慢性心力衰竭住院患者病和诊治状况10年变化趋势
摘要
目的：调查10年间中山医院慢性心力衰竭(CHF)住院患者的一般情况、急性发作诱因、病因、诊断、药物治疗及预后等变化趋势。
材料与方法：收集中山医院1998年7月1日～1999年7月1日(A组)及2008年7月1日～2009年7月1日(B组)临床出院诊断为CHF的出院病例,比较两组临床特征的变化。
结果：
①共入选的610例患者中,其中男性347例,女性263例,平均年龄(58.2±14.6)岁～(64.7±19.1)岁；B组较A组住院时间[(11.5±8.4)：(21.2±15)天,P<0.001]缩短,年再入院率下降(4.7%：14.74%,P<0.001)。
②CHF病因谱变化显著,风湿性瓣膜病由28.85%下降到13.42%(P<0.001),冠心病从23.72%上升到39.93%(P<0.001),CHF急性发作诱因谱亦有所变化,感染由51.28%下降到34.55%(P<0.001),急性冠脉综合征(ACS)由11.53%上升到30.2%(P<0.001)。
③胸片、心超辅助诊断CHF的应用率增加明显(27.88%：73.83%,P<0.001；17.63%：76.51%,P<0.001),心超诊断阳性率亦有明显提升(67.27%：87.72%,P<01.01)；NT-proBNP的应用率为94.3%,阳性率为92.88%。
④白细胞计数(WBC)及红细胞分布宽度(RDW)水平与CHF严重程度存在一定关联。
⑤住院期间药物应用情况A组：利尿剂78.52%、醛固酮受体拮抗剂70.83%、洋地黄类29.81%、非洋地黄类正性肌力药38.2%、硝酸盐75.64%、钙离子拮抗剂(CCB)36.86%、β受体阻滞剂14.1%、血管紧张素转换酶抑制剂(ACEI)44.55%、血管紧张素受体拮抗剂(ARB)0%；B组：利尿剂93.62%、醛固酮受体拮抗剂80.58%、洋地黄类34.9%、非洋地黄类正性肌力药物34.9%、硝酸盐类85.23%、CCB 33.22%、β受体阻滞剂74.16%、ACEI 66.11%、ARB 17.2%。β受体阻滞剂、ACEI及ARB的应用率明显上升,不应用β受体阻滞剂的主要原因是窦性心动过缓。不应用ACEI的主要原因是低血压。
⑥两组住院期间心功能Ⅱ级患者预后无明显差异,心功能Ⅲ、Ⅳ级患者病情恶化(4.85%：1.61%)及死亡(6.33%：2.69%)明显减少。
结论：10年间,中山医院CHF住院患者主要病因从风湿性瓣膜病变为冠心病,急性发作诱因虽然仍以感染为主,ACS所占比例明显升高。NT-proBNP作为CHF急性发作诊断的标志物具有重要意义,WBC及RDW水平与CHF严重程度也存在一定关联。CHF的药物治疗仍以传统药物为主,β受体阻滞剂、ACEI及ARB的应用有明显上升,规范化药物治疗水平有明显提高,住院患者预后改善明显。
Object:To investigate the tendency of general state of health, length of hospitalization, etiology, cause, methods of diagnosis,drug therapy and prognosis of hospitalized patients with chronic heart failure during the past 10 years in Zhongshan hospital.
Methods:All data was taken from the hospitalized cases with chronic heart failure in Zhongshan hospital.The patients of group A were admitted in hospital during Jul 1,1998 to Jul 1,1999;and the patients of group B were admitted in hospital during Jul 1,2008 to Jul 1,2009.
Results:
1.Among the selected 610 patients,347 cases of male and 263 cases of female, the mean age of which are 58.2±14.6(male)and 64.7±19.1(female). The length of hospitalization of group B(11.5+8.4 days)is significantly shorter than that of group A(21.2±15).(P<0.001).And the annual readmission rate of group B(4.7%) is significantly lower than that of group A(14.74%).(P<0.001).
2.The changes in heart failure etiology are significant:the proportion of rheumatic valve disease dropped from the 28.85% to 13.42%, while that of coronary heart disease increased from 23.72% to 39.93% (P<0.001).The cause of acute episode also changed:the proportion of infection dropped from 51.28% to 34.55% (P<0.001),while that of ACS increased from the 11.53% to 30.2%(P<0.001).
