急诊科与心内科慢性心力衰竭急性加重患者的区别分析

Analysis on the differences in patients with acute exacerbation of chronic heart failure between emergency department and cardiology department

目的分析急诊科与心内科慢性心力衰竭急性加重患者的区别.方法连续入选2014年7月至2016年12月于北京大学人民医院急诊科和心内科住院治疗的左室射血分数(LVEF)<40%慢性心力衰竭急性加重的病例.收集病例的一般资料、既往史、入院病情、辅助检查、住院期间治疗、院内疾病结局和出院带药情况.依据患者住院治疗科室不同分为急诊治疗组和心内治疗组,利用SPSS 21.0软件进行数据统计分析.结果共入选203例患者,死亡20例(9.9%).急诊治疗组53例(26.1%),心内治疗组150例(73.9%),其中急诊治疗组的年龄,合并冠心病和糖尿病比例,入院时心功能Ⅳ级比例、收缩压、心率,以及血白细胞计数、C-反应蛋白、谷草转氨酶及血尿素氮,LVEF,住院期间应用呋塞米首剂和日最大剂量,使用硝酸酯类、无创机械通气比例和病死率均偏高,而血红蛋白、红细胞压积、血钠和估算肾小球滤过率偏低,且住院时间短(P<0.05).排除死亡病例,急诊治疗组出院继续口服利尿剂、强心药、硝酸酯类、血管紧张素转化酶抑制剂/血管紧张素受体阻滞剂、β-受体阻滞剂和醛固酮受体拮抗剂比例较低(P<0.05).结论急诊科住院治疗的慢性心力衰竭急性加重患者住院时间较短,但常合并更多危险因素,病情更危重,病死率更高,出院时序贯为口服药的比例较低.

Objective To analyze the differences in patients with acute exacerbation of chronic heart failure between emergency department and cardiology department.Methods Patients with acute exacerbation of chronic heart failure whose left ventricular ejection fraction(LVEF)was less than 40%were enrolled from July 2014 to December 2016 in the emergency department and cardiology department of Peking University Peoplez s Hospital.Data for basic information,past medical history,admission conditions,accessory examinations,treatments during hospitalization,nosocomial outcomes and discharge medications were collected.According to the in patient departments,they were divided into the emergency department treatment group and the cardiology department treatment group.All analyses were performed with SPSS 21.0 statistical software package.Results In total,203 patients were enrolled and 12 patients(9.9%)died.53 patients(26.1%)were hospitalized in the emergency department and 150 patients(73.9%)were hospitalized in the cardiology department.Compared to the cardiology department treatment group,age,proportions with coronary heart disease and diabetes history,proportion of heart function classification IV,systolic blood pressure,heart rate,white blood cell,C reactive protein,aspartate aminotransferase,blood urea nitrogen,LVEF,the first dose and the maximum daily dose of furosemide,proportions of nitrates and non-invasive mechanical ventilation and mortality were higher in the emergency department,but hemoglobin,hematocrit,serum sodium and estimated glomerular filtration rate were lower(P<0.05).Excluding the deaths,the proportions of sequential oral diuretics,inotropes,nitrates,angiotensin-converting enzyme inhibitorte angiotensin receptor blocker,B receptor blocker and mineralocorticoid receptor antagonist at discharge were lower in the emergency department(P<0.05).Conclusion Patients with acute exacerbation of chronic heart failure in the emergency department have shorter hospital duration,but they have more risk factors,worse conditions,higher mortality,and the proportions of sequential oral drugs are lower at discharge.