老年危重症病人肺动脉高压及相关因素分析

Prevalence and relative factors for pulmonary hypertension in the elderly patients with critical illness

目的评估老年危重症病人肺动脉高压(PAH)的发生率、相关因素及预后。方法 122例收治于ICU的老年危重症病人,入室4 d内行超声心动图检查,肺动脉收缩压≥40 mm Hg即拟诊为PAH,同时收集超声心动图数据、相关的临床资料和常规实验室检查数据,运用统计学方法进行相关分析。结果 51例病人拟诊为PAH,老年危重症病人PAH的发生率为41.8%。按2013年WHO诊断标准,其中17例(33.3%)为第2类左心疾病相关的PAH,26例(51.0%)为第3类慢性缺氧性疾病相关PAH。单因素分析显示,慢性阻塞性肺疾病(P=0.031)、呼吸衰竭(P=0.021)、增大的左心房(P=0.038)、右室舒张末内径(P=0.029),左室短轴缩短率下降(P=0.038),脑钠肽前体升高(P=0.046)与PAH的发生相关,多因素分析显示左心房增大、右室舒张末内径增加为老年危重症病人发生PAH的独立危险因素(OR=1.241,P=0.045;OR=1.360,P=0.027)。老年PAH病人ICU内病死率为17/51(33.3%),与肺动脉压正常者比较差异具有统计学意义(P=0.035)。结论老年危重症病人PAH发生率较高,且以第3类PAH为多,增大的左心房及右室舒张末内径为PAH发生的独立危险因素。PAH对其预后带来不利影响,需要引起重视。

Objective To evaluate the prevalence, relative factors and prognosis of pulmonary hypertension （PAH） in the elderly patients with critical illness. Methods 122 elderly patients （aged 74. 4±8.0 years） admitted to the intensive care unit were examined by Doppler echocardiography. PAH was defined as pulmonary artery systolic pressure （PASP） ≥ 40 mmHg. The echocardiography data, relative clinical data and laboratory data were collected. Relative factors associated with PAH in elderly patients with critical illness were analyzed. Results Fifty-one patients （41.8%） were diagnosed as PAH. According to WHO classification, 17 patients （33.3%） belonged to PAH group 2,26 patients （51.0%） belonging to PAH group 3. Based on the univariate analysis, chronic obstructive pulmonary disease（ P= 0. 031 ） , respiratory failure （ P= 0. 021 ） , enlarged left atrium （ P= 0. 038 ） , enlarged right ventricle（P= 0. 029）, decreased left ventricular shortening fraction（P= 0. 038） and increased pro brain natriuretic peptide（P= 0. 046） were significantly associated with PAH. Multivariate regression analysis showed that left atrial diameter （ OR= 1. 241, P= 0. 045）, enlarged right ventricle （ OR= 1. 360, P= 0. 027） were the risk factors of PAH in elderly patients with critical illness. What＇s more, patients with PAH had a higher in-ICU mortality （33.3%, P= 0. 035）. Conclusions The prevalence of PAH is high in elderly patients with critical illness, especially in those patients complicated with enlargement of left atrium and right ventricle. PAH is associated with high mortality, which needs more attention.