中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2010年
10期
606-609
,共4页
刘健%马金萍%黄娇红%王林
劉健%馬金萍%黃嬌紅%王林
류건%마금평%황교홍%왕림
老年住院患者%心力衰竭,充血性,慢性%指南%药物治疗
老年住院患者%心力衰竭,充血性,慢性%指南%藥物治療
노년주원환자%심력쇠갈,충혈성,만성%지남%약물치료
Elderly inpatient%Chronic congestive heart failure%Guideline%Drug treatment
目的 分析老年慢性充血性心力衰竭(CHF)患者药物治疗随指南发布发生变化的情况.方法 选择1990年1月至2007年7月确诊且≥60岁的CHF住院病例3 174例次,根据美国心脏病学会/美国心脏病协会(ACC/AHA)指南发布的时间按每6年一组分为3组,对患者的治疗药物进行回顾性分析.结果 入选病例占同期CHF住院病例的79.2%(3 174/4 010),其中男1 639例次,女1 535例次;年龄60～98岁,平均(71.94±7.07)岁.1990年至1 995年(A组)、1996年至2001年(B组)、2002年至2007年(C组)CHF患者的年龄(岁)逐年增长(68.99±6.71、71.56±6.86、73.79±7.01,F=91.142,P＜0.01);前3位病因均为冠心病(55.3%、64.5%、81.8%)、肺源性心脏病(21.9%、19.3%、5.5%)、风湿性心脏病(16.5%、10.3%、7.5%),3种病因间比较差异有统计学意义(x2=217.979,P＜0.01);入院时美国纽约心脏协会(NYHA)心功能分级Ⅲ、Ⅳ级居多(Ⅲ级1 561例次,Ⅳ级1 433例次,x2=75.828,P＜0.01);预后以好转为主(88.9%、88.3%、92.7%,x2=35.002,P＜0.01).硝酸酯类、β受体阻滞剂、血管紧张素受体拮抗剂、醛固酮拮抗剂的应用逐年代增多(均P＜0.05);洋地黄类应用则逐渐减少(均P＜0.05).血管紧张素转换酶抑制剂和β受体阻滞剂主要用于冠心病,分别为81.3%(1 698/2 088)和87.8%(768/875).结论 指南的发布对老年CHF患者的药物治疗产生了积极影响,老年CHF患者应及时应用对预后有积极意义的治疗药物.
目的 分析老年慢性充血性心力衰竭(CHF)患者藥物治療隨指南髮佈髮生變化的情況.方法 選擇1990年1月至2007年7月確診且≥60歲的CHF住院病例3 174例次,根據美國心髒病學會/美國心髒病協會(ACC/AHA)指南髮佈的時間按每6年一組分為3組,對患者的治療藥物進行迴顧性分析.結果 入選病例佔同期CHF住院病例的79.2%(3 174/4 010),其中男1 639例次,女1 535例次;年齡60～98歲,平均(71.94±7.07)歲.1990年至1 995年(A組)、1996年至2001年(B組)、2002年至2007年(C組)CHF患者的年齡(歲)逐年增長(68.99±6.71、71.56±6.86、73.79±7.01,F=91.142,P＜0.01);前3位病因均為冠心病(55.3%、64.5%、81.8%)、肺源性心髒病(21.9%、19.3%、5.5%)、風濕性心髒病(16.5%、10.3%、7.5%),3種病因間比較差異有統計學意義(x2=217.979,P＜0.01);入院時美國紐約心髒協會(NYHA)心功能分級Ⅲ、Ⅳ級居多(Ⅲ級1 561例次,Ⅳ級1 433例次,x2=75.828,P＜0.01);預後以好轉為主(88.9%、88.3%、92.7%,x2=35.002,P＜0.01).硝痠酯類、β受體阻滯劑、血管緊張素受體拮抗劑、醛固酮拮抗劑的應用逐年代增多(均P＜0.05);洋地黃類應用則逐漸減少(均P＜0.05).血管緊張素轉換酶抑製劑和β受體阻滯劑主要用于冠心病,分彆為81.3%(1 698/2 088)和87.8%(768/875).結論 指南的髮佈對老年CHF患者的藥物治療產生瞭積極影響,老年CHF患者應及時應用對預後有積極意義的治療藥物.
