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目的探讨经胸肺超声彗尾征评估老年心衰患者病情的价值及其与心率变异性(HRV)和预后的关系,为老年心衰病情和预后评估干预提供指导。方法回顾2014年1月—2015年6月台州市中心医院收治的95例老年心衰患者,患者治疗前行床旁经胸肺超声检查并计算彗尾征数量,根据彗尾征数量分为A组(彗尾征数量≥12条,32例)和B组(彗尾征数量<12条,63例)。观察2组心功能HYHA分级及1年生存情况。分析经胸肺超声彗尾征数量与HYHA分级、HRV、1年生存率的关系。结果与B组比较,A组HYHA分级为Ⅲ级和Ⅳ级患者比例显著升高(P<0.05),HYHA分级为Ⅱ级患者比例显著降低(P<0.05)。与B组比较,A组HRV指标[全部窦性R-R间期标准差(SDNN)、24 h每5 min窦性R-R间期平均值标准差(SDANN)]显著降低(P<0.05)。A组1年生存率(84.4%)显著低于B组(98.4%),P<0.05。经胸肺超声彗尾征数量与患者HYHA分级呈正相关(r=0.886,P<0.05),与其1年生存率则呈负相关(r=-0.812,P<0.05),与其SDNN、SDANN呈负相关(r=-0.752、-0.748,P<0.05)。结论经胸肺超声彗尾征与老年心衰患者HYHA分级、HRV及预后密切相关,可用于患者病情和预后评估的参考指标。
Objective To investigate the value of thoracic ultrasound in assessing the severity of heart failure and its relationship with heart rate variability (HRV) and prognosis in elderly patients with heart failure and provide guidance for the intervention of elderly patients with heart failure and prognosis. Methods From January 2014 to June 2015, 95 elderly patients with heart failure admitted to Central Hospital of Taizhou from January 2014 to June 2015 were enrolled in this study. Before bedside, patients underwent thoracic ultrasonography and the number of coma was calculated. According to the number of coma, Group (the number of tail extirpation≥12, 32 cases) and group B (the number of coma of tail <12, 63 cases). Two groups of heart function HYHA grade and 1 year survival were observed. To analyze the relationship between the number of thoracic ultrasonic coma and HYHA classification, HRV, 1-year survival rate. Results Compared with group B, the proportions of HYHA grade Ⅲ and Ⅳ in group A were significantly increased (P <0.05), and the proportion of HYHA grade Ⅱ was significantly decreased (P <0.05). Compared with group B, the HRV index (SDNN of all sinusoids, SDANN of sinus R-R interval every 5 min in 24 h) was significantly lower in group A (P <0.05). The 1-year survival rate (84.4%) in group A was significantly lower than that in group B (98.4%), P <0.05. There was a positive correlation between the number of THA and the HYHA grade (r = 0.886, P <0.05), but negatively correlated with 1-year survival rate (r = -0.812, P <0.05) (R = -0.752, -0.748, P <0.05). Conclusions Thoracic ultrasound is associated with HYHA classification, HRV and prognosis in elderly patients with heart failure, and can be used as a reference index for the evaluation of patient’s condition and prognosis.