3.The application rate of Chest radiography and echocardiography have significantly increased (27.88%:73.83%, P<0.01;17.63%:76.51%,P<0.01). The positive rate of echocardiography also improved significantly (67.27%:87.72%,P<0.01).The application rate and positive rate of NT-proBNP are 94.3% and 92.88%.
4. Levels of white blood cell count (WBC) and red blood cell distribution width (RDW) are associated with the severity of CHF.
5.The Medications during hospitalization of group A:Diuretics 78.52%, aldosterone receptor antagonist 70,83%, digitalis 29.81%,non digitalis inotropic drugs 38.2%,nitrate 75.64%,β-locker 14.1%,ACEI 44.55%,ARB 0%,calcium antagonists 36.86%;group B:diuretics 93.62%, aldosterone receptor antagonist 86.58%,digitalis 34.9%, non-digitalis positive inotropic drugs 34.9%, nitrate 85.23%, calcium antagonists 33.22%,β-locker 74.16%, ACEI 66.11%, ARB 17.2%. The application rate ofβ-blocker, ACEI and ARB significantly increased.sinus bradycardia is the main reason whyβ-blocker is dropped, and the reason that for ACEI dues to low blood pressure.
6. There is no significant difference between the prognosis of patients whose heart function are NYHAⅡ.However, the progression rate(4.85%: 1.61%) and mortality (6.33%:2.69%) of patients, heart function of whom are NYHA III-NYHA IV, are significantly decreased during hospitalization.
Conclusion:The major cause for hospitalized patients with chronic heart failure has shifted from rheumatic valve disease to coronary heart disease during the past ten years.Although infection is still the main cause of acute episode, the proportion of ACS is significantly increased. NT-proBNP plays an important part as a marker for heart failure diagnosis, there is a certain correlation between WBC and RDW levels with the severity of CHF. Drug treatment of heart failure based on traditional medicines, while the use ofβ-locker, ACEI and ARB has been significantly increased. The level of Standardized drug treatment is significantly increased;the prognosis of hospitalized patients is obviously improved.
材料与方法：收集中山医院1998年7月1日～1999年7月1日(A组)及2008年7月1日～2009年7月1日(B组)临床出院诊断为CHF的出院病例,比较两组临床特征的变化。
结果：
①共入选的610例患者中,其中男性347例,女性263例,平均年龄(58.2±14.6)岁～(64.7±19.1)岁；B组较A组住院时间[(11.5±8.4)：(21.2±15)天,P<0.001]缩短,年再入院率下降(4.7%：14.74%,P<0.001)。
②CHF病因谱变化显著,风湿性瓣膜病由28.85%下降到13.42%(P<0.001),冠心病从23.72%上升到39.93%(P<0.001),CHF急性发作诱因谱亦有所变化,感染由51.28%下降到34.55%(P<0.001),急性冠脉综合征(ACS)由11.53%上升到30.2%(P<0.001)。
③胸片、心超辅助诊断CHF的应用率增加明显(27.88%：73.83%,P<0.001；17.63%：76.51%,P<0.001),心超诊断阳性率亦有明显提升(67.27%：87.72%,P<01.01)；NT-proBNP的应用率为94.3%,阳性率为92.88%。
④白细胞计数(WBC)及红细胞分布宽度(RDW)水平与CHF严重程度存在一定关联。
⑤住院期间药物应用情况A组：利尿剂78.52%、醛固酮受体拮抗剂70.83%、洋地黄类29.81%、非洋地黄类正性肌力药38.2%、硝酸盐75.64%、钙离子拮抗剂(CCB)36.86%、β受体阻滞剂14.1%、血管紧张素转换酶抑制剂(ACEI)44.55%、血管紧张素受体拮抗剂(ARB)0%；B组：利尿剂93.62%、醛固酮受体拮抗剂80.58%、洋地黄类34.9%、非洋地黄类正性肌力药物34.9%、硝酸盐类85.23%、CCB 33.22%、β受体阻滞剂74.16%、ACEI 66.11%、ARB 17.2%。β受体阻滞剂、ACEI及ARB的应用率明显上升,不应用β受体阻滞剂的主要原因是窦性心动过缓。不应用ACEI的主要原因是低血压。
⑥两组住院期间心功能Ⅱ级患者预后无明显差异,心功能Ⅲ、Ⅳ级患者病情恶化(4.85%：1.61%)及死亡(6.33%：2.69%)明显减少。
结论：10年间,中山医院CHF住院患者主要病因从风湿性瓣膜病变为冠心病,急性发作诱因虽然仍以感染为主,ACS所占比例明显升高。NT-proBNP作为CHF急性发作诊断的标志物具有重要意义,WBC及RDW水平与CHF严重程度也存在一定关联。CHF的药物治疗仍以传统药物为主,β受体阻滞剂、ACEI及ARB的应用有明显上升,规范化药物治疗水平有明显提高,住院患者预后改善明显。
Object:To investigate the tendency of general state of health, length of hospitalization, etiology, cause, methods of diagnosis,drug therapy and prognosis of hospitalized patients with chronic heart failure during the past 10 years in Zhongshan hospital.
