不同年龄冠心病慢性心衰患者临床特征和出院医嘱用药分析

目的探讨不同年龄段冠状动脉粥样硬化性心脏病(简称冠心病)慢性心力衰竭患者的临床特征,并分析出院医嘱用药情况。方法选取海南省安宁医院2017年12月至2018年12月出院的冠心病慢性心力衰竭患者200例,回顾性分析其临床资料,比较药物应用与年龄、性别、纽约心脏病协会(NYHA)心功能分级、左室射血分数(LVEF)的关系。结果男性多于女性;60~74岁年龄段发病率较高;排名前3的合并症分别为高血压(64. 50%)、糖尿病(50. 50%)、心肌梗死(39. 00%);他汀类、硝酸酯类、阿司匹林、利尿剂、β受体阻滞剂、醛固酮拮抗剂(MRA)、中成药、地高辛使用率较高,血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB)使用率较低;利尿剂女性使用率高于男性(P <0. 05);阿司匹林在60~74岁年龄段的使用率较高,氯吡格雷、利尿剂、钙离子拮抗剂(CCB)、ARB在> 74岁年龄段使用率高于60~74岁及<60岁(P <0. 05);Ⅰ/Ⅱ级的阿司匹林、他汀类使用率高于Ⅲ/Ⅳ级,而氯吡格雷、地高辛、利尿剂、MRA使用率低于Ⅲ/Ⅳ级(P <0. 05);地高辛、MRA在LVEF减低组使用率高于正常组,而ARB及CCB在正常组使用率高于减低组(P <0. 05);单用药物在LVEF减低组中占比低于正常组(P <0. 05);3种合用药物在NYHA分级Ⅲ/Ⅳ级中占比高于Ⅰ/Ⅱ级(P <0. 05)。结论 60~74岁的冠心病慢性心力衰竭患者中阿司匹林使用率较高,> 74岁时氯吡格雷、利尿剂、CCB、ARB使用率较高。应规范他汀类、硝酸酯类、阿司匹林、利尿剂在不同年龄段患者的使用,对于使用率较低且与指南有差距的药物应根据患者疾病状况合理选用。

Clinical Characteristics of Patients with Coronary Heart Disease and Chronic Heart Failure at Different Ages and Analysis of Discharge Medication Prescribed by Doctors

Objective To investigate the clinical characteristics of patients with chronic heart failure( CHF) and coronary heart disease in different age groups,and to analyze the discharge medication prescribed by doctors. Methods A total of 200 patients with chronic heart failure and coronary heart disease who were discharged from Hainan Anning Hospital from December 2017 to December 2018 were selected. Their clinical characteristics were analyzed retrospectively. The relationship between drug use and age,sex,New York Heart Association( NYHA) classification of cardiac function,left ventricular ejection fraction( LVEF) was compared. Results There were more males than females in CHF patients,and the incidence of CHF patients aged 60 to 74 was higher. The top three complication was hypertension,diabetes mellitus and myocardial infarction,accounting for 64. 50%,50. 50% and 39. 00% respectively. Statins,nitrates,aspirin,diuretics,β-blockers,aldosterone antagonists( MRA),Chinese patent medicines and digoxin were used more frequently,while angiotensin converting enzyme inhibitor( ACEI) and angiotensin Ⅱ receptor antagonist( ARB) was used less frequently. The use rate of diuretics in women was higher than that in men( P < 0. 05). The usage rate of aspirin between 60 and 74 years old was higher than that of >74 years old and < 60 years old( P < 0. 05). The utilization rate of clopidogrel,diuretics,calcium antagonists( CCB) and ARB at the age of > 74 was higher than those at the age of 60-74 and < 60( P < 0. 05). The utilization rate of aspirin and statins in grade Ⅰ/Ⅱ was higher than that in grade Ⅲ/Ⅳ,while the utilization rate of clopidogrel,digoxin,diuretics and MRA was lower than those of grade Ⅲ/Ⅳ( P < 0. 05). The utilization rate of digoxin and MRA in the reduced group was higher than that in the normal group,while that of ARB and CCB in the normal group was higher than that in the reduced group( P < 0. 05). The proportion of single drug in the reduced LVEF group was lower than that in the normal group( P < 0. 05). The proportion of three drugs in NYHA grade Ⅲ/Ⅳwas higher than that in grade Ⅰ/Ⅱ( P < 0. 05). Conclusion Aspirin is more commonly used in patients aged 60-74 years with CHF and coronary heart disease,and clopidogrel,diuretics,CCB and ARB is more frequently used in patients aged over 74 years. Statins,nitrates,aspirin and diuretics should be used more regularly in patients of different age groups. Drugs that have low utilization rate and are different from the guidelines should be selected reasonably according to the patients’ disease condition.