老年危重症患者心力衰竭特征及其危险因素分析

Study on the clinical characteristics and risk factors of heart failure in elderly patients with critical illness

目的：探讨老年危重症患者心力衰竭患病率、心力衰竭特点及危险因素。方法：收集2011-12-2014-09我院急诊内科和急诊ICU收治的老年危重症患者216例,回顾性分析老年危重症患者心力衰竭患病率及其特点,并采用多元Logistic回归分析筛选老年危重症患者发生心力衰竭的独立危险因素。结果：216例患者中,59例（27.3%）患者合并心力衰竭,且31例合并心力衰竭患者的左室射血分数（LVEF）≥50%;合并心力衰竭患者的平均年龄明显高于无合并心力衰竭患者[（75.4±10.2）岁vs.（72.0±14.9）岁,t=6.447,P=0.015];左室收缩功能正常的心力衰竭患者平均年龄明显高于左室收缩功能不全的心力衰竭患者[（76.7±9.3）岁vs.（74.3±8.4）岁,t=5.624,P=0.036];多元Logistic回归分析显示,冠心病（OR=8.271,95%CI：5.916~10.821,P=0.000）、瓣膜性心脏病（OR=7.961,95%CI：4.871~11.226,P=0.002）、糖尿病（OR=2.061,95%CI：1.176~3.812,P=0.009）、呼吸衰竭（OR=1.443,95%CI：0.975~2.118,P=0.038）以及肾功能不全（OR=2.038,95%CI：1.661~2.464,P=0.016）均显著增加老年危重症患者心力衰竭发病风险。结论：心力衰竭已成为老年危重症患者不容小觑的问题,通过对老年危重症患者心力衰竭特征及其危险因素进行研究,有助于老年危重症患者的临床救治。

Objective：To analyze the clinical characteristics and risk factors of heart failure in elderly patients with critical illness.Method：From December 2011 to September 2014,a total of 216 elderly patients with critical illness in the emergency internal department and emergency ICU of Affiliated Hospital of Nantong University were studied.The heart failure prevalence rates,characteristics were analyzed retrospectively,and the independent risk factors contributing to heart failure were also analyzed by use of multivariate logistic regression analysis.Result：In the 216 cases,59（27.3%）were with heart failure.Among them there were 31 patients with heart failure whose left ventricular ejection fraction（LVEF）was≥50%.The average age of patients with heart failure was higher than that of patients without heart failure[（75.4±10.2）vs.（72.0±14.9）,t=6.447,P=0.015].The average age of heart failure patients with normal left ventricular systolic function was higher than that of patients with abnormal left ventricular systolic function[（74.3±8.4）vs.（76.7±9.3）,t=5.624,P=0.036].Multivariate logistic regression analysis showed that there was a remarkable positive correlation between the occurrence of heart failure and coronary heart disease（OR=8.271,95%CI：5.916~10.821,P=0.000）,valvular heart disease（OR=7.961,95%CI：4.871~11.226,P=0.002）,diabetes（OR=2.061,95%CI：1.176~3.812,P=0.009）,respiratory failure（OR=1.443,95%CI：0.975~2.118,P=0.038）and renal dysfunction（OR=2.038,95%CI：1.661~2.464,P=0.016）.Conclusion：Heart failure is highly prevalent in elderly patients with critical illness.Study on the clinical characteristics and risk factors of heart failure is helpful to the treatment of elderly patients with critical illness.