2013—2016年湘雅医院心力衰竭住院患者的病因、诊治特点及预后影响因素
| 作者: |
1侯修敏,
1张银妆,
1匡圆圆,
1马琦琳
1 中南大学湘雅医院心血管内科，长沙 410078 |
| 通讯: |
马琦琳
Email: mqilin2004@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.03.013 |
摘要
目的：研究2013年2月至2016年5月湘雅医院心力衰竭住院患者病因、诊治特点及预后影响因素。方法：收集湘雅医院心血管内科住院患者病历1 551例，回顾性分析患者临床资料与心力衰竭预后的相关因素。结果：本研究所纳入患者中男性880例(56.7%)，女性671例(43.3%)。年龄为20~93(65±13)岁。纽约心功能分级(NYHA)II级178例(11.5%)，III级947例(61.1%)，IV级426例
(27.5%)。心力衰竭病程平均为41.46个月(中位12.00个月，四分位距58.00个月)。住院天数为1~66(11.0±6.6) d。再住院发生率18.3%，全因病死率为9.0%。心力衰竭病因主要为冠心病(1 019例，65.7%)，其次分别为扩张型心肌病(289例，18.6%)、高血压性心脏病(93例，6.0%)、风湿性心脏瓣膜病(65例，4.2%)、先天性心脏病(25例，1.6%)及其他(60例，3.9%)。患者住院期间血运重建、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARBs)、β受体阻滞剂、螺内酯、洋地黄类药物及利尿剂的使用率分别为20.1%，71.6%，80.7%，78.1%，34.0%，71.5%。心力衰竭患者再住院发生的危险因素包括：年龄增加，心功能分级级别升高，吸烟，红细胞分布宽度增加，血清超敏C反应蛋白、胱抑素C、肌钙蛋白I、N端前脑钠肽(NT-Pro BNP)水平上升，左室射血分数减低，合并低蛋白血症、高尿酸血症、肺部感染、高脂血症、贫血、肾功能不全、室性心律失常、2型糖尿病及高血压。其中纽约心功能分级、NT-Pro BNP、高尿酸血症、血清胱抑素C水平、肺部感染、室性心律失常及高血压均为再住院发生的独立危险因素。而左室射血分数提高及使用螺内酯、β受体阻滞剂均为保护因素。使用血运重建、ACEI/ARB类药物、β受体阻滞剂、螺内酯的患者预后优于未使用者。结论：心力衰竭患者应预防感染、心律失常，控制血压，早期干预治疗原发病，并积极治疗合并症及并发症。在心力衰竭治疗中应积极合理使用ACEI或ARB类药物、β受体阻滞剂及醛固酮受体拮抗剂，同时需严格把控利尿剂的使用剂量及洋地黄类药物的使用。冠心病合并心力衰竭患者建议及时采用血运重建治疗方案。
关键词：
心力衰竭；病因；诊治；预后分析
(27.5%)。心力衰竭病程平均为41.46个月(中位12.00个月，四分位距58.00个月)。住院天数为1~66(11.0±6.6) d。再住院发生率18.3%，全因病死率为9.0%。心力衰竭病因主要为冠心病(1 019例，65.7%)，其次分别为扩张型心肌病(289例，18.6%)、高血压性心脏病(93例，6.0%)、风湿性心脏瓣膜病(65例，4.2%)、先天性心脏病(25例，1.6%)及其他(60例，3.9%)。患者住院期间血运重建、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARBs)、β受体阻滞剂、螺内酯、洋地黄类药物及利尿剂的使用率分别为20.1%，71.6%，80.7%，78.1%，34.0%，71.5%。心力衰竭患者再住院发生的危险因素包括：年龄增加，心功能分级级别升高，吸烟，红细胞分布宽度增加，血清超敏C反应蛋白、胱抑素C、肌钙蛋白I、N端前脑钠肽(NT-Pro BNP)水平上升，左室射血分数减低，合并低蛋白血症、高尿酸血症、肺部感染、高脂血症、贫血、肾功能不全、室性心律失常、2型糖尿病及高血压。其中纽约心功能分级、NT-Pro BNP、高尿酸血症、血清胱抑素C水平、肺部感染、室性心律失常及高血压均为再住院发生的独立危险因素。而左室射血分数提高及使用螺内酯、β受体阻滞剂均为保护因素。使用血运重建、ACEI/ARB类药物、β受体阻滞剂、螺内酯的患者预后优于未使用者。结论：心力衰竭患者应预防感染、心律失常，控制血压，早期干预治疗原发病，并积极治疗合并症及并发症。在心力衰竭治疗中应积极合理使用ACEI或ARB类药物、β受体阻滞剂及醛固酮受体拮抗剂，同时需严格把控利尿剂的使用剂量及洋地黄类药物的使用。冠心病合并心力衰竭患者建议及时采用血运重建治疗方案。
Etiology, treatment and prognostic factors in patients with heart failure in Xiangya Hospital from 2013 to 2016
CorrespondingAuthor: MA Qilin Email: mqilin2004@163.com
DOI: 10.3978/j.issn.2095-6959.2018.03.013
Abstract
Objective: To study the etiology, treatment and prognostic factors of in-hospital patients with heart failure in Xiangya Hospital from 2013 to 2016. Methods: A total of 1 551 patients with heart failure were collected in our hospital. The clinical data and the prognostic factors of heart failure were retrospectively analyzed. Results: The study included 880 males (56.7%) and 671 (43.3%) females. The patients aged 