Naslov
Kliničke i epidemiološke značajke bolesnika liječenih zbog akutne srčane dekompenzacije
(Clinical and epidemiological characteristics of patients with acute heart failure)

Autori
Potočnjak, Ines

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, diplomski rad, diplomski

Fakultet
Medicinski fakultet

Mjesto
Zagreb

Datum
14.07

Godina
2011

Stranica
24

Mentor
Degoricija, Vesna

Ključne riječi
akutna srčana dekompenzacija ; epidemiologija ; infarkt srca ; komorbiditet ; hipertenzija
(acute decompensated heart failure ; epidemiology ; miocardial infarction ; comorbidity ; hypertension)

Sažetak
Cilj ovog istraživanja jest opisati populaciju bolesnika liječenih zbog akutne srčane dekompenzacije te utvrditi postoje li značajne razlike između ženskog i muškog spola u kliničkoj slici, liječenju i ishodu bolesti i utječu li razlike u komorbiditetu na liječenje i ishod bolesti. Istraživanje na kojem se rad temelji provedeno je u Zavodu za hitnu i intenzivnu medicinu Klinike za unutarnje bolesti Kliničkog bolničkog centra Sestre milosrdnice u Zagrebu. U istraživanje su uključeni bolesnici koji su u razdoblju od godine dana (1.1.2010. - 31.12.2010.) obrađeni u Hitnoj službi Zavoda za hitnu i intenzivnu medicinu s dijagnozom akutne srčane dekompenzacije. Statistička obrada podataka napravljena je za 726 bolesnika obrađenih u prvih šest mjeseci te godine. Iz istraživanja su isključeni bolesnici za koje je daljnjom dijagnostičkom obradom ustanovljeno da nemaju akutnu srčanu dekompenzaciju. Podaci za ovo prospektivno opservacijsko istraživanje dobiveni su iz medicinske dokumentacije (povijesti bolesti i laboratorijski nalazi). Bolesnici su podijeljeni u dvije skupine prema spolu, 317 (43.7%) muškaraca i 409 (56.3%) žena. Istraživanjem je utvrđeno kako ne postoji statistički značajna razlika u ishodu liječenja bolesnika prema spolu kao izoliranoj varijabli, međutim utvrđene su razlike u komorbiditetima između muškaraca i žena. Te razlike pokazale su statistički značajan utjecaj na kliničku prezentaciju bolesti, simptome, znakove, liječenje, laboratorijske nalaze i zaključnu kliničku sliku. Žene su bile statistički značajno starije od muškaraca (78.2 : 73.1 godina, p<0.001), adipoznije (36.0 : 22.6%, p=0.004), uz povećan indeks tjelesne mase (29.2 : 26.6, p=0.032), imale su učestaliju anamnezu kronične hipertenzije (86.7 : 75.6%, p<0.001), akutnu hipertenziju kod prijema (32.8 : 20.7%, p<0.001), fibrilaciju atrija (53.0 : 44.4%, p=0.028), digitalis u kroničnoj terapiji (38.3 : 28.2%, p=0.011), zaključnu kliničku sliku hipertenzivne akutne srčane dekompenzacije (26.7 : 19.7%, p=0.046), viši Simplified Acute Physiology Score II (SAPS) (28.5 : 26.6 zbroj bodova, p=0.001) i češće urinarne infekcije (13.3 : 7.0%, p=0.006), dok su muškarci češće imali kroničnu dilatativnu kardiomiopatiju (15.5 : 5.9%, p<0.001), elektrokardiografske znakove hipertrofije lijeve klijetke (22.2 : 15.6%, p=0.03), nižu ejekcijsku frakciju (39.1 : 45.4%, p=0.003), dilataciju sve četiri komore (18.3 : 6.3%, p=0.022), zaključnu kliničku sliku akutnog koronarnog sindroma s akutnom srčanom dekompenzacijom (5.7 : 2.2%, p=0.046), nalaze desnostranog (16.8 : 14.7, p=0.002) i obostranih pleuralnih izljeva (19.0 : 14.0%, p=0.019), hepatomegaliju (36.9 : 16.0%, p=0.002), povišene vrijednosti alanin transaminaze (ALT) (52.9 : 32.7 J/L, p=0.044) i bilirubina (22.8 : 19.7 mmol/L, p=0.048), viši kreatinin (141.9 : 121.4 µmol/L, p<0.001), te učestalije pušenje cigareta (27.1 : 11.5%, p<0.001) i kroničnu opstruktivnu plućnu bolest (32.0 : 21.2%, p=0.001). S obzirom na utvrđene razlike može se zaključiti da kod muškaraca prevladava koronarna bolest, a kod žena hipertenzija i hipertenzivna bolest srca kao uzrok srčane dekompenzacije.

