摘要
目的:探讨ICU老年心力衰竭(HF)患者的临床特征,分析其预后的影响因素。方法:2021年1月~12月我院ICU收治的148例老年HF患者(≥60岁)的临床资料进行回顾性分析。分析老年HF患者的病史、病因和相关检查资料,总结HF诱发因素和临床特征。根据6个月内发生不良心血管事件情况,患者被分为事件组(70例)和无事件组(78例)。比较两组的一般临床资料,采用单因素和多因素Logistic回归分析ICU老年HF患者预后不良的影响因素。结果:老年HF诱发因素以上呼吸道感染及肺炎34例(22.97%),快速房颤和劳累各20例(13.51%)为主。首发症状为典型心功能不全91例(61.49%),并发神经精神症状24例(16.22%),合并不同程度的焦虑和抑郁患者44例(29.73%)。单因素和多因素Logistic回归结果显示,年龄、NYHAⅢ~Ⅳ级、急性生理与慢性健康评分(APACHEⅡ)、N末端脑利钠肽前体(NT-proBNP)、生长分化因子15(GDF-15)和高敏C反应蛋白(hsCRP)水平是老年HF患者预后不良的独立危险因素(OR=1.021~1.393,P<0.05或<0.01)。结论:ICU老年心力衰竭患者临床表现不典型,诱发因素复杂,APACHEⅡ评分、GDF-15、hsCRP和NT-proBNP水平的检测对此类患者的诊断及预后具有重要的意义。
Objective:To investigate the clinical features and influencing factors of prognosis in elderly patients with heart failure(HF)in ICU.Methods:Clinical data of 148 elderly HF patients(≥60 years old)admitted to ICU of our hospital from January to December 2021 were retrospectively analyzed.Disease history,etiology and related examination data were analyzed in these patients,and predisposing factors and clinical features of HF were summarized.According to incidence of adverse cardiovascular events within 6 months,they were divided into event group(n=70)and no event group(n=78).General clinical data were compared between two groups.Univariate and multivariate Logistic regression were used to analyze influencing factors of poor prognosis in elderly HF patients in ICU.Results:Predisposing factors of elderly HF mainly included upper respiratory tract infections and pneumonia 34 cases(22.97%),20 cases(13.51%)of rapid atrial fibrillation and fatigue respectively.There were 91 cases(61.49%)with typical cardiac insufficiency as initial symptom;24 cases(16.22%)complicated with neuropsychiatric symptom;44 cases(29.73%)complicated with anxiety and depression of different extent.Univariate and multivariate Logistic regression analysis indicated that age,NYHA class Ⅲ~Ⅳ,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,N terminal pro brain natriuretic peptide(NT-proBNP),growth differentiation factor 15(GDF-15)and high sensitive C reactive protein(hsCRP)levels were independent risk factors for poor prognosis in elderly HF patients(OR=1.021~1.393,P<0.05 or<0.01).Conclusion:For elderly HF patients in ICU,clinical manifestations are not typical,and the predisposing factors are complex.It is found that APACHE Ⅱ score,GDF-15,hsCRP and NT-proBNP levels possess important significance for diagnosis and prognosis of these patients.
作者
李敏
郝平
归方
归承莹
吴佳雯
张雯
陈晓丽
LI Min;HAO Ping;GUI Fang;GUI Cheng-ying;WU Jia-wen;ZHANG Wen;CHEN Xiao-li(Department of Cardiology,Affiliated Putuo Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai,200062,China)
出处
《心血管康复医学杂志》
CAS
2024年第4期430-434,共5页
Chinese Journal of Cardiovascular Rehabilitation Medicine
基金
上海市医学重点专科建设计划(ZK2019A11)。
