并发心律失常类型与肺动脉高压患者预后的关联性分析

Association of arrhythmias with prognosis in patients with pulmonary arterial hypertension

目的探究肺动脉高压患者并发不同类型心律失常与疾病预后的关系,为临床评估肺动脉高压患者预后提供理论依据。方法收集本院2015年1月至2016年12月初诊为肺动脉高压而入院治疗的96例病例资料,采用单盲法于治疗前及治疗后进行十二导联心电图检查,并采集心律、节律、P/QRS/T波时间;采用COX回归分析方法,分析ECG波形异常及各型心律失常与后期死亡率之间的关联性。结果 KaplanMeier生存分析可见,肺动脉高压并发心律失常的患者生存时间较窦性心律组明显减少,窦性+新发AF患者及窦性+新发SVT患者的评估结果较窦性心律组低;COX回归分析结果提示不同心律失常患者预后存在差异性(SE=0.207,Wald=3.240,95%CI 0.967-2.178,P<0.05),其中基础窦性心律后期新发房颤患者预后相对较差(SE=0.915,Wald=1.944,95%CI 0.596-21.494,P<0.05)。结论房颤是影响肺动脉高压治疗预后的危险因素,维持窦性心律是治疗肺高压的重要原则之一。

Objective To investigate the relationship between different types of arrhythmias and prognosis in patients with pulmonary hypertension,and to provide theoretical basis for the clinical evaluation of the prognosis of patients with pulmonary hypertension.Methods From January 2015 to December 2016,96 patients with pulmonary hypertension were collected.Twelve lead ECG examination was performed before and after treatment by single blind method,and their heart rhythm,rhythm,and P/QRS/T wave time were collected.It used COX regression analysis method to analyze the relationship between the ECG and the type of abnormal wave arrhythmia and mortality.Results Kaplan-Meier survival analysis showed that the survival time of patients with pulmonary arterial hypertension complicated with arrhythmia was obviously shorter than that in the sinus rhythm group.The evaluation of the sinus+new onset AF group and the sinus+new onset SVT group was lower than that of the sinus rhythm group.COX regression analysis results suggested that different arrhythmia patients had different prognosis(SE=0.207,Wald=3.240,95%CI,0.967-2.178,P<0.05),and the prognosis of patients with sinus rhythm during atrial fibrillation was relatively poor(SE=0.915,Wald=1.944,95%CI,0.596-21.494,P<0.05).Conclusion Atrial fibrillation is a risk factor for the prognosis of pulmonary hypertension,and the maintenance of sinus rhythm is one of the important principles for the treatment of pulmonary hypertension.