摘要
背景慢性阻塞性肺疾病急性加重期(AECOPD)患者住院期间新发心房颤动(NOAF)的危险因素目前仍不明确。目的分析AECOPD患者住院期间NOAF的危险因素,以期为临床诊疗提供一定参考依据。方法选取2013—2018年在首都医科大学附属北京世纪坛医院呼吸与危重症医学科住院的AECOPD患者218例为研究对象,其中入院期间NOAF 87例(39.9%,NOAF组),无NOAF 131例(60.1%,无NOAF组)。收集患者一般资料[包括性别、年龄、吸烟史、慢性阻塞性肺疾病(COPD)病史]、合并症(包括呼吸衰竭、心力衰竭、糖尿病、高血压、高脂血症、陈旧性心肌梗死、慢性肾脏病)发生情况、氧疗情况、用药情况[包括吸入性糖皮质激素(ICS)、抗胆碱能药物、长效β-受体激动剂(LABA)、茶碱类药物、ICS+LABA]、实验室检查指标[包括白细胞计数(WBC)、血红蛋白(HCB)、血小板计数(PLT)、肌酐(Cr)、尿酸(UA)、降钙素原(PCT)、D-二聚体、B型脑钠肽(BNP)]、左心室射血分数(LVEF)、院内预后指标(包括住院期间病死率、气管插管比例、转入ICU比例)、住院时间、住院总费用。AECOPD患者住院期间NOAF的影响因素分析采用多因素Logistic回归分析。结果NOAF组年龄大于无NOAF组,心力衰竭发生率、陈旧性心肌梗死发生率、茶碱类药物使用率、PCT、BNP高于无NOAF组,HGB、LVEF低于无NOAF组,住院时间长于无NOAF组,住院总费用多于无NOAF组(P<0.05)。多因素Logistic回归分析结果显示,心力衰竭[OR=2.975,95%CI(1.550,5.710)]、HGB降低[OR=0.968,95%CI(0.947,0.990)]、PCT升高[OR=1.262,95%CI(1.002,1.591)]、BNP升高[OR=1.000,95%CI(1.000,1.001)]是AECOPD患者住院期间NOAF的独立危险因素(P<0.05)。结论AECOPD患者住院期间NOAF发生率较高,而NOAF会引起AECOPD患者住院时间延长、医疗费用增加;心力衰竭、HGB降低及PCT、BNP升高是AECOPD患者住院期间NOAF的危险因素。
Background The risk factors of new on-set atrial fibrillation(NOAF)in hospitalized patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)are still unclear.Objective To analyze the risk factors of NOAF in AECOPD patients during hospitalization in order to provide some reference for clinical diagnosis and treatment.Methods AECOPD patients who hospitalized in Department of Respiraology and Critical Medicine,Beijing Shijitan Hospital,CMU from 2013 to 2018 were enrolled.Among them,87 patients(39.9%)with NOAF during hospitalization(NOAF group),131 patients(60.1%)without NOAF(non NOAF group).Relevant observation indicators were collected,including general information(including gender,age,smoking history,COPD history),occurrence of complications(including respiratory failure,heart failure,diabetes,hypertension,hyperlipidemia,old myocardial infarction,chronic kidney disease),oxygen therapy,medication conditions(including ICS,anticholinergics,LABA,theophylline drugs,ICS+LABA),laboratory examination indexes(including WBC,HGB,PLT,Cr,UA,PCT,D-Dimer,BNP),LVEF,in-hospital prognostic indicators(including mortality during hospitalization,endotracheal intubation ratio,transfer-to-ICU ratio),length of hospitalization,and total cost of hospitalization.The influencing factors of NOAF in AECOPD patients during hospitalization were analyzed by multivariate Logistic regression analysis.Results The age in the NOAF group was greater than that in the non NOAF group,incidence of heart failure,incidence of old myocardial infarction,the use of theophylline,PCT and BNP in the NOAF group were higher than those in the non NOAF group,HGB and LVEF in the NOAF group were lower than those in the non NOAF group,the hospital stay in the NOAF group was longer than that in the non NOAF group,and the total cost of hospitalization in the NOAF group was higher than that in the non NOAF group(P<0.05).The results of multivariate Logistic regression analysis showed that heart failure[OR=2.975,95%CI(1.550,5.710)],decreased HGB[OR=0.968,95%CI(0.947,0.990)],increased PCT[OR=1.262,95%CI(1.002,1.591)],increased BNP[OR=1.000,95%CI(1.000,1.001)]were the independent risk factors of NOAF during the hospitalization of AECOPD patients(P<0.05).Conclusion The incidence of NOAF is high in patients with AECOPD during hospitalization,and the occurrence of NOAF would cause the prolongation of hospitalization time and the increase of medical expenses;heart failure,the decrease of HGB and the increase of PCT and BNP are the risk factors of NOAF in patients with AECOPD during hospitalization.
作者
李龙
尹航
LI Long;YIN Hang(Department of Respiraology and Critical Medicine,Beijing Shijitan Hospital,CMU,Beijing 100038,China;Department of Respiraology,Beijing Electric Power Hospital,Beijing 100073,China)
出处
《实用心脑肺血管病杂志》
2020年第8期64-68,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
肺疾病
慢性阻塞性
住院
心房颤动
危险因素
Pulmonary disease
chronic obstructive
Hospitalization
Atrial fibrillation
Risk factors
