中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
5期
354-359
,共6页
彭佳华%谭巧霞%肖玉光%邓伟峰%徐佐坤
彭佳華%譚巧霞%肖玉光%鄧偉峰%徐佐坤
팽가화%담교하%초옥광%산위봉%서좌곤
急性心力衰竭综合征%不良预后%负相关因素
急性心力衰竭綜閤徵%不良預後%負相關因素
급성심력쇠갈종합정%불량예후%부상관인소
Acute heart failure syndromes%Poor outcome%Negative risk factor
目的：对急性心力衰竭综合征（AHFS）患者近期和远期不良事件发生的负相关因素进行分析，为急诊进行AHFS低危分层提供依据。方法采用回顾性队列研究方法，纳入广西百色市人民医院和百色市右江区人民医院共125例符合研究标准的AHFS患者，再按近期和远期随访结局分别分为结局不良组和相对低危组。采集患者入院首次病史、体征、辅助检查变量。随访入院至出院后30 d（近期）和1年（远期）不良结局发生情况，Cox回归分析30 d和1年不良结局发生的负相关因素。结果近期不良结局患者58例（46.4%），死亡30例（24.0%）；远期不良结局患者111例（88.8%），死亡39例（31.2%）。Cox多因素分析筛选出不良结局负相关因素7个，分别为无既往或现症心肌梗死〔近期：危险比（HR）＝0.36，95%可信区间（95%CI）＝0.20～0.65，P＝0.001〕、淋巴细胞比例0.20～0.40（近期：HR＝0.13，95%CI＝0.04～0.47，P＝0.002；远期：HR＝0.42，95%CI＝0.26～0.68，P＝0.001）、氧合指数（PaO2/FiO2）＞300 mmHg（1 mmHg＝0.133 kPa，近期：HR＝0.23，95%CI＝0.09～0.54，P＝0.001）、肾小球滤过率（eGFR）＞60 mL·min-1·1.73 m-2（近期：HR＝0.31，95%CI＝0.16～0.64，P＝0.002；远期：HR＝0.54，95%CI＝0.36～0.83，P＝0.004）、左室射血分数（LVEF）＞0.50（近期：HR＝0.29，95%CI＝0.10～0.85，P＝0.024）、V1导联P波终末电势（PtfV1）＞-0.04 mm·s（近期：HR＝0.29，95%CI＝0.14～0.60，P＝0.001）、平面QRS-T夹角＜90°（远期：HR＝0.46，95%CI＝0.27～0.77，P＝0.003）。结论本研究中纳入的AHFS患者近、远期预后差；具有非既往或现症心梗、淋巴细胞比例0.20～0.40、PaO2/FiO2＞300 mmHg、eGFR＞60 mL·min-1·1.73 m-2、PtfV1＞-0.04 mm·s、LVEF＞0.50、平面QRS-T夹角＜90°特征的患者可能有更好的近期和远期预后。
目的：對急性心力衰竭綜閤徵（AHFS）患者近期和遠期不良事件髮生的負相關因素進行分析，為急診進行AHFS低危分層提供依據。方法採用迴顧性隊列研究方法，納入廣西百色市人民醫院和百色市右江區人民醫院共125例符閤研究標準的AHFS患者，再按近期和遠期隨訪結跼分彆分為結跼不良組和相對低危組。採集患者入院首次病史、體徵、輔助檢查變量。隨訪入院至齣院後30 d（近期）和1年（遠期）不良結跼髮生情況，Cox迴歸分析30 d和1年不良結跼髮生的負相關因素。結果近期不良結跼患者58例（46.4%），死亡30例（24.0%）；遠期不良結跼患者111例（88.8%），死亡39例（31.2%）。Cox多因素分析篩選齣不良結跼負相關因素7箇，分彆為無既往或現癥心肌梗死〔近期：危險比（HR）＝0.36，95%可信區間（95%CI）＝0.20～0.65，P＝0.001〕、淋巴細胞比例0.20～0.40（近期：HR＝0.13，95%CI＝0.04～0.47，P＝0.002；遠期：HR＝0.42，95%CI＝0.26～0.68，P＝0.001）、氧閤指數（PaO2/FiO2）＞300 mmHg（1 mmHg＝0.133 kPa，近期：HR＝0.23，95%CI＝0.09～0.54，P＝0.001）、腎小毬濾過率（eGFR）＞60 mL·min-1·1.73 m-2（近期：HR＝0.31，95%CI＝0.16～0.64，P＝0.002；遠期：HR＝0.54，95%CI＝0.36～0.83，P＝0.004）、左室射血分數（LVEF）＞0.50（近期：HR＝0.29，95%CI＝0.10～0.85，P＝0.024）、V1導聯P波終末電勢（PtfV1）＞-0.04 mm·s（近期：HR＝0.29，95%CI＝0.14～0.60，P＝0.001）、平麵QRS-T夾角＜90°（遠期：HR＝0.46，95%CI＝0.27～0.77，P＝0.003）。結論本研究中納入的AHFS患者近、遠期預後差；具有非既往或現癥心梗、淋巴細胞比例0.20～0.40、PaO2/FiO2＞300 mmHg、eGFR＞60 mL·min-1·1.73 m-2、PtfV1＞-0.04 mm·s、LVEF＞0.50、平麵QRS-T夾角＜90°特徵的患者可能有更好的近期和遠期預後。
목적：대급성심력쇠갈종합정（AHFS）환자근기화원기불량사건발생적부상관인소진행분석，위급진진행AHFS저위분층제공의거。방법채용회고성대렬연구방법，납입엄서백색시인민의원화백색시우강구인민의원공125례부합연구표준적AHFS환자，재안근기화원기수방결국분별분위결국불량조화상대저위조。채집환자입원수차병사、체정、보조검사변량。수방입원지출원후30 d（근기）화1년（원기）불량결국발생정황，Cox회귀분석30 d화1년불량결국발생적부상관인소。결과근기불량결국환자58례（46.4%），사망30례（24.0%）；원기불량결국환자111례（88.8%），사망39례（31.2%）。Cox다인소분석사선출불량결국부상관인소7개，분별위무기왕혹현증심기경사〔근기：위험비（HR）＝0.36，95%가신구간（95%CI）＝0.20～0.65，P＝0.001〕、림파세포비례0.20～0.40（근기：HR＝0.13，95%CI＝0.04～0.47，P＝0.002；원기：HR＝0.42，95%CI＝0.26～0.68，P＝0.001）、양합지수（PaO2/FiO2）＞300 mmHg（1 mmHg＝0.133 kPa，근기：HR＝0.23，95%CI＝0.09～0.54，P＝0.001）、신소구려과솔（eGFR）＞60 mL·min-1·1.73 m-2（근기：HR＝0.31，95%CI＝0.16～0.64，P＝0.002；원기：HR＝0.54，95%CI＝0.36～0.83，P＝0.004）、좌실사혈분수（LVEF）＞0.50（근기：HR＝0.29，95%CI＝0.10～0.85，P＝0.024）、V1도련P파종말전세（PtfV1）＞-0.04 mm·s（근기：HR＝0.29，95%CI＝0.14～0.60，P＝0.001）、평면QRS-T협각＜90°（원기：HR＝0.46，95%CI＝0.27～0.77，P＝0.003）。결론본연구중납입적AHFS환자근、원기예후차；구유비기왕혹현증심경、림파세포비례0.20～0.40、PaO2/FiO2＞300 mmHg、eGFR＞60 mL·min-1·1.73 m-2、PtfV1＞-0.04 mm·s、LVEF＞0.50、평면QRS-T협각＜90°특정적환자가능유경호적근기화원기예후。
