影响急性肺栓塞住院时间的相关因素研究

Related Factors Influencing the Hospitalization Time of Acute Pulmonary Embolism

目的研究影响急性肺栓塞患者住院时间长短的相关因素。方法回顾性分析2017年1月至2022年1月于中南大学湘雅二医院收治的急性肺栓塞(APE)患者,通过电子病历系统查询相关资料。急性肺栓塞的诊断标准参考欧洲心脏病学会《2019年APE诊断与治疗指南》,APE依靠肺动脉增强CT(CTA)确诊。收集入院时的一般资料及实验室检查结果,研究终点为住院时间的长短,用Logistics回归模型分析与住院时间相关的因素。结果共99例APE患者纳入研究,其中男性61例,女性38例,平均年龄65岁(51~73岁),住院时间3~28 d,中位时间11 d。以中位数11 d为截点将研究对象分为两组:住院日<11 d(n=54),住院日≥11 d(n=45),D-二聚体水平、危险分层、既往是否饮酒在住院日≥11 d组较住院日<11 d组之间存在差异(P<0.05)。Logistics分析显示入院D-二聚体水平、急性肺栓塞危险分层及既往饮酒史是APE患者住院时间≥11 d的独立危险因素,高水平组(D-二聚体≥3.4μg/ml)较低水平组(D-二聚体<3.4μg/ml)OR值2.874(95%CI:1.054~7.838,P<0.05),高危组较中低危组OR值4.642(95%CI:1.176~18.325,P<0.05),有饮酒史患者较无饮酒史患者OR值3.776(95%CI:1.175~12.135,P<0.05)。结论APE患者入院D-二聚体水平、危险分层、既往饮酒史与住院时间具有独立相关性,入院D-二聚体高、危险程度高、既往有饮酒史的患者临床应予以重视。

Objective To investigate the factors influencing the length of hospital stay in patients with acute pulmonary embolism(APE).Methods Patients with APE admitted to the Second Xiangya Hospital of Central South University from January 2017 to January 2022 were analyzed,and Clinical and biological variables were queried by electronic medical record system.The diagnostic criteria for acute pulmonary embolism are based on《2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society》.Acute pulmonary embolism is diagnosed by pulmonary CTA.A binary logistic regression model was established to evaluate the relationship between D-dimer level and length of hospital stay(LOS).Results A total of 99 APE patients were included in the study,including 61 males and 38 females,with an average age of 65 years(ranging from 51 to 73 years old).The hospitalization time ranged from 3 to 28 days,with a median time of 11 days.Based on the median hospitalization time of 11 days,the subjects were divided into two groups:<11 d group(n=54)and≥11d group(n=45).There were differences in D-dimer levels,risk stratification,and history of alcohol consumption between the two groups(P<0.05).Logistic regression analysis showed that admission D-dimer level,acute pulmonary embolism risk stratification,and history of alcohol consumption were independent risk factors for APE patients with hospital stays≥11 days.The OR value was higher in the high-level group(D-dimer≥3.4μg/ml)than in the low-level group(D-dimer<3.4μg/ml),at OR=2.874(95%CI:1.054~7.838,P<0.05);higher in the high-risk group than the middle-low-risk group at OR=4.642(95%CI:1.176~18.325,P<0.05);and higher among patients with a history of drinking compared to those without at OR=3.776(95%CI:1.175~12.135,P<0.05).Conclusion D-dimer level on admission,risk stratification and patients with a prior history of alcohol use should be independently correlated with length of stay,suggesting that patients with high D-dimer level,high risk,and previous drinking history should be paid more attention in the clinic.