158例慢性心力衰竭患者一年再住院的影响因素分析

Evaluation of Re-Hospitalization Factors in 158 Patients With Chronic Heart Failure

目的:探讨液体潴留等各种可能因素对慢性心力衰竭患者一年再住院的影响。方法:连续收集并整理了2003-01-01至2004-12-31因慢性心力衰竭住我院的患者158例,随访记录人口学资料、心脏功能、住院原因、治疗情况、治疗依从性包括门诊随诊情况及出院一年内的再住院,以一年内心力衰竭再住院为研究终点,通过多因素Logistic回归分析,探讨以上各因素与再住院的关系。结果:液体潴留、不定期门诊随诊是再住院的危险因素。不定期门诊随诊的患者比定期门诊随诊的患者再住院危险性增加了13.471倍(OR=14.471,95%的CI为6.332～37.611,P<0.001)。有液体潴留诱因的患者比没有液体潴留的患者再住院危险性增加了1.645倍(OR=2.645,95%CI为1.184～6.345,P<0.05)。年龄、性别、疾病史、肌钙蛋白T、左心室射血分数、院外规律服药等因素对再住院无影响(P>0.05)。结论:有效的疾病管理模式如提高患者治疗依从性包括定期门诊随诊、控制液体潴留等可能降低慢性心力衰竭患者的再住院。

Objective ：To invcstigate the re-hospitalization factors including fluid retention in patients with chronic heart failure （CHF）. Methods：A total of 158 consecutive patients from January 2003 to December 2004 in our hospital with CHF were recruited. The data included demographic factor, cardiac function, reason for hospitalization, compliance with medication and re-hospitalization within 1 year after discharge. The re-hospitalization was considered as the primary end point event. Multivariate logistic regression was used to investigate the relationship between those factors and the end point event. Results：We identified two independent predictors for patients＇ re-admission. There were excessive fluid retention （OR 2. 645, 95% CI 1. 184-6. 345, P 〈0.05 ） , and irregular outpatient visits（ OR 14. 471, 95% CI 6. 332-37.611, P 〈 0. 001 ）. The re-admission for patients with fluid retention was 1. 745-fold higher than patients without fluid retention, and irregular outpatient visit was 14. 44-fold higher than patient with regular hospital check up. While the age, gender, medical history, left ventricular ejection fractiotl were no statistical meaning for patients＇ re-admission（P 〉 0. 05）. Conclusion： The effective management such as compliance with medication, regular hospital check up and well-controlled fluid retention could be the key points for reducing re-hospitalization in CHF patients.