【摘要】：背景射血分數(shù)降低的急性心力衰竭(AHFr EF)和射血分數(shù)保留的急性心力衰竭(AHFp EF)患者短期預后差異不顯著,但遠期隨訪資料缺乏。目的比較AHFr EF和AHFp EF患者出院后3年內(nèi)再住院率和病死率,并探討影響患者再住院的危險因素。方法選取2011—2012年于內(nèi)蒙古醫(yī)科大學附屬醫(yī)院急診科和內(nèi)蒙古自治區(qū)人民醫(yī)院急診科首次診斷為急性心力衰竭(AHF)的患者296例為研究對象,依據(jù)左心室射血分數(shù)(LVEF),將患者分為AHFr EF組(LVEF50%,n=171)和AHFp EF組(LVEF≥50%,n=125)。記錄患者性別、年齡、吸煙史、合并癥、急性冠脈綜合征(ACS)、充血性心力衰竭(CHF)、影像學檢查、B型利鈉肽(BNP)水平,以及出院醫(yī)囑用藥情況。出院后通過電話或門診隨訪3年,觀察終點為心腦血管源再住院或死亡。結(jié)果兩組高血壓、慢性阻塞性肺疾病(COPD)、ACS、CHF、左心室擴大檢出率,以及BNP≥220 ng/L、出院醫(yī)囑口服β-受體阻滯劑(β-RB)比例比較,差異均有統(tǒng)計學意義(P0.05)。兩組因ACS、腦卒中及惡性心律失常引起的再住院率比較,差異均無統(tǒng)計學意義(P0.05)。AHFr EF組因心力衰竭引起的再住院率高于AHFp EF組,且總再住院率高于AHFp EF組(P0.05)。多因素Cox比例風險回歸模型分析顯示,高血壓〔HR=1.450,95%CI(1.036,2.030)〕和BNP≥220 ng/L〔HR=1.894,95%CI(1.327,2.702)〕是AHF患者再住院的獨立危險因素(P0.05)。AHFr EF組1、2、3年生存率分別為98%、95%、85%,AHFp EF組1、2、3年生存率分別為98%、94%、86%。兩組生存曲線比較,差異有統(tǒng)計學意義(χ2=6.656,P=0.010)。結(jié)論 AHFr EF患者3年內(nèi)因心力衰竭引起的再住院率高于AHFp EF患者,3年生存率低于AHFp EF患者;高血壓和高水平BNP是AHF患者再住院的獨立危險因素。臨床應加強對AHFr EF患者的隨訪,改善合并高血壓患者的血壓控制水平。
[Abstract]:Background there is no significant difference in short-term prognosis between patients with acute heart failure (AHFr EF) with low ejection fraction and (AHFp EF) with acute heart failure (AHFp EF) with retained ejection fraction, but the long-term follow-up data are lacking. Objective to compare the rate of rehospitalization and mortality of patients with AHFr EF and AHFp EF within 3 years after discharge, and to explore the risk factors affecting the rehospitalization of patients. Methods A total of 296 patients with acute heart failure (AHF) were selected from the emergency department of the affiliated Hospital of Inner Mongolia Medical University and the Emergency Department of the people's Hospital of Inner Mongolia Autonomous region from 2011 to 2012. According to left ventricular ejection fraction (LVEF), the patients were divided into AHFr EF group (LVEF50) and AHFp EF group (LVEF 鈮，

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