慢性阻塞性肺疾病急性加重期患者心电图表现及其与患者生存状况的关系研究

摘要

目的 分析慢性阻塞性肺疾病急性加重期(AECOPD)患者心电图(ECG)表现及其与患者生存状况的关系.方法 选取2014—2016年三峡大学人民医院收治的AECOPD患者181例,根据患者生存状况分为生存组140例与死亡组41例.回顾性分析两组患者一般资料及ECG表现,AECOPD患者生存状况的影响因素分析采用Cox比例风险回归模型,采用log-rank检验比较不同校正QT间期离散度(QTcd)患者生存率.结果 两组患者性别、吸烟史、冠心病发生率、脑血管疾病发生率、糖尿病发生率、慢性肾脏病发生率、慢性阻塞性肺疾病全球倡议(GOLD)气流受限分级、心率、第1秒用力呼气容积占预计值的百分比(FEV1%)、P波高度、P波最大宽度、QRS波群宽度、PR间期、QT间期、校正QT间期(QTc)、P波离散度(PWd)比较,差异无统计学意义(P>0.05);生存组患者年龄及QT间期离散度(QTd)、QTcd小于死亡组(P <0.05).Cox比例风险回归模型分析结果显示,年龄〔HR =0.429, 95%CI(0.210,0.876)〕、QTcd〔HR=0.384,95%CI(0.195,0.755)〕是AECOPD患者生存状况的影响因素(P<0.05).QTcd<48 ms者生存率高于QTcd≥48 ms者(P<0.05).结论 QTcd是AECOPD患者生存状况的影响因素,且QTcd≥48 ms的患者死亡风险较高.%Objective To analyze the electrocardiographic findings in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and its relation with the survival status. Methods A total of 181 patients with AECOPD were selected in the People′s Hospital of China Three Gorges University from 2014 to 2016,and they were divided into survival group(n = 140)and death group(n = 41)according to the survival status.General information and electrocardiographic findings in the two groups were retrospectively analyzed,Cox proportional hazard regression model was used to analyze the influencing factors of survival status in patients with AECOPD,and log-rank test was used to compare the survival rate in patients with different corrected QT interval dispersion(QTcd). Results No statistically significant differences of gender,smoking history,incidence of coronary heart disease,cerebrovascular disease,diabetes or chronic kidney disease, GOLD airway limitation grade,heart rate,FEV1%,P -wave height,P -wave maximum width,QRS complex width,PR interval,QT interval,corrected QT interval(QTc)or P-wave dispersion(PWd)was found between the two groups(P>0.05);age in survival group was statistically significantly younger than that in death group,meanwhile QT interval dispersion (QTd)and QTcd in survival group were statistically significantly smaller than those in death group(P < 0.05). Cox proportional hazard regression model analysis results showed that,age〔HR =0.429,95%CI(0.210,0.876)〕and QTcd〔HR=0.384,95%CI(0.195,0.755)〕were influencing factors of survival status in patients with AECOPD(P<0.05). Survival rate in AECOPD patients with QTcd less than 48 ms was statistically significantly higher than that in AECOPD patients with QTcd equal or over 48 ms(P<0.05). Conclusion QTcd is one of influencing factors of survival status in patients with AECOPD,risk of death significantly elevated in AECOPD patients with QTcd equal or over 48 ms.