俯身呼吸困难对射血分数降低的心力衰竭患者病情评价的价值

Clinical value of bendopnea in chronic heart failure patients with reduced left ventricular ejection fraction

目的探讨俯身呼吸困难对射血分数降低的心力衰竭（HFrEF）患者病情的评价价值。方法入选2014年1月至2016年1月在解放军第九十一医院心内科住院诊疗的HFrEF患者192例，按照有无俯身呼吸困难将患者分为俯身呼吸困难组和非俯身呼吸困难组，并将俯身呼吸困难组患者按照俯身呼吸困难症状出现的时间分为0~10 s亚组、11~20 s亚组和21~30 s亚组。对入选患者进行俯身呼吸困难的评估，检测患者的心功能评价指标，包括左心室射血分数（LVEF）、6 min步行距离（6－MWD）、N末端B型利钠肽原（NT－proBNP）及纽约心脏协会（NYHA）心功能分级。并分析俯身呼吸困难与LVEF、6－MWD、NT－proBNP和NYHA心功能分级的关系。结果入选患者中74例（38.54%）发生了俯身呼吸困难症状，症状平均出现时间为（8.62±2.29） s。俯身呼吸困难组患者LVEF明显低于非俯身呼吸困难组（P〈0.05），6－MWD明显低于非俯身呼吸困难组（P〈0.05），NT－proBNP水平明显高于非俯身呼吸困难组（P〈0.05），NYHA心功能Ⅳ级患者明显多于非俯身呼吸困难组（P〈0.05）。且俯身呼吸困难0~10 s亚组（n=39）、11~20 s亚组（n=20）和21~30 s亚组（n=15）患者间LVEF、6－MWD、NT－proBNP和NYHA Ⅳ级患者例数比较差异均有统计学意义（P均〈0.05），随着俯身呼吸困难出现时间的缩短，患者心功能呈现逐步下降的趋势。结论俯身呼吸困难症状在HFrEF患者中发生率较高，其与患者的心功能指标存在密切的关系，具有一定的病情评价价值。

ObjectiveTo explore the clinical value of bendopnea in chronic heart failure patients with reduced ejection fraction （HFrEF）.MethodsAccording to the existence of bendopnea or not, a total of 192 consecutive chronic heart failure patients with HFrEF admitted to our department from January 2014 to January 2016 were divided into the bendopnea group and non-bendopnea group. Subgroup analysis was performed in the subgroups with various bendopnea symptoms appearance time （0-10 s, 11-20 s and 21-30 s）. The relationship between bendopnea and left ventricular ejection fraction （LVEF）, 6-minute walking distance （6-MWD）, NT-proBNP and NYHA classification were analyzed.ResultsBendopnea was confirmed in 74 out of 192 （38.54%） cases with HFrEF, and the average time of symptoms appearance was （8.62±2.29） s. LVEF and 6-MWD values were significantly lower in the bendopnea group than those in the non-bendopnea group （both P〈0.05）. The NT-proBNP level and the prevalence of patients with NYHA grade Ⅳ were significantly higher in the bendopnea group than those in the non-bendopnea group （both P〈0.05）. There were significant difference on LVEF, 6-MWD, NT-proBNP and patients with NYHA grade Ⅳ in bendopnea patients with various bendopnea symptoms appearance time （all P〈0.05） and shorter bendopnea symptoms appearance time was related to severe symptoms and signs of chronic heart failure.ConclusionThe incidence rate of bendopnea is high in patients with HFrEF, and which is related closely to the cardiac function and shorter bendopnea symptoms appearance time is related to severe symptoms and signs of chronic heart failure in HFrEF patients.