CAJ | 학술논문

目的评价遵循指南对慢性心力衰竭(心衰)患者进行优化药物治疗的可行性和有效性,强调遵循指南治疗、改善心衰预后的重要意义.方法连续入组2001年1月至2009年6月间就诊的231例左室射血分数≤40%的门诊心衰患者,按指南推荐给予优化药物治疗,随访至2009年12月31日.计算该组人群的病死率及再住院率,评价治疗前后心脏结构及功能的改变.结果 (1)217例患者完成随访,中位随访时间为35(6～108)个月,血管紧张素转换酶抑制剂和B受体阻滞剂达到指南推荐靶剂量的比率分别为50.7%及37.3%.(2)该研究总病死率11.5%,年平均病死率3.9%;随访期间再住院率27.6%.(3)治疗后左室舒张末期内径显著减小(68.2 mm与62.2 mm,P＜0.01),恢复至正常及接近正常大小(男≤60 mm,女≤55 mm)者共为43.2%.治疗后左室射血分数显著提高(29.8%与43.3%,P＜0.01),＞40%者为60.4%,≤40%但较治疗前提高≥10%者为22.9%.结论遵循指南对心衰患者进行优化药物治疗可以显著改善心脏重构和心功能、降低病死率.
목적 평개준순지남대만성심력쇠갈(심쇠)환자진행우화약물치료적가행성화유효성,강조준순지남치료、개선심쇠예후적중요의의.방법 련속입조2001년1월지2009년6월간취진적231례좌실사혈분수≤40%적문진심쇠환자,안지남추천급여우화약물치료,수방지2009년12월31일.계산해조인군적병사솔급재주원솔,평개치료전후심장결구급공능적개변.결과 (1)217례환자완성수방,중위수방시간위35(6～108)개월,혈관긴장소전환매억제제화B수체조체제체도지남추천파제량적비솔분별위50.7%급37.3%.(2)해연구총병사솔11.5%,년평균병사솔3.9%;수방기간재주원솔27.6%.(3)치료후좌실서장말기내경현저감소(68.2 mm여62.2 mm,P＜0.01),회복지정상급접근정상대소(남≤60 mm,녀≤55 mm)자공위43.2%.치료후좌실사혈분수현저제고(29.8%여43.3%,P＜0.01),＞40%자위60.4%,≤40%단교치료전제고≥10%자위22.9%.결론 준순지남대심쇠환자진행우화약물치료가이현저개선심장중구화심공능、강저병사솔.
Objective To evaluate the effects of optimal pharmacotherapy according to guideline on treating chronic heart failure(CHF)in real world clinical practice. Methods A total of 231 consecutive outpatients with reduced left ventricular ejection fraction(LVEF≤40%)and enlarged left ventricular end diastolic diameter(male ＞55 mm, female ＞60 mm)were recruited from January 2001 to June 2009. All patients were treated with optimal pharmacotherapy according to guideline recommendations and followed up to December 31,2009. Mortality, rehospitalization and changes of heart size and cardiac function at baseline and at the end of follow-up period were analyzed. Results(1)14 patients were lost during follow-up (6. 1%), and follow-up was complete in 217 patients(93.9%). 97.2% and 98.2% patients were prescribed angiotensin converting enzyme(ACE)inhibitors and β-blockers(βB). Combined of ACE inhibitors and BB use was applied in 95.3% patients. The target dose of ACE inhibitors and βB were reached in 50. 7% and 37.3% patients.(2)Lower mortality and re-hospitalization rates were observed in this cohort: all-cause morality, average annual mortality was 11.5% and 3.9% respectively. Rehospitalization rate was 27.6%.(3)Left ventricular end-diastolic diameter(LVEDD)decreased from (68.2 ±7.2)mm to(62. 2 ±9. 6)mm. LVEDD value was normal or near normal(male≤60 mm, female ≤55 mm)in 43.2% patients. LVEF improved form(29. 8 ±7. 5)% to(43. 3 ± 11.8)%, LVEF was ＞40% in 60.4% patients, LVEF was ≤ 40% but increased ≥ 10% after treatment in 22.9%patients. Conclusion Optimal pharmacotherapy according to guideline can improve prognosis of outpatients with CHF.