老年危重症患者心衰发病特征及相关危险因素分析

Characteristics and risk factors for heart failure in elderly patients in intensive care unit

目的 分析老年危重症住院患者心衰构成比及临床特点,并探讨老年危重症患者发生心衰的相关危险因素。方法 采用回顾性队列研究的方式,连续收集2010年1月至2014年6月笔者单位ICU收治的2 871例老年危重症患者作为研究对象,收集患者临床资料,计算心衰构成比,分析患者心衰特点,采用多因素Logistic回归分析筛选老年危重症患者发生心衰的相关危险因素。结果2 871例老年危重症患者中,689例患者合并有心衰,心衰构成比为24.0%。心衰患者的平均年龄高于无心衰患者[（77.2±10.6）岁vs.（72.9±15.6）岁,t=6.759,P〈0.001];而心衰患者与无心衰患者的性别构成之间差异无统计学意义（χ^2=1.021,P=0.312）。有126例（22.7%）患者的左室射血分数（LVEF）〈40%;低LVEF的老年危重症患者相较于左室收缩功能正常的心衰患者的年龄明显偏小[（73.5±12.6）岁vs.（77.4±9.7）岁,t=-7.456,P〈0.001],而男性所占比例更多（68.1%vs.53.1%;χ^2=47.977,P〈0.001）。多因素Logistic回归分析显示：冠心病（OR=8.907）、瓣膜性心脏病（OR=7.152）、糖尿病（OR=2.213）、肾功能不全（OR=2.905）、急诊手术（OR=3.374）是老年危重症患者心衰发病的独立危险因素。结论 老年危重症患者的心衰发病受到基础病因等多因素影响,针对老年危重症患者维持肾脏功能、减少急诊手术等可以有效降低心衰的发病风险。

Objective To analyze the prevalence and clinical characteristics of heart failure （HF） in elderly patients in intensive care unit （ICU）, and to explore the risk factors contributing to HF. Methods A retrospective cohort study was adopted to collect 2871 cases of elderly critically ill patients admitted to the ICU of Sichuan Provincial People＇s Hospital from January 2010 to June 2014. We collected the clinical data of these elderly critically ill patients, calculated the prevalence of HF, and analyzed the characteristics of the HF patients. Multivariate logistic regression analysis was used to screen risk factors contributing to HF. Results Of the 2871 critically ill elderly patients, 689 had HF, with the prevalence rate of 24.0%. The average age of HF patients was higher than that of non-HF ones [（77.2±10.6） years old vs. （72.9±15.6） years old, t = 6. 759, P〈0.001]; however, the two groups of patients did not differ significantly in gender composition （ x2= 1. 021, P=0. 312）. There were 126 （22.7%） patients with left ventricular ejection fraction （LVEF） 〈40%; critically ill patients with lower LVEF were significantly younger than those with normal LVEF [（73.5 ± 12.6 years） vs. （77.4±9.7） years old, t = -7.456, P〈0.001], and the proportion of men was greater （68. 1% vs. 53. 1%; Zz =47. 977, P〈0.001）. Multivariate Logistic regression analysis showed that coronary heart disease （OR = 8. 907）, valvular heart disease （OR = 7. 152）, diabetes （ OR = 2. 213）, renal insufficiency （ OR = 2. 905）, and emergency surgery （ OR = 3. 374） were the independent risk factors for the onset of HF in the elderly critically ill patients. Conclusion The etiology of HF in critically ill elderly patients is multi-factorial including the underlying cause. Maintaining renal function and reducing emergency surgery for elderly critically ill patients can reduce the risk of HF.