目的 探讨入院时心率水平和急性肺栓塞(acute pulmonary embolism，APE)患者30 d全因死亡率和30 d APE相关特异性死亡率的关系。方法 选取2019年2月-2023年7月在安阳市人民医院就诊的的APE患者296例，根据患者入院时心率将其分为六组:组1为心率＜80次/min;组2为80＜100次/min;组3为100＜110次/min;组4为110＜120次/min;组5为120＜140次/min;组6为≥140次/min。对比分析六组患者的临床结局。应用logistic回归分析探讨心率和APE患者临床结局的关系。结果 296例APE患者的30 d全因死亡率5。74％;30 d APE特异死亡率2。36％。以30 d全因死亡为因变量，和组2(参比)比较，组1是显著的保护因素，组3、组4、组5、组6是显著的危险因素。六组对应的心率水平的影响OR值分别为:0。605、1。000、1。615、1。707、2。011、2。447，除参比外P均＜0。05。以30 d特异死亡为因变量，和组2(参比)比较，组1是显著的保护因素，组3、组4、组5、组6是显著的危险因素，OR值分别为:0。437、1。000、1。683、2。005、2。382、2。822，除参比外P均＜0。05。将心动过速定义为心率≥100次/min时，简化急性肺栓塞严重程度指数(simplified pulmonary embolism severity index，sPESI)对低危 APE患者预测的灵敏度从94。52％提高到95。99％;将心动过速定义为心率≥80次/min的时候，sPESI对低危APE患者预测的灵敏度进一步提高到98。01％。结论 入院时心率高会增加APE患者死亡率。心率截断值的修改提高了sPESI对低危人群的预测灵敏度。
Impact of admission heart rate on the prognosis of acute pulmonary embolism
Objective To investigate the relationship between heart rate at admission and 30 day all-cause mortality and 30 day acute pulmonary embolism(APE)related specific mortality in patients with APE.Methods Totally 296 APE patients who were treated in Anyang People's Hospital from February 2019 to July 2023 were selected.According to the heart rate of pa-tients upon admission,they were divided into 6 groups:group 1 had a heart rate of＜80 beats/min;group 2 was 80-＜100 times/min;group 3 was 100-＜110 times/min;group 4 was 110-＜120 beats/min;group 5 was 120-＜140 beats/min;group 6 was ≥140 times/min.Compare and analyze the clinical outcomes of 6 groups of patients.Logistic regression analysis was used to explore the relationship between heart rate and clinical outcome in patients with APE.Results The 30 day all-cause mortality of 296 patients with APE was 5.74％;the specific mortality of 30 day APE was 2.36％.Using 30 day all-cause mortality as the dependent variable,compared with group 2(reference),group 1 was a significant protective factor,while groups 3,4,5,and 6 were significant risk factors.The OR values of the 6 groups corresponding heart rate levels were 0.605,1.000,1.615,1.707,2.011,and 2.447,respectively,with P＜0.05 except for the reference group.Using 30 day specific death as the dependent variable,compared with group 2(reference),group 1 was a significant protective factor,while group 3,group 4,group 5,and group 6 were significant risk factors.The OR values were 0.437,1.000,1.683,2.005,2.382,and 2.822,respectively,with P＜0.05 for all groups except for the reference.When tachycardia was defined as heart rate ≥100 beats/min,the sensitivity of simplified pulmonary embolism severity index(sPESI)in predicting low-risk APE patients increased from 94.52％ to 95.99％;when tachycardia was defined as heart rate ≥80 beats/min,the sensitivity of sPESI in predicting low-risk APE patients was further improved to 98.01％.Conclusion High heart rate on admission will increase the mortality of patients with APE.The modification of heart rate cutoff value will improve the prediction sensitivity of sPESI to low-risk population.
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