指南对老年慢性充血性心力衰竭住院患者药物治疗的影响

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.

A study of the influence of the guideline on the treatment of chronic congestive heart failure in the elderly

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.