基于HIS系统的慢性心力衰竭患者预后影响因素相关性分析

Correlation Analysis of Prognostic Factors in Patients with CHF Based on HIS system

目的:回顾性分析不同预后心力衰竭患者的影响因素和中西医诊疗情况。方法:选取576例慢性心衰患者,以心血管事件再住院及死亡情况作为终点事件,分为预后不良组和预后良好组,回顾性分析一般资料、基础疾病、合并症、理化检查、中医四诊信息、中医证型、中西医治疗及用药情况等临床资料,筛选预后影响因素。结果:慢性心力衰竭患者不同预后组间比较,年龄、心功能分级、基础疾病有脑梗死、合并症有肺部感染、脉搏频率、血小板、尿素氮、血钠、血氯、NT-proBNP、尿蛋白差异具有统计学意义(P<0.05);心脏彩超中各项指标组间差异无统计学意义(P>0.05);中医证型阳气虚衰证、气虚血瘀证组间差异具有统计学意义(P<0.05);药物方面应用利尿剂、洋地黄、使用中医诊疗技术,组间差异具有统计学意义(P<0.05)。根据以上进行单因素分析结果,提取P<0.05项目及中医舌脉结果,进行logistic多因素回归分析。结论:中医证型为气虚血瘀证、舌质红、使用中医诊疗技术、规范服药是心衰预后的独立保护性因素。年龄、心功能、NT-proBNP升高、尿蛋白阳性、应用利尿剂洋地黄、血钠血氯降低、中医脉象为数脉等是心衰患者预后不良的独立危险因素。

Objective:To retrospectively analyze the influencing factors of patients with chronic heart failure(CHF)with different prognosis and the diagnosis and treatment of Chinese and western medicine.Methods:576 patients with CHF,with cardiovascular events and deaths as the end points,were divided into the poor prognosis group and the good prognosis group.The general information,basic diseases,complications,physical and chemical examinations,TCM four-diagnosis information,TCM syndrome types,as well as Chinese and western medications were retrospectively analyzed to screen prognostic factors.Results:There were statistical differences in age,cardiac function grade,basic diseases including cerebral infarction,complications including pulmonary infection,pulse frequency,platelet,urea nitrogen,serum sodium,blood chlorine,NT-proBNP and urinary protein between the two different prognosis groups(P<0.05).There were no statistical differences in cardiac ultrasound indexes between the two groups(P>0.05).There were significant differences in TCM syndrome of Qi deficiency and syndrome of Qi deficiency and blood stasis between the two groups(P<0.05).In terms of applications of diuretics,digitalis and TCM diagnosis and treatment techniques,there were statistical differences between the two groups(P<0.05).According to the above results of univariate analysis,the items with P<0.05 and the results of tongue and pulse of TCM were extracted for logistic multivariate regression analysis.Conclusion:TCM syndromes of Qi deficiency and blood stasis,red tongue,TCM diagnosis and treatment technology application,and standardized medication are independent protective factors for the prognosis of CHF.Age,heart function,elevated NT-proBNP,positive urine protein,application of diuretic,digitalis,lowered blood sodium and chloride,and frequent pulse in TCM are independent risk factors for poor prognosis in patients with CHF.