목적 분석노년만성충혈성심력쇠갈(CHF)환자약물치료수지남발포발생변화적정황.방법 선택1990년1월지2007년7월학진차≥60세적CHF주원병례3 174례차,근거미국심장병학회/미국심장병협회(ACC/AHA)지남발포적시간안매6년일조분위3조,대환자적치료약물진행회고성분석.결과 입선병례점동기CHF주원병례적79.2%(3 174/4 010),기중남1 639례차,녀1 535례차;년령60～98세,평균(71.94±7.07)세.1990년지1 995년(A조)、1996년지2001년(B조)、2002년지2007년(C조)CHF환자적년령(세)축년증장(68.99±6.71、71.56±6.86、73.79±7.01,F=91.142,P＜0.01);전3위병인균위관심병(55.3%、64.5%、81.8%)、폐원성심장병(21.9%、19.3%、5.5%)、풍습성심장병(16.5%、10.3%、7.5%),3충병인간비교차이유통계학의의(x2=217.979,P＜0.01);입원시미국뉴약심장협회(NYHA)심공능분급Ⅲ、Ⅳ급거다(Ⅲ급1 561례차,Ⅳ급1 433례차,x2=75.828,P＜0.01);예후이호전위주(88.9%、88.3%、92.7%,x2=35.002,P＜0.01).초산지류、β수체조체제、혈관긴장소수체길항제、철고동길항제적응용축년대증다(균P＜0.05);양지황류응용칙축점감소(균P＜0.05).혈관긴장소전환매억제제화β수체조체제주요용우관심병,분별위81.3%(1 698/2 088)화87.8%(768/875).결론 지남적발포대노년CHF환자적약물치료산생료적겁영향,노년CHF환자응급시응용대예후유적겁의의적치료약물.
Objective To investigate the changes in drug treatment in elderly inpatients with chronic congestive heart failure (CHF) after the publication of the guideline. Methods Three thousands one hundred and seventy-four hospitalized patients over 60 years old with CHF admitted from January 1990 to July 2007 to Second Hospital of Tianjin Medical University were enrolled, and the patients were divided into three groups according to every 6 years by the time when guideline of the American College of Cardiology/American Heart Association (ACC/AHA) was published. The changes in drug treatment were analyzed retrospectively. Results The proportion of enrolled patients was 79.2% (3 174/4 010) of total number of CHF patients. The number of male patients was 1 639, and that of the female 1535. The ageranged 60 - 98 years old with the mean age (71.94±7.07) years old. Three groups were from 1990 to 1995(group A), from 1996 to 2001 (group B) and from 2002 to 2007 (group C) respectively. The patients' age (years old) of three groups increased year by year (mean age of each group was 68. 99±6. 71, 71.56± 6. 86,73. 79 ±7.01 respectively, F= 91. 142, P＜0. 01 ). The three major causes of heart failure were coronary heart disease (55.3%, 64. 5%, 81.8%), pulmonary heart disease (21.9%, 19.3%,5.5%) and rheumatic heart disease (16. 5%, 10. 3%, 7.5%). The difference among the three causes was statistically significant (x2= 217. 979, P＜0. 01). Cardiac function on admission was mostly New York Heart Association (NYHA)grade Ⅲ or Ⅳ (1 561 cases of NYHA Ⅲ , 1 433 cases of NYHA Ⅳ , x2=75. 828, P＜0. 01). The outcome was mostly improved (the proportion of three groups was 88.9%, 88.3%, 92.7%, respectively,x2=35.002, P＜0.01). The frequency of using nitrate esters, β-blocker, angiotensin receptor blocker (ARB), aldosterone antagonist was increased year by year (all P＜0. 05). The use of digitalis was decreased gradually (both P＜0. 05). The angiotensin converting enzyme inhibitor (ACEI) and β-blocker were mostly used in coronary heart disease, and their frequency was 81.3% (1 698/2 088) and 87.8% (768/875)respectively. Conclusion The guidelines made positive effects on the treatment of elderly inpatients with CHF. The treatment drugs that can improve the prognosis of CHF should be used in this group in time.