ObjectiveTo assess negative risk factors associate with short-term and long-term poor outcome of acute heart failure syndromes(AHFS) and provide evidence to emergently proceed to AHFS low risk stratification.Methods A retrospective cohort study was conducted. 125 AHFS patients who met research criterion were enrolled from Guangxi Baise People's Hospital and Youjiang District People's Hospital of Baise City. The patients were divided into poor outcome and relatively low-risk groups by the results of short- and long-term follow-up of their outcomes. The patient's vital signs and disease history were collected at the first time after admission, and auxillary examination parameters were recorded. The poor outcomes occurring in the follow-up periods from the admission to after discharge for 30 days(short-term) and 1 year(long-term)were recorded, and Cox hazard regression was used to analyze the negative risk factor in the short- and long-term.Results There were 58 cases(46.4%)with poor outcome and 30 cases(24.0%)dead in short-term, and there were 111 cases(88.8%) with poor outcome and 39 cases(31.2%) dead in the long-term follow up. Seven negative risk factors were identified by Cox regression. They were no previous or de novo myocardial infarction〔short-term: hazard ratio(HR)=0.36, 95% confidence interval (95%CI)=0.20-0.65,P=0.001〕, lymphocyte ratio 0.20-0.40(short-term:HR=0.13, 95%CI=0.04-0.47, P=0.002; long-term:HR=0.42, 95%CI=0.26-0.68,P=0.001),oxygenation index(PaO2/FiO2)>300 mmHg (1 mmHg=0.133 kPa,short-term:HR=0.23, 95%CI=0.09-0.54,P=0.001),estimated glomerular filtration rate (eGFR)>60 mL·min-1·1.73 m-2(short-term:HR=0.31, 95%CI=0.16-0.64,P=0.002;long-term:HR=0.54, 95%CI=0.36-0.83,P=0.004),left ventricular ejection fraction(LVEF)>0.50(short-term:HR=0.29, 95%CI= 0.10-0.85,P=0.024), P wave terminal force in lead V1(PtfV1)>-0.04 mm·s(short-term:HR=0.29, 95%CI= 0.14-0.60,P=0.001), planar QRS-T angle<90°(long-term:HR=0.46, 95%CI=0.27-0.77,P=0.003). ConclusionsOur patients with AHFS cohort have very poor outcomes both in short-term and long-term follow up. Those with the following characteristics: no previous or de novo myocardial fraction, lymphocyte ratio 0.20-0.40, PaO2/FiO2>300 mmHg, eGFR>60 mL·min-1·1.73 m-2, PtfV1>-0.04 mm·s, LVEF>0.50 and planar QRS-T angle<90°are more likely to have optimal short-term and long-term outcome.
