老年急性心力衰竭患者血糖水平与短期预后的关系

Relationship between blood glucose level and short-term prognosis in elderly patients with acute heart failure

目的:探讨血糖水平与老年急性心力衰竭(AHF)患者短期预后的相关性。方法:选取286例老年AHF患者,根据血糖水平分为血糖升高组和血糖正常组,使用镇静剂、利尿剂、扩血管药物等进行相应的治疗,随访30 d,观察并记录患者的一般临床资料:性别、年龄、体质量指数、并发症、诱发因素、既往疾病史、心率、血压、临床用药、生化指标、30 d短期预后。结果:2组患者性别、年龄、体质量指数、慢性阻塞性肺疾病史、心率、舒张压以及镇静剂、利尿剂、血管紧张素Ⅱ受体拮抗剂(ARB)、血管紧张素转换酶抑制剂(ACEI)的使用情况无显著差异(均P>0.05);与血糖正常组比较,血糖升高组的高血压史、冠状动脉疾病史、心力衰竭史、收缩压、血糖明显升高,扩血管药物使用明显降低(均P<0.05);血糖升高组的病死率显著高于血糖正常组(9.5%vs 2.5%,P<0.05)。患者的高血压史、心力衰竭史、冠状动脉疾病史、收缩压、扩血管药物使用等与AHF患者的短期预后无相关关系(均P>0.05);患者的血糖水平与患者短期预后有相关性(P<0.05)。结论:血糖水平可以作为老年AHF患者短期预后的独立预测因素,临床可根据患者血糖情况及时对患者采取干预措施。

Objective：To study the relationship between blood glucose level and short-term prognosis in elderly patients with acute heart failure （AHF）.Method：286 elderly patients with AHF were collected.According to the blood glucose level, the patients were divided into the normal glucose level group and high glucose level group.The patients were followed up for 30 days.The gender, age, body mass index, complications, predisposing factors and the history of the diseases were observed and recorded.Result：There were no significant differences in gender, age, body mass index, chronic obstructive pulmonary disease history, heart rate, diastolic blood pressure, sedative, diuretic, ARB, and ACEI between the two groups （P〉0.05）.The incidence of previous hypertension, coronary heart disease and heart failure, systolic blood pressure and blood glucose were significantly increased, and the dosage of vasodilators was significantly reduced in the high glucose level group as compared with those in the normal glucose level group （P〈0.05 for all）.The mortality rate in the high glucose level group was significantly higher than in the normal glucose level group （9.5% vs 2.5%, P〈0.05）.The history of hypertension, heart failure and coronary artery disease, systolic blood pressure, and the usage of vasodilators had no significant correlation with the short-term prognosis of elderly patients with AHF （P〉0.05 for all）.There was a significant correlation between the blood glucose level and the short-term prognosis of elderly patients with AHF （P〈0.05）.Conclusion：Blood glucose levels in elderly patients with AHF can be used as an independent predictor of short-term prognosis.Clinically, appropriate treatment program can be made according to the glucose levels.