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目的探讨慢性心力衰竭患者首次住院至1年内死亡的相关原因。方法回顾性分析903例慢性心力衰竭患者的临床资料,根据住院期间及院外随访1年情况,分为存活组790例和死亡组113例。观察低钠血症对预后的影响。结果纳入研究的903例慢性心力衰竭患者总病死率为12.5%(113/903)。死亡组(n=113)的血脂水平、心率、心腔内径、射血分数、肾小球滤过率估计值(eGFR)、血尿酸、低钠血症、N末端B型利钠肽原(NT-pro BNP)水平与存活组间比较差异有统计学意义(P<0.05)。入院低钠血症患者86例,低钠血症的发生率为9.5%(86/903)。与非低钠血症患者相比,低钠血症患者入院血压水平较低、NYHA心功能分级及N末端B型利钠肽原(NT-pro BNP)水平较低(P<0.01)。Kaplan.Meier生存分析结果显示,低钠血症患者院内病死率、随访1年内全因死亡及心力衰竭死亡风险均明显高于非低钠血症患者(P<0.01)。多变量Cox比例风险模型分析结果显示,校正多种混杂因素后,入院时低钠血症仍然是心力衰竭住院患者随访1年内全因死亡和心力衰竭死亡(HR=2.458,95%CI 1.704~3.545,P<0.01)的独立预测因素。结论入院低钠血症是我国住院心力衰竭患者院内死亡及随访1年内全因死亡和心力衰竭死亡的独立预测因素(P<0.01)。
Objective To investigate the causes of death from first hospitalization to 1 year in patients with chronic heart failure. Methods The clinical data of 903 patients with chronic heart failure were retrospectively analyzed. According to the duration of hospitalization and 1-year follow-up of hospital, there were 790 survivors and 113 death patients. To observe the impact of hyponatremia on prognosis. Results Totally 903 patients with chronic heart failure enrolled in the study had a total case fatality rate of 12.5% (113/903). Blood lipids, heart rate, intracardiac diameter, ejection fraction, estimated glomerular filtration rate (eGFR), serum uric acid, hyponatremia, N-terminal pro-brain natriuretic peptide NT-pro BNP) between the survival group and the difference was statistically significant (P <0.05). 86 patients with hyponatremia admitted, the incidence of hyponatremia was 9.5% (86/903). Compared with non-hyponatremia patients, hyponatremia patients had lower admission blood pressure, NYHA functional class and lower N-terminal pro-brain natriuretic peptide (NT-pro BNP) levels (P <0.01). Kaplan-Meier survival analysis showed that in-hospital mortality in patients with hyponatremia, all-cause mortality and heart failure mortality within 1 year after follow-up were significantly higher than those without hyponatremia (P <0.01). Multivariate analysis of Cox proportional hazards model showed that hyponatremia on admission was still attributable to death from all-cause mortality and heart failure within one year of follow-up (HR = 2.458, 95% CI 1.704-3.545 , P <0.01) independent predictors. Conclusions Admission of hyponatremia is an independent predictor of hospital mortality in hospitalized patients with heart failure and all-cause mortality and heart failure death within one year of follow-up (P <0.01).