多器官病变在心力衰竭死亡患者中的发生状况和趋势

Multiple organ damage in patients dying from acute decompensated heart failure

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.

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.