舒张性心衰和收缩性心衰临床比较

摘要

Objective:To retrospectively analyze clinical data of patients with heart failure (HF) for understand clinical characteristics,hospitalization costs and curative effects constituent ratio of diastolic heart failure (DHF) and systolic heart failure (SHF) in order to elevate recognition for two HF.Methods:According level of left ventricular ejection fraction (LVEF),a total of 807 HF patients in Affiliated Union Hospital of Fujian Medical University were divided into to DHF group (LVEF＞45％,n=656) and SHF group (LVEF≤45％,n=151).According to NYHA classification,two HF group were respectively further divided into class Ⅱ,Ⅲ,Ⅳ subgroups respectively.Clinical data of two HF group were compared.Results:Structure ratio of DHF and SHF occupied 81.3％ and 18.7％ respectively.Heart function:Compared with DHF group,there were significant increase in NYHA Ⅲ,Ⅳ class (23.5％,9.6％ vs.47.7％,21.9％),E/A rate [(0.74±0.31) vs.(1.26±0.56)] in SHF group.Clinical characteristics:Female ratio of DHF group was higher than that of SHF group; Compared with DHF group,there were significant increase in percentages of patients with coronary heart disease,pneumonia,chronic renal dysfunction,arrhythmia and cardiac enlargement,significant decrease in percentage of patients with hypertension,P＜0.001 all in above indexes; and significant increase in mean duration of hospital stay [(12.9±8.1) d vs.(14.5±11.6) d,P ＜0.05],hospitalization cost [12323 (8530～33815) yuan vs.19554 (9186～49927) yuan,P ＜0.05] and mortality rate during hospitalization (0.5％ vs.3.3％,P ＜0.01) in SHF group.Conclusion:Diastolic heart failure is of high proportion among heart failure.Compared with DHF patients,the heart failure,cardiac damage were more severe,the admission duration,hospitalization costs and mortality rate during hospitalization were more in systolic heart failure.%目的:回顾性分析心衰患者的资料,了解舒张性心衰和收缩性心衰临床特点、费用、疗效等的异同,提高对二者的认识.方法:选择福建医科大学附属协和医院心内科住院的807例心衰患者,根据左室射血分数(LVEF)水平分为两组:LVEF＞45％者为舒张性心衰(DHF)组,LVEF≤45％者为收缩性心衰(SHF)组,然后每个组根据NYHA心功能分级分为Ⅱ、Ⅲ、Ⅳ3组.比较两组的临床资料.结果:结构比:DHF和SHF分别占81.3％及18.7％.心功能:相对DHF组,SHF组的NYHAⅢ、Ⅳ级(23.5％,9.6％比47.7％,21.9％),E/A显著增大[(0.74±0.31)比(1.26±0.56)].临床特点:DHF组女性比例较SHF组显著增大；心脏增大,心律失常比例显著增大,冠心病、肺炎、慢性肾功能不全的比例显著上升,高血压病比例、入院收缩压水平则显著较低,以上P均＜0.001；SHF组平均住院时间明显延长[(12.9±8.1)d比(14.5±11.6)d,P＜0.05],住院费用[12323(8530～33815)元比19554 (9186～49927)元,P＜0.05]、住院期间死亡率(0.5％比3.3％,P＜0.01)显著较高.结论:舒张性心衰在心衰中占的比例很大,收缩性心衰的心衰更重,心脏损害更重,住院天数更长,住院费用更多、住院期间死亡率更高.