CAJ | 학술논문

目的了解急性失代偿心力衰竭住院死亡患者中多器官病变的发生状况和趋势.方法回顾性分析2006年1月至2007年阜外心血管病医院重症监护病房30例住院死亡的急性失代偿心力衰竭患者的临床资料,对呼吸衰竭、肾功能不全、肝功能不全、肺部感染和贫血在入院时和死亡前的情况进行分析和比较.结果 30例死亡患者平均年龄(55±22)岁.男19例,女11例,NYHA心功能Ⅲ级者7例、Ⅳ级者23例.病因包括心脏瓣膜病17例、扩张型心肌病6例、缺血性心肌病4例、心脏瓣膜病合并陈旧性心肌梗死2例、限制型心肌病1例.平均住院时间(8.8±7.4)d.入院时合并肺部感染、肾功能不全、呼吸衰竭、肝功能不全和贫血者分别有15、6、7、13和7例,合并多器官(2个以上器官功能)病变者15例.死亡前,上述器官病变者分别增加至27、24、20、19例(P＜0.05或0.01)和9例(P＞0.05),合并多器官病变者增至29例(97%、P＜0.01).在发生致命性心律失常的11例患者中,3例在入院时合并多器官病变,另7例患者在心律失常事件后发生了多器官病变.而在未发生致命性心律失常的19例患者中,12例在入院时即合并多器官病变,7例在死亡前发生多器官病变.在发生致命性心律失常而早期心肺复苏成功且存活12 h以上的6例患者,均在心肺复苏之后发生了多器官病变,主要是肾功能不全、肺部感染、呼吸衰竭.结论急性失代偿心力衰竭患者在心衰恶化到死亡的过程中普遍发生了多器官病变,以肺郎感染、肾功能不全和呼吸衰竭的增加最显著.
목적 료해급성실대상심력쇠갈주원사망환자중다기관병변적발생상황화추세.방법 회고성분석2006년1월지2007년부외심혈관병의원중증감호병방30례주원사망적급성실대상심력쇠갈환자적림상자료,대호흡쇠갈、신공능불전、간공능불전、폐부감염화빈혈재입원시화사망전적정황진행분석화비교.결과 30례사망환자평균년령(55±22)세.남19례,녀11례,NYHA심공능Ⅲ급자7례、Ⅳ급자23례.병인포괄심장판막병17례、확장형심기병6례、결혈성심기병4례、심장판막병합병진구성심기경사2례、한제형심기병1례.평균주원시간(8.8±7.4)d.입원시합병폐부감염、신공능불전、호흡쇠갈、간공능불전화빈혈자분별유15、6、7、13화7례,합병다기관(2개이상기관공능)병변자15례.사망전,상술기관병변자분별증가지27、24、20、19례(P＜0.05혹0.01)화9례(P＞0.05),합병다기관병변자증지29례(97%、P＜0.01).재발생치명성심률실상적11례환자중,3례재입원시합병다기관병변,령7례환자재심률실상사건후발생료다기관병변.이재미발생치명성심률실상적19례환자중,12례재입원시즉합병다기관병변,7례재사망전발생다기관병변.재발생치명성심률실상이조기심폐복소성공차존활12 h이상적6례환자,균재심폐복소지후발생료다기관병변,주요시신공능불전、폐부감염、호흡쇠갈.결론 급성실대상심력쇠갈환자재심쇠악화도사망적과정중보편발생료다기관병변,이폐랑감염、신공능불전화호흡쇠갈적증가최현저.
Objective To detect the occurring and developing patterns of multiple organ damage in patients dying from acute decompensated heart failure (ADHF). Methods The clinical data of 30 hospitalized patients of ADHF were analyzed. The dying causes included renal, hepatic, respiratory dysfunctions, infection and anemia. All patients received continuous cardiac rhythm monitoring. Their renal,hepatic and respiratory function, infection and anemia were evaluated at admission and during the last 24 hours pre-death respectively. And the results were compared. Results There were 19 males and 11 females. The average age was (55 ± 22) years old. Among them, 7 cases were of NYHA class Ⅲ and 23 cases NYHA class Ⅳ at admission. The causes of heart failure included valvular heart disease ( n = 17 ),dilated cardiomyopathy ( n = 6 ), ischemic cardiomyopathy ( n = 4 ), valvular heart disease and previouscardiac infarction ( n = 2) and restrictive cardiomyopathy ( n = 1 ). From admission to death, the average hospitalization duration was( 8.8 ± 7.4) days. Eleven cases suffered from sudden cardiac death due to lethal arrhythmias including ventricular tachycardia, ventricular fibrillation and sinus arrest. Another 19 cases had no lethal arrhythmias, but they suffered cardiac shock eventually. Among all 30 cases, there were 15 cases with pulmonary infection, 13 caseswith hepatic dysfunction, 6 cases with renal dysfunction, 7 caseswith respiratory failure, 7 cases with anemia and 15 cases with multiple organ damage at admission. However, the pre-death values increased to 26 (87%, P＜0.01), 19 (63%, P ＜0.05), 24 (80%, P ＜0.01 ), 20(67%, P＜0.01), 9 (30%, P＞0.05) and29 (97%, P＜0.01) respectively. Conclusion Multiple organ damage evolves and worsens to result in death in ADHF patients.