2022 年第 5 期 第 17 卷

非高危肺栓塞合并心力衰竭病史患者的临床表现及不良事件发生的影响因素分析

Clinical manifestation and influencing factors of adverse events in patients with non high-risk pulmonary embolism complicated with previous heart failure

作者：田春营1高娜2王卫华1马迎辉3

英文作者：Tian Chunying1 Gao Na2 Wang Weihua1 Ma Yinghui3

单位：1首都医科大学附属北京安贞医院急诊危重症中心，北京100029；2首都医科大学附属北京安贞医院风湿免疫科，北京100029；3首都医科大学附属北京安贞医院护理部，北京100029

英文单位：1Department of Emergency and Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Rheumatology and Immunology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 3Department of Nursing Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：肺栓塞；心力衰竭；危险因素

英文关键词：Pulmonaryembolism;Heartfailure;Riskfactors

• 摘要：

• 目的 探讨非高危肺栓塞合并心力衰竭病史患者的临床表现及不良事件发生的影响因素。方法 回顾性分析2016年1月至2017年12月首都医科大学附属北京安贞医院收治的260例非高危肺栓塞患者的临床及随访资料。根据患者是否合并心力衰竭病史，分为心力衰竭组（92例）和非心力衰竭组（168例）。比较2组临床资料、实验室检测指标、临床症状及随访期间不良事件发生情况。分析非高危肺栓塞患者发生不良事件的危险因素。结果 心力衰竭组年龄、心率、住院时间、跌倒评分均高于/长于非心力衰竭组，左心室射血分数低于非心力衰竭组，右心功能不全、糖尿病、冠心病（冠状动脉粥样硬化性心脏病）、下肢深静脉血栓、院内心力衰竭比例均高于非心力衰竭组，差异均有统计学意义（均P＜0.05）。心力衰竭组D-二聚体水平高于非心力衰竭组，动脉血氧分压、动脉血氧饱和度、动脉血二氧化碳分压、高密度脂蛋白水平均低于非心力衰竭组，差异均有统计学意义（均P＜0.05）。心力衰竭组呼吸困难、晕厥比例均高于非心力衰竭组，差异均有统计学意义（均P＜0.05）。随访期间，心力衰竭组发生严重出血、全因死亡比例均高于非心力衰竭组［7.6%（7/92）比1.2%（2/168）、17.4%（16/92）比8.3%（14/168）］（均P＜0.05）。多因素Cox回归分析结果显示，高血压病（风险比=0.36,95%置信区间：0.15~0.85，P=0.02）、右心功能不全（风险比=0.33,95%置信区间：0.14~0.77，P=0.01）及动脉血氧饱和度（风险比=0.97,95%置信区间：0.94~1.00，P=0.04）是发生不良事件的独立危险因素。结论  非高危肺栓塞合并心力衰竭病史患者出现下肢深静脉血栓、低氧血症、呼吸困难、晕厥及跌倒的风险更高。高血压病、右心功能不全及动脉血氧饱和度是非高危肺栓塞患者发生不良事件的独立危险因素。

• Objective  To explore clinical manifestation and influencing factors of adverse events in patients with non high-risk pulmonary embolism complicated with previous heart failure. Methods Clinical and follow-up data of 260 patients with non high-risk pulmonary embolism admitted to Beijing Anzhen Hospital, Capital Medical University from January 2016 to December 2017 were retrospectively analyzed. According to whether patients complicated with previous heart failure, they were divided into heart failure group (92 cases) and non heart failure group (168 cases). The clinical data, clinical laboratory indexes, clinical symptoms, and adverse events during follow-up were compared between the two groups. The risk factor for adverse events in patients with non high-risk pulmonary embolism was analyzed. Results  The age, heart rate, length of stay, fall score in heart failure group were higher/longer than those in non heart failure group, left ventricular ejection fraction in heart failure group was lower than that in non heart failure group, and proportions of right ventricular dysfunction, diabetes mellitus, coronary atherosclerotic heart disease, lower extremity deep venous thrombosis and hospital heart failure in heart failure group were higher than those in non heart failure group (all P<0.05). The level of D-dimer in heart failure group was higher than that in non heart failure group, and levels of arterial oxygen partial pressure, arterial oxygen saturation, carbon dioxide partial pressure and high-density lipoprotein in heart failure group were lower than those in non heart failure group (all P<0.05). The proportions of dyspnea and syncope in heart failure group were higher than those in non heart failure group (both P<0.05). During follow-up, proportions of severe bleeding and all-cause death in heart failure group were higher than those in non heart failure group［7.6%（7/92） vs 1.2%（2/168）, 17.4%（16/92） vs 8.3%（14/168）］(both P<0.05). Multivariate Cox regression analysis showed that hypertension (hazard ratio=0.36, 95% confidence interval: 0.15-0.85, P=0.02), right ventricular dysfunction (hazard ratio=0.33, 95% confidence interval: 0.14-0.77, P=0.01) and arterial oxygen saturation (hazard ratio=0.97, 95% confidence interval: 0.94-1.00, P=0.04) were independent risk factors for adverse events. Conclusions Patients with non high-risk pulmonary embolism complicated with previous heart failure are more likely to suffer lower extremity deep vein thrombosis, hypoxemia, dyspnea, syncope and fall. Hypertension, right ventricular dysfunction and arterial oxygen saturation are independent risk factors for adverse events in patients with non high-risk pulmonary embolism.