论文部分内容阅读
目的 确立急性心力衰竭(acute heart failure,AHF)的早期死亡风险预测因子.方法 前瞻性入选2015年7月-2016年9月北京天坛医院急诊就诊AHF患者,收集患者临床资料,研究终点为7d死亡率.比较AHF患者死亡组与生存组临床资料的差异,分析AHF急诊早期死亡风险预测因子.结果 共有520例AHF患者纳入本研究,随访7d,67例死亡,死亡率为12.9％.死亡组高龄(＞80岁)、既往慢性肾功能不全、脑血管病且改良Rankin卒中量表(modified rankin scale,MRS) ＞2者明显多于生存组.与生存组相比,死亡组患者来诊时心率更快,收缩压(systolic pressure,SBP)水平更低,且SBP＜ 120 mmHg更多见于死亡组.另外,死亡组患者动脉血氧分压(partial pressure of oxygen in arterial blood PaO2)＜ 60 mmHg、心肌肌钙蛋白I(cardiac troponin I,cTnI)＞0.04 ng/mL、Na+＜ 135 mEq/L、尿素氮(blood urea nitrogen,BUN) ≥43 mg/dL、肌酐(serum creatinine,Scr)＞2.0 mg/dl更多见于死亡组患者.Logistic回归分析结果显示,年龄＞80岁(P=0.011)、脑血管病病史(MRS＞2)(P=0.043)、SBP＜ 120 mmHg(P＜ 0.001)、PaO2＜ 60 mmHg (P =0.023)、BUN≥43 mg/dl(P ＜0.001)、TNI＞0.04 ng/mL (P=0.031)为AHF患者7d死亡的独立预测因子.结论 年龄＞80岁、脑血管病病史(MRS＞2)、SBP＜ 120 mmHg、PaO2＜ 60 mmHg、BUN≥43 mg/dl、TNI＞0.04 ng/mL为AHF早期死亡的独立预测因子.“,”Objective To analyze the predictor for early death of acute heart failure (AHF) in emergency department.Methods AHF Patients presented to the emergency department were prospectively recruited into the study.Data of clinical history,vital signs,electrocardiogram,chest X-ray,readily available laboratory tests and major treatment were collected.The primary end-point was 7-day mortality after initial presentation.Base-line demographic and clinical characteristics were compared between survival group and death group.Multivariate logistic regression was performed to determine the the predictor for early death of acute heart failure.Results 520 AHF patients were included in the study.7-day mortality was 12.9％.Compared with survival group,age＞80 years,chronic renal failure and stoke history with MRS ＞2 were more frequently seen in death group.Also,more rapid heart rate,SBP ＜ 120mmHg,PaO2 ＜ 60 mmHg,TNI＞0.04 ng/mL,Serum sodium concentration ＜ 135mEq/L,BUN concentration≥43mg/dL,Serum creatinine (Scr)＞ 2.0 mg/dl were more frequently presented in death group.Logistic regression analysis showed that age＞80 years (P =0.011) s、stoke history with MRS ＞2 (P =0.043),SBP ＜ 120mmHg (P ＜ 0.001),PaO2 ＜ 60mmHg (P =0.023),BUN ≥43mg/dl (P ＜ 0.001)and TNI＞0.04ng/ml(P =0.031)were independent predictors for 7-day mortality.Conclusion For AHF patients presented to emergency department,age＞80 years、stoke history with MRS ＞2、SBP ＜ 120 mmHg、PaO2 ＜ 60 mmHg、BUN ≥43 mg/dl and TNI＞0.04 ng/mL were independent predictors for early death.