributing to HF. Methods A retrospective analysis of the data of HF was carried out in 887 HF patients (54. 2％ ) males; age (69.83± 13.57) years oldadmitted to the medical ICU from October 2006 through June 2010. Clinical variables were systematically reviewed for all enrolled patients. HF as either major or additional diagnosis was recorded and the potential risk factors for HF were explored. Left ventricular systolic function was evaluated in HF patients by using ejection fraction (EF) measured by echocardiography. Multivariate Logistic regression analysis was used to identify the independent factors contributing to HF in medical ICU patients. Results Of the 887 patients, 74. 1％ aged 65 years or over, and 53％ had organ dysfunction. The prevalence of HF in medical ICU patients was 22. 8％. Echocardiography measurement revealed that left ventricular systolic function was preserved in 62. 5％ of HF patients with an EF ＞ 50％. Underlying heart diseases were identified in 72. 8％ of the HF patients, and coronary artery disease accounted for the vast majority (52. 5％ ), followed by valvular heart disease ( 17. 8％ ). Structural heart diseases were not identified in 27. 2％ of the HF patients. 4) After the adjustment of age and gender, multivariate regression analysis showed that coronary artery disease ( OR =7. 364, 95％ CI: 4. 979 ～ 10. 890, P ＜0. 01 ), valvular heart disease ( OR =18. 023, 95％ CI: 9. 280 ～ 35. 002, P ＜ 0. 01 ), diabetes mellitus ( OR =2. 154, 95％ CI: 1. 227 ～ 3. 784, P =0. 0076), respiratory failure ( ( OR =1. 527, 95％ CI: 1. 045 ～ 2. 229, P =0. 0285 ), and renal dysfunction ( OR =2. 638, 95％ CI: 1. 621 ～ 4. 294, P =0. 0001 ) were associated with risk increased for HF in medical ICU. Conclusions HF is highly prevalent in medical ICU and its etiology is multi-factorial. The high rate of HF with preserved EF highlights the importance of enhanced alertness for HF with preserved systolic function in ICU.