Abstract: Background　The treatment outcome of chronic heart failure during hospitalization is affected by many factors.Previous research mostly focused on the provincial hospital，but rarely focused on primary hospital.Objective　To explore the influencing factors of the treatment outcome of chronic heart failure（CHF）treated in primary hospitals.Methods　339 inpatients diagnosed with CHF of gradeⅡ-Ⅳby New York Heart Association（NYHA）classification in Zaozhuang Central District People's Hospital during June 2012 to July 2018 were selected as the research objects.They were divided into improvement group（n=320）and deterioration group（n=19）according to treatment outcome.The data of gender，age，admission factors，medical history，diagnosis，imaging examination，cardiac ultrasound，biochemical examination，medication，treatment outcome was collected，and the differences between the two groups was compared by unconditional Logistic regression analysis，to explore the influencing factors of the treatment outcome.The patients were divided into ≤100 mm Hg group（41 cases），100 mm Hg < systolic pressure < 130 mm Hg group（132 cases），≥130 mm Hg group（166 cases） according to the systolic blood pressure at admission and the clinical treatment outcomes in the 3 groups were compared.Results　The proportion of pulmonary infection，left ventricular end-diastolic diameter，pulmonary artery systolic blood pressure，transglutaminase，urea nitrogen，NT-proBNP，and the application rate of dobutamine in the worsening group were higher than the improvement group.The high-density lipoprotein cholesterol，prealbumin，blood sodium，blood chloride，application rate of β-blockers and statins were lower than the improvement group（P<0.05）.The results of unconditional Logistic regression analysis showed that systolic blood pressure〔OR=0.977，95%CI（0.972，0.981），P<0.001〕，pulmonary infection〔OR=4.799，95%CI（1.156，19.919），P=0.031〕，aspartate aminotransferase〔OR=1.003，95%CI（1.000，1.006），P=0.039〕，albumin 〔OR=0.910，95%CI（0.891，0.928），P<0.001〕，application rate of β-blockers 〔OR=0.202，95%CI（0.046，0.898），P=0.036〕，application rate of spironolactone〔OR=0.125，95%CI（0.066，0.235），P<0.001〕，application rate of statins 〔OR=0.307，95%CI（0.121，0.779），P=0.013〕，application rate of dobutamine 〔OR=9.173，95%CI（1.351，62.272），P=0.023〕 are the influencing factors of treatment outcome of CHF patients（P< 0.05）.In the ≤100 mm Hg group，7 cases（17.1%）deteriorated，34 cases improved（82.9%）；in the 100 mm Hg < systolic pressure <130 mm Hg group，5 cases（3.8%）deteriorated，127 cases improved（96.2%）；in the ≥130 mm Hg group，7 cases deteriorated（4.2%），159 cases（95.8%）improved.Comparison among the three groups，the differences of improvement rates of CHF patients were statistically significant（χ2=8.369，P=0.015）；the proportion of deterioration in the ≤100 mm Hg group was higher than the 100 mm Hg < systolic pressure <130 mm Hg group（χ2=6.619，P=0.010）and the ≥130 mm Hg group（χ2=6.700，P=0.010）.Conclusions　The treatment outcome of CHF in primary hospitals can be affected by many factors.Pulmonary infection，systolic blood pressure ≤100 mm Hg at admission，low albumin protein，impaired liver function，and application of dobutamine are risk factors for treatment outcome of CHF，and the use of β-blockers，spironolactone and statins are protective factors.

Key words: Heart failure, Primary hospitals, Treatment outcome, Influencing factors

摘要： 背景　住院期间心力衰竭治疗转归受多种因素影响。既往研究多集中在省市级医院心力衰竭再住院率、死亡率的影响因素方面，而涉及基层医院心力衰竭治疗转归的影响因素研究较少。目的　研究基层医院慢性心力衰竭（CHF）患者治疗转归的影响因素。方法　采用回顾性分析的方法选取2012年6月—2018年7月入住枣庄市市中区人民医院美国纽约心脏病协会（NYHA）心功能分级Ⅱ~Ⅳ级的CHF患者339例为研究对象，根据疾病治疗转归情况分为好转组（320例）和恶化组（19例），收集患者的性别、年龄、入院诱发因素、病史、诊断、影像学检查、心脏超声、生化检查、用药情况、治疗转归等信息，并比较两组间有无差异，采用非条件Logistic回归分析探讨影响治疗转归情况的因素。根据入院时收缩压情况将患者分为≤100 mm Hg组（41例）、100 mm Hg<收缩压<130 mm Hg组（132例）、≥130 mm Hg组（166例），并比较3组CHF患者的临床治疗转归情况。结果　恶化组中肺部感染比例、左心室舒张末期内径、肺动脉收缩压水平、谷氨酰胺转移酶水平、尿素氮水平、NT-proBNP水平、多巴酚丁胺的应用比例高于好转组，高密度脂蛋白胆固醇、前清蛋白水平、血钠水平、血氯水平、β-受体阻滞剂的应用比例、他汀类药物的应用比例低于好转组（P<0.05）。非条件Logistic回归分析结果显示，收缩压〔OR=0.977，95%CI（0.972，0.981），P<0.001〕、肺部感染情况〔OR=4.799，95%CI（1.156，19.919），P=0.031〕、天冬氨酸氨基转移酶水平〔OR=1.003，95%CI（1.000，1.006），P=0.039〕、清蛋白水平〔OR=0.910，95%CI（0.891，0.928），P<0.001〕、β-受体阻滞剂应用情况〔OR=0.202，95%CI（0.046，0.898），P=0.036〕、螺内酯应用情况〔OR=0.125，95%CI（0.066，0.235），P<0.001〕、他汀类药物应用情况〔OR=0.307，95%CI（0.121，0.779），P=0.013〕、多巴酚丁胺应用情况〔OR=9.173，95%CI（1.351，62.272），P=0.023〕是CHF患者临床治疗转归情况的影响因素（P<0.05）。≤100 mm Hg组中恶化7例（17.1%）、好转34例（82.9%），100 mm Hg<收缩压<130 mm Hg组中恶化5例（3.8%）、好转127例（96.2%），≥130 mm Hg组中恶化7例（4.2%）、好转159例（95.8%）。3组CHF患者临床治疗转归情况比较，差异有统计学意义（χ2=8.369，P=0.015）；其中≤100 mm Hg组CHF患者临床治疗恶化比例高于100 mm Hg<收缩压<130 mm Hg组、≥130 mm Hg组（χ2=6.619、6.700，P=0.010、0.010）。结论　基层医院CHF临床治疗转归受多种因素影响，并发肺部感染、入院时收缩压≤100 mm Hg、低清蛋白水平、肝功能受损、应用多巴酚丁胺均可导致CHF临床治疗转归不良，而应用β-受体阻滞剂、螺内酯和他汀类药物是CHF临床治疗转归的保护性因素。

关键词: 心力衰竭, 基层医院, 治疗转归, 影响因素分析