心力衰竭并发复杂性室性心律失常相关因素分析

Analysis of Related Factors of Complex Ventricular Arrythmia in Heart Failure Patients

目的探讨心力衰竭患者并发复杂性室性心律失常的相关因素。方法收集心力衰竭患者519例,根据24小时动态心电图结果,将LOWN分级1~2级的患者纳入Ⅰ组(共284例),LOWN分级3~5级的患者纳入Ⅱ组(共235例),利用单因素及多因素回归,回顾性分析心力衰竭患者一般资料及相关实验室结果等指标与复杂性室性心律失常发生的相关性。结果心力衰竭患者发生复杂性室性心律失常的独立相关因素为体重指数≥24 kg/m 2(OR 1.727,95%CI 1.139~2.619)、舒张压下降(OR 0.987,95%CI 0.974~1.000)、左室舒张末径增加(OR 1.064,95%CI 1.033~1.097)、左室射血分数下降(OR 0.973,95%CI 0.949~0.999)、β受体阻滞剂使用(OR 1.883,95%CI 1.175~3.019)及西地兰使用(OR 9.788,95%CI 2.094~45.739),P<0.05。结论超重、左室舒张末期内径增加及左室射血分数下降是心力衰竭患者发生复杂性室性心律失常的独立相关因素,应注重心力衰竭患者的体重管理。在心力衰竭合并复杂性室性心律失常患者的随访中,血压监测、24小时动态心电图和超声心动图是有必要的。西地兰和β受体阻滞剂通常被用于心力衰竭合并复杂性室性心律失常。

Objective To explore the related factors of complex ventricular arrythmia in heart failure patients.Methods We retrospectively analyzed 519 chronic heart failure patients who hospitalized at The First Affiliated Hospital of Chongqing Medical University.Group I(284 patients)and GroupⅡ(235 patients)were enrolled with LOWN grade 1 to 2 and LOWN grade 3 to 5 according to 24-hour ambulatory electrocardiogram.The general information,laboratory data etc.were analyzed.Results Independent related factors of complex ventricular arrythmia in heart failure patients are BMI≥24 kg/m 2(OR 1.727,95%CI 1.139~2.619),decreased diastolic blood pressure(OR 0.987,95%CI 0.974~1.000),increased left ventricular end diastolic diameter(OR 1.064,95%CI 1.033~1.097),decreased LVEF(OR 0.973,95%CI 0.949~0.999),the use ofβ-blocker(OR 1.883,95%CI 1.175~3.019)and the use of cedilanid(OR 9.788,95%CI 2.094~45.739),P<0.05.Conclusion BMI≥24 kg/m 2,decreased diastolic blood pressure,increased left ventricular end diastolic diameter and decreased LVEF are independent related factors of complex ventricular arrythmia in heart failure patients.Attention should be paid to weight management in heart failure patients.Meanwhile,follow-up of blood pressure,24 h ambulatory ECG and echocardiography for heart failure patients with complex ventricular arrhythmia are necessary.Cedilanid andβ-blocker are frequently implied to control ventricular arrhythmia in heart failure patients.