慢性心力衰竭患者入院血压水平对心源性死亡的判断价值

The relationship between the level of blood pressure on admission and the cardiac death in patients with chronic heart failure

目的:探讨慢性心力衰竭(CHF)患者入院血压水平对心源性死亡的判断价值。方法:入选2015-01-2015-12就诊于河北医科大学第二医院的CHF患者共119例,测量并记录患者入院时收缩压、舒张压及脉压,依据不同血压水平进行分组,以心源性死亡为随访终点,随访时间≥6个月,比较各组心源性死亡的发生情况。结果:119例CHF患者随访6个月后,心源性死亡22例,Kaplan-Meier生存分析结果显示,入院收缩压<100mmHg(1mmHg=0.133kPa)的CHF患者生存率明显低于入院收缩压100~130mmHg及>130mmHg者(P<0.01);入院脉压<35 mmHg的CHF患者生存率明显低于入院脉压35~55 mmHg及>55 mmHg者(P<0.01)。多因素Cox风险比例模型分析显示,入院时低收缩压(RR=0.891,95%CI:0.828~0.958)和氨基末端B型钠尿肽前体升高(RR=12.921,95%CI:2.373~70.353)是CHF患者近期发生心源性死亡的主要危险因素。结论:入院时低收缩压是判断CHF患者心源性死亡的独立预测因素。

Objective：To explore the relationship between the level of blood pressure on admission and the cardiac death in patients with chronic heart failure.Method：A total of 119 patients with chronic heart failure in our hospital from January 2015 to December 2015 were included in the study.The systolic blood pressure,diastolic blood pressure and pulse pressure of the patients were measured and recorded At the time of admission,The patients were divided into different groups according to different blood pressure levels.We analyzed the cardiac death from these groups after 6 months follow-up.Result：Twenty two patients died during the followed up period.The survival rate of patients with SBP〈100 mmHg at admission was significantly lower than that of the patients with SBP at 100-130 mmHg and SBP〉130 mmHg at admission（P〈0.01）.The survival rate of patients with PP〈35 mmHg at admission was significantly lower than that of the patients with PP at 35-55 mmHg and PP〉55 mmHg at admission（P〈0.01）.Multivariate Cox analysis showed that the low systolic blood pressure and N-terminal natriuretic peptide elevation at admission were the major risk factors for cardiac death in patients with chronic heart failure.Conclusion：Low systolic blood pressure at admission was an independent predictor of the cardiac death of patients with chronic heart failure.