关键词: 心力衰竭, 基层医院, 治疗转归, 影响因素分析

Abstract: Background　The treatment outcome of chronic heart failure during hospitalization is affected by many factors.Previous research mostly focused on the provincial hospital，but rarely focused on primary hospital.Objective　To explore the influencing factors of the treatment outcome of chronic heart failure（CHF）treated in primary hospitals.Methods　339 inpatients diagnosed with CHF of gradeⅡ-Ⅳby New York Heart Association（NYHA）classification in Zaozhuang Central District People's Hospital during June 2012 to July 2018 were selected as the research objects.They were divided into improvement group（n=320）and deterioration group（n=19）according to treatment outcome.The data of gender，age，admission factors，medical history，diagnosis，imaging examination，cardiac ultrasound，biochemical examination，medication，treatment outcome was collected，and the differences between the two groups was compared by unconditional Logistic regression analysis，to explore the influencing factors of the treatment outcome.The patients were divided into ≤100 mm Hg group（41 cases），100 mm Hg < systolic pressure < 130 mm Hg group（132 cases），≥130 mm Hg group（166 cases） according to the systolic blood pressure at admission and the clinical treatment outcomes in the 3 groups were compared.Results　The proportion of pulmonary infection，left ventricular end-diastolic diameter，pulmonary artery systolic blood pressure，transglutaminase，urea nitrogen，NT-proBNP，and the application rate of dobutamine in the worsening group were higher than the improvement group.The high-density lipoprotein cholesterol，prealbumin，blood sodium，blood chloride，application rate of β-blockers and statins were lower than the improvement group（P<0.05）.The results of unconditional Logistic regression analysis showed that systolic blood pressure〔OR=0.977，95%CI（0.972，0.981），P<0.001〕，pulmonary infection〔OR=4.799，95%CI（1.156，19.919），P=0.031〕，aspartate aminotransferase〔OR=1.003，95%CI（1.000，1.006），P=0.039〕，albumin 〔OR=0.910，95%CI（0.891，0.928），P<0.001〕，application rate of β-blockers 〔OR=0.202，95%CI（0.046，0.898），P=0.036〕，application rate of spironolactone〔OR=0.125，95%CI（0.066，0.235），P<0.001〕，application rate of statins 〔OR=0.307，95%CI（0.121，0.779），P=0.013〕，application rate of dobutamine 〔OR=9.173，95%CI（1.351，62.272），P=0.023〕 are the influencing factors of treatment outcome of CHF patients（P< 0.05）.In the ≤100 mm Hg group，7 cases（17.1%）deteriorated，34 cases improved（82.9%）；in the 100 mm Hg < systolic pressure <130 mm Hg group，5 cases（3.8%）deteriorated，127 cases improved（96.2%）；in the ≥130 mm Hg group，7 cases deteriorated（4.2%），159 cases（95.8%）improved.Comparison among the three groups，the differences of improvement rates of CHF patients were statistically significant（χ2=8.369，P=0.015）；the proportion of deterioration in the ≤100 mm Hg group was higher than the 100 mm Hg < systolic pressure <130 mm Hg group（χ2=6.619，P=0.010）and the ≥130 mm Hg group（χ2=6.700，P=0.010）.Conclusions　The treatment outcome of CHF in primary hospitals can be affected by many factors.Pulmonary infection，systolic blood pressure ≤100 mm Hg at admission，low albumin protein，impaired liver function，and application of dobutamine are risk factors for treatment outcome of CHF，and the use of β-blockers，spironolactone and statins are protective factors.

Key words: Heart failure, Primary hospitals, Treatment outcome, Influencing factors