肺心病并发冠状动脉粥样病变的临床特点、危险因素调查分析

Clinical characteristics and risk factors of coronary atherosclerotic lesions in pulmonary heart disease

目的探讨慢性肺源性心脏病（肺心病）并发冠状动脉粥样硬化病变的临床特点、危险因素调查分析。方法收集260例肺心病患者的临床资料，按是否合并冠状动脉粥样硬化病变分为A（肺心病并发冠状动脉病变组，n=62）、B组（单纯肺心病组，n=198），总结肺心病并发冠状动脉病变临床特点及其危险因素。结果①A组病程长于B组，其既往吸烟史所占比例、合并高血压及糖尿病、心律失常所占比例、合并低氧血症、酸碱失衡、电解质紊乱、左心功能不全比例高于B组，且其肺功能分级、心功能分级、呼吸功能分级均高于B组（P〈0．05）；②多因素分析显示，病程、合并高血压、合并心律失常、心功能分级、呼吸功能分级、低氧血症、电解质紊乱、左心功能不全为肺心病并发冠状动脉粥样硬化病变的独立危险因素（P〈0．05）。结论病程、高血压、心律失常、心功能分级、电解质紊乱、低氧血症、呼吸功能分级均与肺心病并发冠状动脉粥样病变有关，积极控制危险因素，强化对症支持，重视日常锻炼及营养摄入，降低心脏负荷，有助于降低肺心病并发冠状动脉病变风险。

Objective To investigate the clinical characteristics and risk factors of coronary atherosclerotic lesions in chronic pulmonary heart disease （PHD）. Methods The clinical data of 260 patients with PHD were collected and divided into group A （PHD with coronary lesions group, n = 62） and group B （simple PHD group, n=198）. The clinical characteristics and risk factors of coronary lesions in PHD were summarized. Results OThe course of disease in group A was longer than that in group B. The proportions of patients with previous smoking history, being complicated with hypertension and diabetes, arrhythmia, hyoxemia, acid-base imbalance, electrolyte disturbance and left ventricular dysfunction in group A were higher than those in group B, and the grades of lung function, cardiac function and respiratory function were higher than those in group B （ P 〈 0.05） ; （2） The multivariate analysis showed that course of disease, being complicated with hypertension, arrhythmia, cardiac function grade, respiratory function grade, hypoxemia, electrolyte disturbance and left ventricular dysfunction were the independent risk factors for PHD complicated with coronary atherosclerotic lesions （P 〈 0.05 ）. Conclusions The course of disease, hypertension, arrhythmia, cardiac function grade, electrolyte disturbance, hypoxemia and respiratory function grade are related to PHD complicated with coronary atherosclerotic lesions. Actively controlling risk factors, strengthening symptomatic and supportive treatment, paying attention to daily exercise and nutrition intake and reducing cardiac load is helpful to reduce the risk of PHD complicated with coronary atherosclerotic lesions.