摘要
目的:分析合并右心功能不全(RVD)的急性肺血栓栓塞症(APE)患者的远期预后的影响因素。方法:入选2012年2月至2017年8月,于首都医科大学附属北京安贞医院急诊重症监护病房(EICU)收治的首次确诊APE伴RVD患者129例。抗凝治疗6-12个月通过肺通气/灌注显像(V/Q scan)评估是否存在残余血栓,分为残余血栓组及非残余血栓组。通过门诊或电话对纳入患者进行长期随访。研究终点包括全因死亡、复发和慢性血栓栓塞性肺动脉高压。通过Kaplan-Meier法描述患者终点事件的发生率,Log-rank检验生存率差异。Cox比例风险模型分析合并RVD的APE患者远期预后的影响因素。结果:共纳入129例患者,年龄25-85岁,平均年龄(63.3±13,3)岁,男性53例(41.1%),女性76例(58.9%),其中残余血栓组76例(58.9%),非残余血栓组53例(41.1%)。随访时间为(52.2士26.6)个月。据Kaplan-Meier法描述残余血栓组和非残余血栓组的总预后不良差异有统计学意义(P=0.009)。Cox单因素及多因素风险比例模型分析提示与预后不良相关的危险因素包括:无诱发因素(HR=3.325,95%CI:1.056-9.973,P=0.040)、残余血栓(HR=3.062,95%CI:1.035-9.061,P=0.043)。结论:残余血栓是合并RVD的APE患者预后的危险因素。
Objective:To analyze the influencing factors of long-term prognosis of patients with acute pulmonary thromboembolism(APE)complicated with right ventricular dysfunction(RVD).Methods:A total of 129 patients with APE associated with RVD were enrolled and treated in the Emergency Intensive Care Unit(EICU),Beijing Anzhen Hospital,Capital Medical University from February 2012 to August 2017.Anticoagulant therapy 6-12 months through the lung ventilation/perfusion imaging(V/Q scan)to assess whether there is residual blood clots,divided into residual thrombus group and non residual thrombus.The included patients were followed up for a long time by outpatient or telephone.Endpoints included all-cause death,recurrence,and chronic thromboembolic pulmonary hypertension.Kaplan-Meier method was used to describe the incidence of end point events in patients,and log-rank test was used to test whether the difference in survival rate was statistically significant.Cox proportional risk model was used to analyze the factors influencing the long-term prognosis of APE patients with RVD.Results:Participants included 129 patients,aged 25-85,average age(63.3+13.3),the male 53 cases(41.1%),female,76 cases(58.9%),the residual thrombus group 76 cases(58.9%),the residual thrombus group 53 cases(41.1%).Follow-up time was(52.2±26.6)months.According to Kaplan and Meier method to describe prognosis,there were statistically significant differences in residual thrombus group and non residual thrombus recurrence(P=0.009).Cox,the single factor analysis and multi-factor risk proportion model independent risk factors associated with poor prognosis include:without inducing factors(HR=3.325,95%CI:1.056-9.973,P=0.040),and residual thrombus(HR=3.062,95%CI:1.035-9.061,P=0.043).Conclusions:Residual thrombosis is an independent risk factor for the prognosis of APE patients with RVD.
作者
李雅敏
米玉红
陆艳辉
齐玥
孟晶晶
孙黎黎
闫树凤
许铭缨
张晓丽
LI Yamin;MI Yuhong;LU Yanhui;QI Yue;MENG Jinging;SUN Lili;YAN Shufeng;XU Min-gying;ZHANG Xiaoli(Emergency&Critical Care Center,Beijing Anzhen Hospital,Capital Medical Uninversity,Beijing Institute of Heart,Laung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
CAS
2021年第4期330-335,共6页
Journal of Cardiovascular and Pulmonary Diseases
基金
北京市朝阳区科学技术和信息化局-朝阳区社会发展科技计划项目(CYSF2049)。
关键词
急性肺栓塞
右心功能不全
预后
Acute pulmonary thromboembolism
Right ventricular dysfunction
Prognosis
