心力衰竭患者低血压预后不佳

Low Blood Pressure Predicted Worse Prognosis of Patients with Congestive Heart Failure

背景心力衰竭表现为心脏收缩和(或)舒张功能的重度受损,并伴有神经体液因素的改变。血压作为一个综合反映全身血流动力学的指标,同样受到神经体液的调节,提示血压在心力衰竭的病情发展过程中具有一定的意义。目的探讨动态血压监测(ABPM)在心力衰竭患者预后判断中的价值。方法2007-02-12期间住院的心力衰竭患者92例,均行ABPM,并准确记录监测时的心功能分级。至少随访3月,以死亡为观察终点,以不同血压水平分组,绘制生存曲线并对其进行统计检验。对影响预后的因素进行单因素和多因素Cox风险比例模型分析,探讨ABPM在心力衰竭患者预后判断中的价值。结果所有心力衰竭患者至少随访3月后,有17例死亡,24 h平均收缩压(24 h SBP)<105 mmHg、24 h平均血压(24 h MBP)<80 mmHg和24 h平均脉压(24 h PP)<35 mmHg的心力衰竭患者生存率明显低于24 h SBP≥105 mmHg、24 h MBP≥80 mmHg和24 h PP≥35 mmHg的心力衰竭患者(P<0.01)。在单因素Cox风险比例模型分析中,心功能Ⅳ级、病因为扩张性心肌病、24 h SBP<105 mmHg、24 h MBP<80 mmHg和24 h PP<35 mmHg均是影响预后的因素,但在多因素Cox风险比例模型分析中,只有心功能Ⅳ级和24 h SBP<105 mmHg对预后有显著影响。结论低血压心力衰竭患者死亡率增加,收缩压、平均压、脉压是影响心力衰竭患者预后的重要因素,24 h SBP<105 mmHg是死亡终点的独立预测指标,提示临床医师对重症心力衰竭患者需进行血压监护,在应用具有降压作用的治疗心力衰竭的药物时应当十分慎重。

Background There are a paucity of data on the relationship between ambulatory blood pressure parameters（ABPM） and the prognosis of heart failure. Objective To explore the prognostic value of ABPM for patients with congestive heart failure （CHF）. Methods A total of 92 inpatients with CHF were monitored with am- bulatory blood pressure, and their cardiac function classifications were followed up for at least three months. Plo- ting survival rate against different blood pressure levels a Kaplan-Meier survival curve was constructed. Univariate and multivariate Cox proportional hazard model analysis were used to explore the prognostic value of ABPM for patients with CHF. Results Seventeen patients died during the followed up period. The survival rate of the patients with SBP〈105 mmHg, MBP〈80 mmHg and pulse pressure （PP） 〈35 mmHg was significantly lower than that of the patients with SBP≥105 mmHg, MBP≥80 mmHg and PP≥35 mmHg （P%0.01）. Univariate Cox analysis showed that New York Association （NYHA） Ⅳ, dilated eardiomyopathy （DCM）, SBP 〈105 mmHg, MBP〈80 mmHg and PP〈35 mmHg were determinants for prognosis factors for cardiac death. Multivariate Cox analysis showed that only NYHA Ⅳ and SBP 〈105 mmHg were the significant risk factors for prognosis. Conclusions Our data demonstrated hypotension increases mortality in patients with heart failure. SBP 〈105 mmHg is an independent predisposing risk factor for worse prognosis, suggesting the treatment of cardiac failure should be strictly individulized, cautiously monitoring BP changed.