电解质紊乱对老年室性心律失常患者预后的影响

黄景; 孙东; 谭焱

doi:10.12125/j.chj.202411060

电解质紊乱对老年室性心律失常患者预后的影响

Impact of electrolyte imbalance on the prognosis of elderly patients with ventricular arrhythmia

摘要

摘要:
目的探讨电解质紊乱对老年室性心律失常患者预后的预测价值。
方法选择2021年2月～2024年3月于南部战区总医院住院治疗的250例老年室性心律失常患者作为研究对象，根据入院后3个月内预后情况分为预后良好（n=211）和预后不良组（n=39）。收集患者年龄、性别、病程、体质量指数、吸烟史、心律失常类型、用药种数、左室射血分数、高血压病史、糖尿病史、是否经介入或手术治疗、是否合并冠心病、是否合并心肌缺血、纽约心脏病学会（NYHA）心功能分级、尿素氮（BUN）、血清肌酐（Scr）、是否存在脂质代谢异常、Na⁺紊乱、K⁺紊乱、Ca²⁺紊乱、Mg⁺紊乱等资料并进行单因素比较。采用Logistic回归分析影响老年室性心律失常患者死亡的独立因素，并采用受试者工作特征（ROC）曲线分析独立因素预测患者死亡的效能。
结果与预后良好组比较，预后不良组在Na⁺紊乱比例、K⁺紊乱比例、Ca²⁺紊乱比例、Mg²⁺紊乱比例均增高，均P<0.01；Logistic回归分析显示，Na⁺、K⁺、Ca²⁺、Mg²⁺紊乱是老年室性心律失常患者预后的独立影响因素（OR=1.513、1.442、1.476、1.737，均P<0.05）；Spearman分析显示，Na⁺、K⁺、Ca²⁺、Mg²⁺紊乱与老年心律失常患者预后呈中度正相关关系（r=0.465、0.353、0.494、0.316，均P<0.05）；ROC曲线分析显示，Na⁺、K⁺紊乱对老年室性心律失常患者预后均具有一定预测作用（AUC=0.818、0.787，均P<0.01）。
结论电解质紊乱与老年室性心律失常患者预后密切相关，Na⁺、K⁺、Ca²⁺、Mg²⁺代谢紊乱是老年室性心律失常患者预后不良的独立危险因素，Na⁺、K⁺紊乱对老年室性心律失常患者预后不良的预测价值较高。

Abstract:
AIM To investigate the predictive value of electrolyte imbalance on the prognosis of elderly patients with ventricular arrhythmia.
METHODS A total of 250 elderly patients with ventricular arrhythmia, who were hospitalized in our hospital from February 2021 to March 2024, were selected as research subjects. They were divided into good prognosis and poor prognosis groups based on their prognosis within 3 months after admission. Data were collected on the patients’ age, sex, disease duration, body mass index (BMI), smoking history, type of arrhythmia, number of medications, left ventricular ejection fraction (LVEF), history of hypertension, history of diabetes, intervention or surgery history, coronary heart disease history, myocardial ischemia, New York Heart Association (NYHA) cardiac function classification, blood urea nitrogen (BUN), serum creatinine (Scr), lipid metabolism, and electrolyte disturbances (Na⁺, K⁺, Ca²⁺, Mg²⁺). These data were compared using univariate analysis. Logistic regression analysis was used to identify independent factors affecting mortality in elderly patients with ventricular arrhythmia, and receiver operating characteristic (ROC) curves were employed to assess the predictive efficacy of these independent factors on patient mortality.
RESULTS Compared with the group with good prognosis, the group with poor prognosis showed an increase in the proportion of Na⁺ disorder, K⁺ disorder, Ca2⁺ disorder, and Mg2⁺ disorder, all of which were P<0.01; Logistic regression analysis showed that disturbances in Na⁺, K⁺, Ca2⁺, and Mg2⁺were independent prognostic factors for elderly patients with ventricular arrhythmia (OR=1.513, 1.442, 1.476, 1.737, all P<0.05); Spearman analysis showed that disturbances in Na⁺, K⁺, Ca2⁺, Mg2⁺ were moderately positively correlated with the prognosis of elderly patients with arrhythmia (r=0.465, 0.353, 0.494, 0.316, all P<0.05); ROC curve analysis showed that Na⁺and K⁺disturbances have a certain predictive effect on the prognosis of elderly patients with ventricular arrhythmia (AUC=0.818, 0.787, both P<0.01).
CONCLUSION Electrolyte disturbances are closely associated with the prognosis of elderly patients with ventricular arrhythmia. Disturbances in Na⁺, K⁺, Ca²⁺, and Mg²⁺ metabolism are independent risk factors for poor prognosis in these patients. Notably, disturbances in Na⁺ and K⁺ levels exhibit relatively high predictive value for poor prognosis in elderly patients with ventricular arrhythmia.

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