摘要：
目的 评估血液浓缩对急性心力衰竭(AHF)患者预后的影响.方法 选取因急性呼吸困难在我院ICU急救的急性心力衰竭患者482例,测定患者的血红蛋白(Hb)、红细胞比容(HCT)、白蛋白、总蛋白、血清肌酐(Cr)及B型尿钠肽(BNP)水平,评估血液浓缩与非血液浓缩患者、早发(发生时间≤4 d)与晚发(发生时间＞4d)血液浓缩患者预后的差异;采用Cox比例危险模型评估血液浓缩与病死率、再住院治疗的相关性.结果 共有185例(38.4％)患者发生血液浓缩,其中早发血液浓缩84例,晚发血液浓缩101例.与非血液浓缩患者比较,血液浓缩患者在出院时BNP水平降低值[(-319.3±49.4)pg/mL vs.(-196.0 ±26.3)pg/mL,P=0.004]与体质量降低值[(-2.4±0.5)kg vs.(-1.7±0.3)kg,P=0.008]显著提高,差异有统计学意义,提示血液浓缩患者有明显的淤血减轻迹象.与非血液浓缩患者比较,血液浓缩患者肾功能恶化发生率显著提高(36.8％ vs.27.6％,P=0.035).Cox回归分析表明,血红蛋白(OR =0.95,95％ CI0.93～0.98,P＜0.001)、总蛋白(OR =0.94,95％ CI 0.92～0.96,P＜0.001)、白蛋白(OR =0.93,95％ CI 0.91 ～ 0.96,P＜0.001)水平与患者住院期间的血液浓缩发生率呈负相关.血液浓缩与患者90 d病死率下降(HR =0.60,95％ CI 0.38 ～0.96,P=0.013)显著相关,晚发血液浓缩与90 d病死率下降显著相关(HR=0.41,95％ CI 0.19 ～0.90,P=0.037).结论 急性心力衰竭患者的血液浓缩是一种容易测量且廉价的病理生理信号,并与较低的病死率相关,而晚发血液浓缩与病死率下降显著相关.%Objective To evaluate the effect of haemoconcentration on the prognosis of patients with acute heart failure.Methods 482 patients with acute heart failure treated in our hospital were included.The hemoglobin,hematocrit,albumin,total protein,creatinine and B-type natriuretic peptide (BNP) were measured.And evaluated the prognosis of the difference between haemoconcentration and non-haemoconcentration patients,early haemoconcentration (≤4 d) and late haemoconcentration (＞ 4 d) patients with the prognosis of the difference.The Cox proportional hazards model was used to assess the correlation between blood concentration and mortality,re-hospitalization of the relevance.Results 185 (38.4％) patients developed haemoconcentration,including 84 patients with early haemoconcentration and 101 patients with latehaemoconcentration.Compared with non-haemoconcentration patients,the BNP reduction [(-319.3 ± 49.4) pg/mL vs.(-196.0 ± 26.3)pg/mL,P =0.004] and body weight reduction [(-2.4 ± 0.5) kg vs.(-1.7 ± 0.3) kg,P =0.008] increased significantly,the difference was statistically significant,suggesting that haemoconcentration in patients with significant signs of congestion reduction.Compared with non-haemoconcentration patients,the incidence of worsening renal function was significantly higher in patients with haemoconcentration (36.8％ vs.27.6％,P =0.035).Cox regression analysis showed that hemoglobin (OR =0.95,95 ％ CI 0.93 ～0.98,P ＜0.001),total protein (OR =0.94,95％ CI 0.92 ～0.96,P ＜0.001),albumin (OR =0.93,95％ CI 0.91 ～ 0.96,P ＜ 0.001) were negatively correlated with the incidence of haemoconcentration during hospitalization.The blood concentration was significantly associated with a 90-day mortality reduction (HR =0.60,95％ CI 0.38 ～ 0.96,P =0.013).The late haemoconcentration was significantly associated with a 90-day mortality reduction (HR =0.41,95％ CI 0.19 ～0.90,P=0.037).
