论文部分内容阅读
目的研究慢性心力衰竭住院患者药物治疗的变化。方法整理天津医科大学第二医院心脏科1980年1月—2008年8月住院的慢性心力衰竭(CHF)病例资料,按住院年代分为Ⅰ(1980—1989年)、Ⅱ(1990—1999年)、Ⅲ(2000—2008年)三组,对患者临床特征、预后、治疗药物变化进行回顾性分析。结果共入选患者2458例,男性1275例,女性1183例,≥60岁患者占80.5%。冠心病患者应用较多的药物依次是硝酸酯类药物、抗血小板药物和血管紧张素转换酶抑制剂(ACEI),风湿性心脏病和肺源性心脏病患者则主要应用硝酸酯、利尿剂和洋地黄。Ⅰ、Ⅱ、Ⅲ组患者利尿剂应用率均较高,分别为61.2%,71.0%和66.5%(P=0.007),特别是在心功能Ⅳ级(按NYHA分级)、风湿性心脏病及扩张型心肌病患者中。随着年代变迁,ACEI、β-受体阻滞剂和醛固酮受体拮抗剂的使用率明显增加,差异有统计学意义(P<0.01),洋地黄制剂的应用却呈减少趋势(P<0.01)。Ⅰ、Ⅱ、Ⅲ组患者住院期间病死率逐渐减少(分别为9.5%,8.9%和5.3%),差异有统计学意义(P<0.01),住院天数明显缩短,中位数为25、13、11d,差异有统计学意义(P<0.01)。结论 CHF临床治疗仍以利尿剂和洋地黄制剂为主,ACEI、β-受体阻滞剂和醛固酮受体拮抗剂的应用明显增加。患者住院病死率呈降低趋势,可能与治疗药物变化相关。
Objective To study the changes of medication in hospitalized patients with chronic heart failure. Methods The data of chronic heart failure (CHF) hospitalized in Department of Cardiology of the Second Hospital of Tianjin Medical University from January 1980 to August 2008 were classified into Ⅰ (1980-1989), Ⅱ (1990-1999) , Ⅲ (2000-2008) three groups, the clinical features of patients, prognosis, treatment of drug changes were retrospectively analyzed. Results A total of 2458 patients were selected, including 1275 males and 1183 females, accounting for 80.5% of the patients ≥60 years. Nitric acid esters, antiplatelet drugs and angiotensin-converting enzyme inhibitors (ACEIs) were the most commonly used drugs in patients with coronary heart disease. Patients with rheumatic heart disease and pulmonary heart disease mainly used nitrates, diuretics and foreign substances Rehmannia. Patients in group I, II and III had higher rates of diuretic use of 61.2%, 71.0% and 66.5%, respectively (P = 0.007), especially in patients with grade IV heart disease (classified according to NYHA class), rheumatic heart disease and dilatation Cardiomyopathy patients. With the change of ages, the usage of ACEI, β-blockers and aldosterone receptor antagonists increased significantly (P <0.01), and the application of digitalis decreased (P <0.01 ). The mortality rate of patients in Ⅰ, Ⅱ and Ⅲ groups decreased gradually (9.5%, 8.9% and 5.3% respectively), the difference was statistically significant (P <0.01), the days of hospitalization were significantly shortened, the median was 25,13, 11d, the difference was statistically significant (P <0.01). Conclusion The clinical treatment of CHF is still diuretics and digitalis preparations, ACEI, β-blockers and aldosterone receptor antagonists increased significantly. Patients in-hospital mortality decreased, may be related to changes in the treatment of drugs.