慢性心力衰竭反复住院的多因素分析.DOCVIP

慢性心力衰竭反复住院的多因素分析 上海杨思医院心内科 陆露 沈心逸 冯升 赵焕昌 【摘要】 目的： 探讨慢性心力衰竭( CHF)患者反复住院的相关因素。方法：2011年1月-2013年1月间住院的196例慢性心衰患者分为住院次数为5次或以上（78例）和住院次数为1-2次（118例）的两组, 考察两组的性别、年龄、病程、冠心病占比、吸烟史、高血压、糖尿病、液体潴留、NYHA 分级、NT-proBNP，LVEF,入院时心率，焦虑抑郁状态，感染诱因，规律用药，共15个因素。结果：多因素logistic多元回归分析法显示，两组间在性别构成、冠心病构成比、糖尿病、病程、吸烟史及高血压共6个因素无统计学显著意义差异；而余下的9个因素存在统计学显著意义差异，即年龄（P=0.03）、明显的液体潴留（P0.01）、入院初的NYHA 分级（P=0.04）、NT-proBNP（P0.01）、LVEF＜40%（P=0.02）、入院时心率（P0.01）、有明显的焦虑抑郁状态（P=0.04）、感染诱因（P0.01）、规律用药（P0.01）。结论:对于CHF患者，不论在住院期或出院后，重视及发现焦虑抑郁的存在，并给予必要的治疗，坚持规则服用速尿及螺内酯、ARB或ACEI 、β-阻滞剂，控制心率，防治感染的发生，可能是减少反复入院次数的可行措施。 【关键词】: 慢性心力衰竭; 再住院; 多元回归分析 The analysis of mutiple factor on repeat hospitalization in the clonic hart fallure [Abstract] Objective: To investigate the correlative factors on repeat hospitalization with clonic hart fallure(CHF).Methed:196 cases with CHF were dived into tow groups that was the gtoup of exceeded or equal to 5 times in admission(78 cases) and the group 1-2 times(118 cases) in January 2011 to January 2013.The gender; age; pathogenesis…include 15 factors were analysis. Result The logistic mutiple regression analysis showed that there were no significant differencess on the gender; age; the percentage of corronary heart disease; the diabetes； the pathogenesis the smoking history and hypertension between the two groups. However the other nine factors manifested signifiant differencess that were the age(P=0.03); the body fluids retention(P0.01); NYHA classification(P=0.04); NT-proBNP(P0.01); LVEF(p=0.02); heart rate before admission(P0.01); the anxiety-depression state(p=0.04); the infective prcipitating factor (P0.01); the using drug regularly (P0.01). Conclusion: It may be the operable intervention that may reduce the repeat hospitalization to pay attention and recognize the patient with anxiety-depression state and afford a compatible therapy, to use furosemide and spironolactone for regulation body fluid retention and ARB,β-brocking agent regularly, controlling hea