CAJ | 학술논문

目的了解老年心衰患者药物干预的实际情况,为临床规范化治疗提供资料和依据.方法入选天津医科大学第二医院1973年7月至2007年7月、天津市第一中心医院1983年1月至2002年12月年龄60～98岁的心力衰竭住院患者,回顾性调查年龄、性别、病因、心功能、药用等,根据年代分为1973～1979、1980～1989、1990～1999、2000～2007年共4组,建立数据库并应用SPSS13.0软件分析.结果入选4704例次,占同期成人心力衰竭患者(6602例次)的71.3%,男2430例次(51.7%),女2274例次(48.3%),平均年龄(71.3±7.1)岁,80～98岁的患者占12.8%(4704/6602).1973～1979、1980～1989年组前3位病因分别为肺心病、冠心病和风湿性心脏病(风心病),1990～1999、2000～2007年组的前3位病因则分别为冠心病、肺心病和风心病.心力衰竭治疗药物在4组的应用差异有统计学意义(均P<0.05),血管紧张素转换酶抑制(ACEI)+β受体阻滞剂2种药物合用、ACEI+β受体阻滞剂+醛固酮拮抗剂3药物合用也呈逐年代增加.各种药物及联合应用最多的病因分别为冠心病、风心病、肺心病及扩张型心肌病.随心功能级别的增加,利尿剂、洋地黄制剂、醛固酮拮抗剂、ACEI+β受体阻滞剂+醛固酮拮抗剂3药合用、利尿剂+洋地黄制剂+ACEI+β受体阻滞剂4药合用的应用比例增加;β受体阻滞剂以心功能美国纽约心脏病协会(NYHA)心功能分级Ⅱ级和Ⅲ级的患者应用多;ACEI在NYHA心功能分级Ⅲ级的患者应用多;血管紧张素Ⅱ受体拮抗剂(ARB)以NYHAⅢ级和Ⅳ级患者居多.结论天津市部分医院老年心力衰竭住院患者的治疗药物以利尿剂、硝酸酯制剂和洋地黄制剂等为主;ACEI、β受体阻滞剂、ARB、醛固酮拮抗剂等药物的应用逐年代增加迅速.
목적 료해노년심쇠환자약물간예적실제정황,위림상규범화치료제공자료화의거.방법 입선천진의과대학제이의원1973년7월지2007년7월、천진시제일중심의원1983년1월지2002년12월년령60～98세적심력쇠갈주원환자,회고성조사년령、성별、병인、심공능、약용등,근거년대분위1973～1979、1980～1989、1990～1999、2000～2007년공4조,건립수거고병응용SPSS13.0연건분석.결과 입선4704례차,점동기성인심력쇠갈환자(6602례차)적71.3%,남2430례차(51.7%),녀2274례차(48.3%),평균년령(71.3±7.1)세,80～98세적환자점12.8%(4704/6602).1973～1979、1980～1989년조전3위병인분별위폐심병、관심병화풍습성심장병(풍심병),1990～1999、2000～2007년조적전3위병인칙분별위관심병、폐심병화풍심병.심력쇠갈치료약물재4조적응용차이유통계학의의(균P<0.05),혈관긴장소전환매억제(ACEI)+β수체조체제2충약물합용、ACEI+β수체조체제+철고동길항제3약물합용야정축년대증가.각충약물급연합응용최다적병인분별위관심병、풍심병、폐심병급확장형심기병.수심공능급별적증가,이뇨제、양지황제제、철고동길항제、ACEI+β수체조체제+철고동길항제3약합용、이뇨제+양지황제제+ACEI+β수체조체제4약합용적응용비례증가;β수체조체제이심공능미국뉴약심장병협회(NYHA)심공능분급Ⅱ급화Ⅲ급적환자응용다;ACEI재NYHA심공능분급Ⅲ급적환자응용다;혈관긴장소Ⅱ수체길항제(ARB)이NYHAⅢ급화Ⅳ급환자거다.결론 천진시부분의원노년심력쇠갈주원환자적치료약물이이뇨제、초산지제제화양지황제제등위주;ACEI、β수체조체제、ARB、철고동길항제등약물적응용축년대증가신속.
Objective To understand the practical application of drug intervention in elderly patients with chronic heart failure (CHF) for providing evidences and data for a standard treatment. Methods The elderly CHF patients aged at least 60 years who were hospitalized from July 1973 toJuly 2007 in the Second Hospital of Tianjin Medical University and from January 1983 to December 2002 in Tianjin First Center Hospital were enrolled. The age, gender, etiology, heart function and drug therapy were retrospectively analyzed. The patients were divided into 4 groups: group 1973-,group 1980-, group 1990- and group 2000-2007. And the data were collected and analyzed by SPSS 13.0 software. Results A total of 4704 cases were enrolled, of which there were 2430 (51.7%)male and 2274 (48. 3%) female. Mean age was (71.3±-7. 1) years. The patients aged 80 years andover accounted for 12.8% (603/4704). The first three ranking causes were pulmonary heart disease,coronary heart disease and rheumatoid heart disease in group 1973- and 1980-. And those were coronary heart disease, pulmonary heart disease and rheumatoid heart disease in group 1990 and 2000-2007. The combined uses of angiotension converting enzyme inhibitors(ACEI) and β-receptor blocker,and of ACEI, β-receptor blocker and aldosterone antagonist were also increasing year by year. Patients with coronary heart disease, rheumatoid heart disease, pulmonary heart disease and dilated cardiomyopathy had a higher proportion of multiple drugs cotreatment. The differences in the frequency of all drugs use among four groups of CHF had a statistical significance (p＜0.05). The usage of ACEI combined with β-receptor blocker and aldosterone antagonist, and ACEI combined withβ-receptor blocker, diuretic and digitalis was increasing along with the heart function becoming serious. The patients with a heart function of New York Heart Association (NYHA) Ⅱ or Ⅲ class received more β-receptor blocker. And ACEI was used at most in patients with NYHA Ⅲ class. The angiotension Ⅱ receptor blockers(ARB) was used at most in NYHA Ⅲ or Ⅳ class. Conclusions Nitrate, diuretic and digitalis are the main therapeutic agents in hospitalized patients with CHF in some regions of Tianjin. ACEI, β-receptor blocker and ARB are used in a rapid increment. There are still some problems such as standardizing the heart failure treatment and prevention in the elderly.