Zhang Yun-Yun, Xu Fan, Chu Ming, Bi Li-Qing
Yun-yun Zhang, Department of Geriatric Intensive Care Unit, Jiangsu Province Hospital, Nanjing, 210029, China.
Fan Xu, Department of Geriatric Intensive Care Unit, Jiangsu Province Hospital, Nanjing, 210029, China.
Pak J Med Sci. 2017 Jan-Feb;33(1):27-32. doi: 10.12669/pjms.331.10913.
To assess the incidence, possible risk factors and prognosis of pulmonary arterial hypertension (PAH) in critically ill elderly patients.
We selected 122 cases admitted to the ICU, ages 60-93 years old. An echocardiography examination was performed within four days after admission to the ICU. PAH is usually suspected if the patient's pulmonary artery systolic pressure ≥ 40 mmHg. We collected echocardiography data, relevant clinical data and routine laboratory data; we then used a statistical method to analyze the risk factors for PAH in critically ill elderly patients and examined its impact on the prognosis.
Total 51 patients were diagnosed with PAH. The prevalence of critically ill elderly patients with PAH was 41.8%. The ANOVA analysis showed that if patients had COPD ( = 0.031) and/or respiratory failure ( = 0.021), they were more prone to PAH. An enlarged left atrium ( = 0.038) and/or right ventricle ( = 0.029), a declining left ventricle fractional shortening rate ( = 0.038), and an elevated amount of the brain natriuretic peptides ( = 0.046) were all associated with the occurrence of PAH. Multivariate regression analysis showed that the left atrial diameter ( = 0.045) was the risk factor in critically ill elderly patients with PAH. The 30-day mortality rate was 33.3% for elderly patients with PAH, which is statistically significant ( = 0.035) when compared with the mortality rate of patients with normal pulmonary artery pressure. Our multivariate regression analysis also showed that, for critically ill elderly patients admitted in the ICU, PAH ( = 0.039) is risk factor for increased mortality.
A higher incidence of PAH occurs in critically ill elderly patients. PAH is more likely to occur in patients with an enlarged left atrium, and these problems adversely impact the prognosis.
评估危重症老年患者肺动脉高压（PAH）的发病率、可能的危险因素及预后。
选取122例入住重症监护病房（ICU）的患者，年龄60 - 93岁。在入住ICU后4天内进行超声心动图检查。若患者肺动脉收缩压≥40 mmHg，则通常怀疑患有PAH。我们收集了超声心动图数据、相关临床数据及常规实验室数据；然后采用统计学方法分析危重症老年患者PAH的危险因素，并考察其对预后的影响。
共51例患者被诊断为PAH。危重症老年PAH患者的患病率为41.8%。方差分析显示，若患者患有慢性阻塞性肺疾病（COPD）（P = 0.031）和/或呼吸衰竭（P = 0.021），则更易患PAH。左心房（P = 0.038）和/或右心室扩大（P = 0.029）、左心室短轴缩短率下降（P = 0.038）以及脑钠肽水平升高（P = 0.046）均与PAH的发生有关。多因素回归分析显示，左心房直径（P = 0.045）是危重症老年PAH患者的危险因素。PAH老年患者的30天死亡率为33.3%，与肺动脉压正常患者的死亡率相比，差异有统计学意义（P = 0.035）。我们的多因素回归分析还显示，对于入住ICU的危重症老年患者，PAH（P = 0.039）是死亡率增加的危险因素。
危重症老年患者PAH的发病率较高。PAH更易发生于左心房扩大的患者，且这些问题对预后有不利影响。
