老年心力衰竭患者674例回顾性分析
摘要
目的:回顾分析新疆医科大学第一附属医院近3年(2005-01-01至2007-12-31)老年慢性心力衰竭住院的病例发病年龄、病因、诱因、临床特点及药物治疗使用情况,了解心衰治疗指南对临床实践的影响,并为今后慢性心力衰竭的预防和治疗提供指导和参考依据。方法:收集新疆医科大学第一附属医院心血管内科2005-2007年,第一诊断为心力衰竭的住院病历674例。详细记录病例的一般情况、病因、合并症、主要检查及药物治疗等项目。采用回顾性分析病例资料的方法进行分析和比较。结果:共有674例老年慢性心衰患者入选。心衰男性分布多于女性,男女比例为1.42,平均年龄为69.56±6.618,心功能Ⅲ、Ⅳ级占住院病人的大多数(78.6%),以Ⅲ级最多(53.7%)。心衰病因主要为冠心病(54.7%),高心病(27.2%),扩心病(15.3%),风心病(12.3%)。心衰主要诱因为肺部感染(29.4%)、心律失常(26%)、心肌缺血(17.4%)、不明原因(10.4%),心律失常中房颤最多,占41.7%。药物使用比例,ACEI/ARB为90.9%、硝酸酯7 7.2%、螺内酯67.4%、β受体阻滞剂62.6%、利尿剂59.5%、洋地黄36.9%。3年间利尿剂、硝酸酯、洋地黄类药物使用比例逐年减少。结论:心衰住院治疗药物以ACEI/ARB、β受体阻滞剂和醛固酮拮抗剂为主,利尿剂、硝酸酯及洋地黄使用逐年减少,但较2002年慢性心力衰竭治疗建议要有仍有一定的差距,与2007年心衰治疗指南相比差距更显著。仍需加强临床医师对心衰指南在临床实践中的应用。
Objective: TO analys the age,etiology, predisposing cause and drug using of the aged patients with heart failure(CHF),and to get the message of the effects of guidelines for management of chronic heart failure on clinical practice. Methods: Retreospective analysis of 674 HF hospital records taken from patients aged≥60 years,discharged from Jan.1 2005 to Dec.31.2007. Results: Male was greater than famale in distribution of CHF,mean age is 69.56±6.618. The patients with heart function of levelⅢandⅣwere 78.6% in the total patients. The main etiology were coronary artery disease(54.7%), hypertensive heart disease(27.2%), dilated cardiomyopathy (15.3%).The main predisposing cause were pneumonia,arhythmia and ischemia. Angiotensin-converting enzyme inhibitor or angiotensin receptor blockers (90.9%),βblocker(62.6%) and aldosterone (67.4%)were used mostly. Inversely,The digitalis, diuretic and vasodilator agent were used less and less. Conclusion: The main using drug of heart failure are Angiotensin-converting enzyme inhibitor or angiotensin receptor blockers,βblocker and aldosterone,but there is still some gap between optimal medical strategy and clinical practice in the management of heart failure. The study suggest that greater efforts are required to improve training and clinical practice of primary care teams in the manegment of heart failure.
Objective: TO analys the age,etiology, predisposing cause and drug using of the aged patients with heart failure(CHF),and to get the message of the effects of guidelines for management of chronic heart failure on clinical practice. Methods: Retreospective analysis of 674 HF hospital records taken from patients aged≥60 years,discharged from Jan.1 2005 to Dec.31.2007. Results: Male was greater than famale in distribution of CHF,mean age is 69.56±6.618. The patients with heart function of levelⅢandⅣwere 78.6% in the total patients. The main etiology were coronary artery disease(54.7%), hypertensive heart disease(27.2%), dilated cardiomyopathy (15.3%).The main predisposing cause were pneumonia,arhythmia and ischemia. Angiotensin-converting enzyme inhibitor or angiotensin receptor blockers (90.9%),βblocker(62.6%) and aldosterone (67.4%)were used mostly. Inversely,The digitalis, diuretic and vasodilator agent were used less and less. Conclusion: The main using drug of heart failure are Angiotensin-converting enzyme inhibitor or angiotensin receptor blockers,βblocker and aldosterone,but there is still some gap between optimal medical strategy and clinical practice in the management of heart failure. The study suggest that greater efforts are required to improve training and clinical practice of primary care teams in the manegment of heart failure.
引文
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[3]上海市心力衰竭调查协作组.上海市1980,1990,2000年心力衰竭住院患者流行病学及治疗状况调查[J].中华心血管病杂志,2002;230(:1)24-27
[4] Swedberg, Kcleland J, Dadrie H, et al. Guedeline of the diagnosis and treatment of chronic heart failure:executive summary (update2005):the task for the diagnosis and treatment of Chronic Heart Failure of the Europena Socirty of Cardiology[J]. Eur Heart J,2005;Jun,26:1115-1140
[5]中华医学会心血管分会.中国部分地区1980、1990、2000年慢性心力衰竭住院病例回顾性调查[J].中华心血管病杂志,2002;8:450-454
[6] American Heart Association.2002 Heart and Stroke Statistcal Update.Dallas[J]. TX:American Heart Association,2002:19
[7] AronsonD,Bugrer AI. Gende-related dieffrences inmodulation of hear tratein Patients with congestive heart failure[J]. Cardiovase Electrophysiol,2000;11:1071- 1077
[8] Dash R,Rank,KF, CarrAN,et al. Gender influenees on sarcoplasmie reticulum Ca2+ handuling in failing humanmn myoeardium[J]. J A Mol Cell Cardiol,2001;33: 1345-1353
[9] Griffin M,Lee,Zhao,Letal. Gender一related dieffrences in Porliefrative responseof cardiac fibroblasts to hypoxia:ect , of estrogen[J]. J A Mol Cell Cardiol, 2000;215:21-30
[10] Salf S Yongefi W, Harlan M, et al. Sex-based dieffrences in the efect of Digoxin for the treatment of heart failure[J]. N Eng J Med,2002;347:1403-1411
[11] JalalK,Heidi J,Kirwkood F, et al. Gender diefrences in advaneed heart failure: Insihgts from the BEST study[J]. Am Co11 Cardiol,20O3;42:2128-21
[12] Nobuyuki Shiba and Hiroaki Shimokawa .Chronic heart failure in Japan: Implications of the CHART studies[J]. Vasc Health Risk Manag,2008;February; 4(1): 103–113
[13]王路宏,刘杰,苗懿德,等.老年人多病因心力衰竭542例临床分析[J].中华临床医师杂志,2008;2(5):529-533
[14]何为.老年心力衰竭313例诱因分析[J].现代医院.2008;(8)8:29-30
[15]缪海雄,夏向南.老年多病因心力衰竭的临床调查[J].中华保健医学杂志,2008;(10)5:340-342
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