心血管康复医学杂志2024,Vol.33Issue(4) :430-434.DOI:10.3969/j.issn.1008-0074.2024.04.11

ICU老年心力衰竭患者的临床特征及预后影响因素分析

Analysis of clinical characteristics and influencing factors of prognosis in elderly patients with heart failure in ICU

李敏 郝平 归方 归承莹 吴佳雯 张雯 陈晓丽
心血管康复医学杂志2024,Vol.33Issue(4) :430-434.DOI:10.3969/j.issn.1008-0074.2024.04.11

ICU老年心力衰竭患者的临床特征及预后影响因素分析

Analysis of clinical characteristics and influencing factors of prognosis in elderly patients with heart failure in ICU

李敏 1郝平 1归方 1归承莹 1吴佳雯 1张雯 1陈晓丽1
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作者信息

  • 1. 上海中医药大学附属普陀医院心内科,上海市 200062
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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、NYHA Ⅲ~Ⅳ级、急性生理与慢性健康评分(APACHE Ⅱ)、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,APACHE Ⅱ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.

Abstract

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 ex-amination data were analyzed in these patients,and predisposing factors and clinical features of HF were summa-rized.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 a-nalysis 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.

关键词

心力衰竭/老年人/预后

Key words

Heart failure/Aged/Prognosis

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基金项目

上海市医学重点专科建设计划(ZK2019A11)

出版年

2024
心血管康复医学杂志
福建省康复医学会 中国康复医学会

心血管康复医学杂志

CSTPCD
影响因子:1.157
ISSN:1008-0074
参考文献量9
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