梁见弟 叶继亮 梁丽珍 陈丽玲

【摘要】 目的：探究慢性心力衰竭（CHF）患者室性心律失常的特點及相关因素。方法：回顾性分析2020年1-6月本院连续收治的60例CHF患者的临床资料，分析CHF患者室性心律失常的特点及相关因素。结果：24 h动态心电图结果显示，60例患者中，46例发生室性心律失常，14例未发生室性心律失常。38例患者发生室性早搏，其中室性早搏二联律27例（71.05%），频发室性早搏11例（28.95%）。非持续性室性心动过速患者8例，其中单形性7例（87.50%），多形性1例（12.50%）。单因素分析结果显示心律失常组患者心功能分级、平均心率、LVEF、BNP与非心律失常组患者比较，差异均有统计学意义（P<0.05）;两组患者性别、年龄、吸烟史比较，差异均无统计学意义（P>0.05）。多因素logistic分析结果显示心功能分级Ⅲ、Ⅳ级，平均心率≥70次/min、BNP≥350 pg/mL是CHF患者发生室性心律失常的危险因素，LVEF≥50%是CHF患者发生室性心律失常的保护因素（P<0.05）。结论：CHF患者室性心律失常发生率较高，以室性早搏为主，患者心功能分级、平均心率、LVEF、BNP是室性心律失常发生的影响因素。

【关键词】 慢性心力衰竭 室性心律失常 相关因素 多因素分析

Analysis of Characteristics and Related Factors of Ventricular Arrhythmia in 60 Patients with Chronic Heart Failure/LIANG Jiandi， YE Jiliang， LIANG Lizhen， CHEN Liling. //Medical Innovation of China， 2021， 18（12）： -155

[Abstract] Objective： To explore the characteristics and related factors of ventricular arrhythmias in patients with chronic heart failure （CHF）. Method： A retrospective analysis was performed on the clinical data of 60 patients with CHF who consecutively admitted to the hospital from January to June 2020， the characteristics and related factors of ventricular arrhythmias were analyzed among patients with CHF. Result： 24 h Holter monitoring showed that among the 60 patients， there were 46 cases of ventricular arrhythmia and 14 cases without ventricular arrhythmia. Ventricular premature beats occurred in 38 patients， including 27 cases （71.05%） with bigeminy of ventricular prematurebeat and 11 cases （28.95%） with frequent ventricular premature beat. There were 8 cases of non-persistent ventricular tachycardia， including 7 cases （87.50%） of monomorphism and 1 case （12.50%） of pleomorphism. Univariate analysis results showed that there were statistically significant differences in cardiac function grading， average heart rate， LVEF and BNP of patients in arrhythmia group compared with those in non-arrhythmia group （P<0.05）. There were no significant differences in gender， age and smoking history between the two groups （P>0.05）. Multivariate logistic analysis showed that heart function grade Ⅲ and Ⅳ， average heart rate≥70 beats/min， BNP≥350 pg/mL were risk factors of ventricular arrhythmia in CHF patients， LVEF≥50% were protective factors of ventricular arrhythmia in CHF patients （P<0.05）. Conclusion： The incidence of ventricular arrhythmia in patients with CHF is high， mainly ventricular premature beats. Cardiac function grading， average heart rate， LVEF and BNP are the influencing factors of ventricular arrhythmia.

[Key words] Chronic heart failure Ventricular arrhythmia Related factors Multivariate analysis

First-authors address： Dongguan Peoples Hospital， Dongguan 523000， China

doi：10.3969/j.issn.1674-4985.2021.12.036

慢性心力衰竭（CHF）是各種心脏病进展到终末阶段的表现，CHF患者表现为心律失常、呼吸困难、乏力等症状[1]。室性心律失常是CHF患者的常见并发症，其发病率在30%～80%，对CHF患者的预后产生了一定影响[2]。室性心律失常分为室性早搏、室性心动过速、心室扑动与心室颤动3类，其中室性早搏多见于老年患者，室性心动过速多见于急性心肌梗死、室壁瘤、心衰等情况，心室扑动与心室颤动多见于缺血性心脏病[3]。此前于迎根等[4]学者研究证实，CHF患者发生室性心律失常的情况与患者心脏疾病及CHF的严重程度存在一定联系。恶性心律失常指在短时间内引起患者发生血流动力学障碍，导致患者晕厥甚至猝死的心律失常，包括心室扑动与心室颤动、阵发性室上性心动过速、非持续性室性心动过速等[5]。……