Methods:All data was taken from the hospitalized cases with chronic heart failure in Zhongshan hospital.The patients of group A were admitted in hospital during Jul 1,1998 to Jul 1,1999;and the patients of group B were admitted in hospital during Jul 1,2008 to Jul 1,2009.
Results:
1.Among the selected 610 patients,347 cases of male and 263 cases of female, the mean age of which are 58.2±14.6(male)and 64.7±19.1(female). The length of hospitalization of group B(11.5+8.4 days)is significantly shorter than that of group A(21.2±15).(P<0.001).And the annual readmission rate of group B(4.7%) is significantly lower than that of group A(14.74%).(P<0.001).
2.The changes in heart failure etiology are significant:the proportion of rheumatic valve disease dropped from the 28.85% to 13.42%, while that of coronary heart disease increased from 23.72% to 39.93% (P<0.001).The cause of acute episode also changed:the proportion of infection dropped from 51.28% to 34.55% (P<0.001),while that of ACS increased from the 11.53% to 30.2%(P<0.001).
3.The application rate of Chest radiography and echocardiography have significantly increased (27.88%:73.83%, P<0.01;17.63%:76.51%,P<0.01). The positive rate of echocardiography also improved significantly (67.27%:87.72%,P<0.01).The application rate and positive rate of NT-proBNP are 94.3% and 92.88%.
4. Levels of white blood cell count (WBC) and red blood cell distribution width (RDW) are associated with the severity of CHF.
5.The Medications during hospitalization of group A:Diuretics 78.52%, aldosterone receptor antagonist 70,83%, digitalis 29.81%,non digitalis inotropic drugs 38.2%,nitrate 75.64%,β-locker 14.1%,ACEI 44.55%,ARB 0%,calcium antagonists 36.86%;group B:diuretics 93.62%, aldosterone receptor antagonist 86.58%,digitalis 34.9%, non-digitalis positive inotropic drugs 34.9%, nitrate 85.23%, calcium antagonists 33.22%,β-locker 74.16%, ACEI 66.11%, ARB 17.2%. The application rate ofβ-blocker, ACEI and ARB significantly increased.sinus bradycardia is the main reason whyβ-blocker is dropped, and the reason that for ACEI dues to low blood pressure.
6. There is no significant difference between the prognosis of patients whose heart function are NYHAⅡ.However, the progression rate(4.85%: 1.61%) and mortality (6.33%:2.69%) of patients, heart function of whom are NYHA III-NYHA IV, are significantly decreased during hospitalization.
Conclusion:The major cause for hospitalized patients with chronic heart failure has shifted from rheumatic valve disease to coronary heart disease during the past ten years.Although infection is still the main cause of acute episode, the proportion of ACS is significantly increased. NT-proBNP plays an important part as a marker for heart failure diagnosis, there is a certain correlation between WBC and RDW levels with the severity of CHF. Drug treatment of heart failure based on traditional medicines, while the use ofβ-locker, ACEI and ARB has been significantly increased. The level of Standardized drug treatment is significantly increased;the prognosis of hospitalized patients is obviously improved.
引文
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