20–93 (65±13) years. There were 178 (11.5%) patients with New York Heart Association (NYHA) functional classification at class II, 947 (61.1%) at class III, 426 (27.5%) at class IV. The average duration of heart failure was 41.46 months (median 12.00 months, interquartile range 58.00 months). Hospitalization days in this study were 1–66 (11.0±6.6) days. The rehospitalization rate in this study was 18.3%, and all-cause mortality rate was 9.0%. The main causes of heart failure were coronary heart disease (1019 cases, 65.7%), followed by dilated cardiomyopathy (289 cases, 18.6%), hypertensive heart disease (93 cases, 6.0%), rheumatic heart disease (65 cases, 4.2%), congenital heart disease (25 cases, 1.6%) and others (60 cases, 3.9%). The proportion of hospitalized patients using revascularization, angiotensin converting enzyme-inhibitors/angiotensin receptor blockers (ACEI/ARBs), spirolactone, digitalis and diuretic were 20.1%, 71.6%, 80.7%, 78.1%, 34.0% and 71.5%, respectively. Increasing ages of patients with heart failure; the higher level of NYHA functional classification; smoking; elevated red blood distribution width; increased serum concentration of hypersensitivity reaction protein C, cystatin C, troponin I and N-terminal pro-B type natriuretic peptide (NT-Pro BNP); decreased left ventricular ejection fraction; accompanying with hypoproteinemia, hyperuricemia, pulmonary infection, hyperlipidemia, anemia, renal insufficiency, ventricular arrhythmia, type 2 diabetes and hypertension were risk factors for rehospitalization. The prognosis of patients administrated with revascularization, ACEI/ARBs, β-blockers and spirolactone were better than non-users. Among them, NYHA functional Classification, NT-Pro BNP level, Hyperuricemia, Cystatin C level, Pulmonary infection, Ventricular Arrhythmia and Hypertension were independent risk predictors of rehospitalization in patients with heart failure, while elevated left ventricular ejection fraction, the use of β-blockers and spirolactone were protective factors. Conclusion: Prevention of infection and arrhythmia, controlling blood pressure and treatment of primary disease and complications are recommended to prolong life of patients with heart failure. In the treatments of heart failure, ACEI/ARBs, β-blockers and aldosterone receptor antagonists should be used reasonably. Meanwhile, the dosage of diuretics and digitalis drugs should be strictly controlled. Patients with coronary heart disease and heart failure are advised to timely use the revascularization.
Keywords：
heart failure; etiology; treatment; prognosis; analysis