老年慢性心力衰竭患者反复入院的影响因素分析

Analysis of influencing factors of repeated admission in elderly patients with chronic heart failure

目的探讨导致老年慢性心力衰竭(CHF)患者反复入院的相关因素。方法收集老年CHF患者171例,收集患者经治疗出院后2年内的诊疗资料,根据是否因心力衰竭(以下简称心衰)反复入院分为对照组53例和反复入院组118例。收集两组患者的年龄、既往病史、日常生活能力(ADL)受损情况、首次入院时实验室检查结果、超声心动图检查结果及并发症情况。收集患者出院后2年内的预后情况资料(心衰再次入院、其他疾病再次入院、心衰相关的死亡及全因死亡)。采用logistic回归法分析导致反复入院的影响因素。结果与对照组比较,反复入院组年龄较高,ADL重度受损患者的比例较高,既往合并慢性阻塞性肺疾病、瓣膜病的比例较高,并发心律失常患者的比例较高,贫血患者的比例较高,血清脑钠肽前体(Pro-BNP)水平、左室舒张末期内径(LVEDD)较高(P均<0.05)。反复入院组出院后2年内心衰相关死亡及全因死亡的发生率均高于对照组(P分别为0.002、0.008)。logistic回归分析显示,年龄>71.1岁、既往瓣膜病史、ADL重度受损、LVEDD>5.7 cm可作为CHF患者出院后2年内反复入院的独立预测因素(P均<0.05)。结论老年CHF患者反复入院发生率高,年龄>71.1岁、既往瓣膜病史、ADL重度受损、LVEDD>5.7 cm可作为老年CHF患者出院后2年内反复入院的独立预测因素。

Objective To investigate the related factors of repeated admission in elderly patients with chronic heart failure.Methods 171 cases of elderly patients with CHF were collected,and the diagnosis and treatment data within 2 years after discharge were collected.They were divided into control group(n=53)and repeated admission group(n=118),according to whether they were re-admitted due to chronic heart failure within 2 years.The age,past medical histo⁃ry,ADL impairment,aboratory examination results at first admission,echocardiographic examination results and compli⁃cations of the two groups were collected.The prognosis data(readmission of heart failure,readmission of other diseases,death related to heart failure and all-cause death)within 2 years after discharge were collected.Logistic regression was used to analyze the influencing factors of repeated admission.Results Compared with the control group,the repeated ad⁃mission group had higger age,higher proportion of patients with severe ADL damage,chronic obstructive pulmonary dis⁃ease,valvular disease,arrhythmia and anemia,higher serum Pro-BNP level and left ventricular end diastolic diameter(LVEDD)(all P<0.05).The incidence of heart failure related death and all-cause death in the repeated admission group was higher than that in the control group(P=0.002,0.008,respectively).Logistic regression analysis showed that age>71.1 years old,history of valvular disease,severe impairment of ADL,and elevated LVEDD>5.7 cm can be used as inde⁃pendent predictors of readmission in elderly patients within 2 years after discharge(all P<0.05).Conclusion The el⁃derly CHF patients have a high incidence of repeated admissions,and age>71.1 years old,history of valvular disease,se⁃vere impairment of ADL,and elevated LVEDD>5.7 cm can be used as independent predictors of readmission in elderly patients within 2 years after discharge.