Izvorni jezik
Hrvatski

Znanstvena područja
Kliničke medicinske znanosti

Napomena
The aim of this study is to describe a population of patients treated for acute decompensated heart failure and to investigate the differences in clinical presentation, treatment and outcome between female and male genders and the impact of differences in comorbidity on the treatment and outcome of disease. The study on which this paper is based on was conducted at the Sister of Mercy University Hospital Centre in Zagreb. This study included patients diagnosed with acute heart failure that were examined in the hospital emergency ward during a one year period (1st January to 31st December 2010). A statistical analysis was performed on 726 patients examined in the hospital emergency ward in first six months of the year. Patients who were examined as not having acute heart failure were excluded from study. The data for this prospective observational study was obtained from medical documentation (patients’ history and laboratory data). Patients were divided into two groups according to gender 317 (43.7%) male and 409 (56.3%) female. The study revealed that there is no statistically important difference in patients’ outcome according to gender as an isolated variable, but instead differences in comorbidities between genders were present. These differences had a statistically important impact on their clinical presentation, symptoms, signs, treatment, laboratory tests and final clinical presentation. Women were statistically significantly older than men (78.2 : 73.1 years, p<0.001), adipose (36.0 : 22.6%, p=0.004), with higher body mass index (29.2 : 26.6, p=0.032), had higher anamnestic data in hypertension (86.7 : 75.6%, p<0.001), acute hypertension on admission (32.8 : 20.7%, p<0.001), atrial fibrillation (53.0 : 44.4%, p=0.028), digitalis in chronic therapy (38.3 : 28.2%, p=0.011), final clinical presentation of hypertensive acute heart failure (26.7 : 19.7%, p=0.046), higher Simplified Acute Physiology Score II (SAPS) (28.5 : 26.6 total score, p=0.001) and had more often urinary infections (13.3 : 7.0%, p=0.006), while men had more often chronic dilatative cardiomiopaty (15.5 : 5.9%, p<0.001), electrocardiographic signs of left ventricule hypertrophy (22.2 : 15.6%, p=0.03), lower ejection fraction (39.1 : 45.4%, p=0.003), dilatation of all four heart chambers (18.3 : 6.3%, p=0.022), final clinical presentation of acute coronary syndrome with acute heart failure (5.7 : 2.2%, p=0.046), findings of right (16.8 : 14.7, p=0.002) and bilateral (19.0 : 14.0%, p=0.019) pleural effusion, hepatomegaly (36.9 : 16.0%, p=0.002), higher value of alanin transaminase (ALT) (52.9 : 32.7 J/L, p=0.044) and bilirubin (22.8 : 19.7 mmol/L, p=0.048), higher creatinine (141.9 : 121.4 µmol/L, p<0.001), smoking (27.1 : 11.5%, p<0.001) and chronic obstructive pulmonary disease (32.0 : 21.2%, p=0.001). Taking into consideration the determined differences, it can be concluded that in men coronary heart disease is predominant whereas in women hypertension and hypertensive heart disease as cause of heart failure are a predominant factor.

POVEZANOST RADA