经胸肺超声彗尾征评估老年心衰患者病情的价值及其与HRV和预后的关系

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。 

Value of ultrasound lung comets in assessing illness severity in elderly heart failure patients and its relationship with heart rate variability and prognosis of patients

Objective To explore the value of ultrasound lung comets in assessing the illness severity of heart failure in elderly patients and its relationship with heart rate variability (HRV) and prognosis of patients. Methods A total of 95 cases of elderly heart failure in our hospital between January,2014 and June,2015 were selected as the research object.All of the patients received on bed lung ultrasound examination and comets number calculation before the treatment and were divided into group A (comets number ≥ 12,n=32) and group B (comets number<12,n=63) based on comets number.Cardiac function New York heart association (HYHA) grading and one-year survival rate were compared on the basis of follow-up.The relationships between ultrasound lung comets number and their HYHA grading,one-year survival rate and HRV were analyzed. Results Compared with group B,the ratio of HYHA class Ⅲ and Ⅳ patients in group A were higher,while the percentage of HYHA class Ⅱ patients was lower (P<0.05).The HRV indexes,such as standard deviation of all normal sinus RR intervals over 24 h (SDNN) and standard deviation of the averaged normal sinus RR intervals for all 5-mm segments (SDANN),one-year survival rate in group A were lower as compared with group B (P<0.05).Spearman correlation analysis results showed that ultrasound lung comets number of elderly heart failure patients was positively correlated with HYHA grading (r=0.886,P<0.05),while negatively correlated with one-year survival rate (r=-0.812,P<0.05);Pearson correlation analysis results showed a negatively correlated with SDNN and SDANN (r=-0.752,-0.748,P<0.05). Conclusion Ultrasound lung comets in the elderly heart failure patients are correlated with illness severity,HRV and prognosis,which can be used as reference on condition and prognosis of patients.