急性失代偿性心力衰竭老年患者死亡危险因素分析

Analysis of the risk factors for the death of elderly patients with acute decompensated heart failure

目的探讨急性失代偿性心力衰竭(ADHF)老年患者死亡的危险因素。方法选取2014年3月至2016年10月茂名石化医院收治的ADHF老年患者173例,依据生存状况分为存活组(n=147例)和死亡组(n=26例),对2组患者的临床资料进行单因素和多因素logisitic回归分析。结果年龄、心率、室壁运动异常、左心室射血分数≤50%、发病至入院时间、贫血、糖尿病、冠状动脉粥样硬化性心脏病、心力衰竭史、心室颤动、纽约心脏学会(NYHA)分级≥Ⅲ级、收缩压、舒张压、白细胞计数及肌酸激酶同工酶、脑钠肽、血肌酐、血尿酸、肌酐清除率、白蛋白、血红蛋白、C反应蛋白、脂蛋白a水平与ADHF老年患者的生存状况有一定相关性(P<0.05)。Logisitic回归分析显示,年龄、NYHA分级≥Ⅲ级、左心室射血分数≤50%及脑钠肽、C反应蛋白和脂蛋白a水平是ADHF老年患者死亡的独立危险因素(P<0.05)。结论 ADHF老年患者死亡风险较大,年龄、NYHA分级≥Ⅲ级、左心室射血分数≤50%及脑钠肽、C反应蛋白和脂蛋白a水平是ADHF老年患者死亡的独立危险因素。

Abstract： Objective To investigate the risk factors for the death of elderly patients with acute decompensated heart failure（ADHF）. Methods A total of 173 elderly patients with ADHF were selected from March 2014 to October 2016 in Maoming Petrochemical Hospital. The patients were divided into survival group （ n = 147 ） and death group （ n = 26 ） according to the survival status. The clinical data of patients in the two groups were analyzed by univariate and multivariate logisitic re- gression analysis. Results The age, heart rate, wall motion abnormality, left ventrieular ejection fraction ~〈50% , onset to hos- pitalization time, anemia, diabetes mellitus, coronary atherosclerofic heart disease, heart failure history, ventricular fibrillation, New York Heart Association （NYHA） classification I〉 m, systolic blood pressure, diastolic blood pressure, white blood cell count and the levels of creatine kinase isoenzyme, brain natriuretic peptide,serum creatinine, serum uric acid, creatinine clear- ance,albumin,hemoglobin,C-reactive protein, lipoprotein-a were related to the survival status of elderly patients with ADHF （P 〈0. 05）. Logisitic regression analysis showed that the age, NYHA classification t〉 Ⅲ, left ventricular ejection fraction 50% and the brain natriuretic peptide, C-reactive protein, lipoprotein-a levels were the independent risk factors for the death of elderly patients with ADHF （ P 〈 0.05 ）. Conclusion The elderly patients with ADHF have the greater risk of death. The age, NYHA classification≥ III, left ventricular ejection fraction ≤ 50% and the brain natriuretic peptide, C-reactive protein, lip- oprotein-a levels are the independent risk factors for the death of elderly patients with ADHF.