老年慢性心力衰竭临床特点及药物治疗分析

目的 研究老年慢性心力衰竭临床特点、各种口服药物的应用情况及与《慢性心力衰竭诊断和治疗指南》（以下简称“指南”）的符合情况.方法 回顾分析2008年1月～2012年12月于沈阳军区总医院住院的3909例慢性心力衰竭患者的临床特点、口服药物包括利尿剂、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂（ACEI/ARB）、β-受体阻滞剂、硝酸酯类药物、洋地黄类药物、醛固酮受体拮抗剂]及静脉药物（包括硝酸酯类、硝普钠、冻干重组脑钠肽、利尿剂、营养心肌药物、西地兰）的应用情况.结果 慢性心力衰竭患者病因仍以冠心病为首,共2408例,占61.6％;住院患者以Ⅲ级、Ⅳ级心衰为主,Ⅲ级1673例（42.8％）,Ⅳ级1165例（29.8％）;临床心衰阶段（C期）3227例（82.5％）,难治性终末心衰阶段（D期）682例（17.5％）;在口服药物的使用方面,利尿剂、ACEI/ARB、β-受体阻滞剂使用较前逐渐上升,醛固酮受体拮抗剂的使用于2010年,2011年有所下降,2012年再次上升,可见对于慢性心衰的治疗与指南的符合情况以利尿剂为最好,其次是醛固酮受体拮抗剂,β-受体阻滞剂及ACEI/ARB的应用仍不理想.洋地黄类药物及硝酸酯类药物应用仍不可缺少.静脉用药均应用于Ⅲ级及Ⅳ级心功能不全,利尿剂、硝酸酯制剂、营养心肌药物应用率相似,硝普钠、洋地黄制剂应用率逐年下降,冻干重组脑钠肽应用逐年上升.结论 对于慢性心力衰竭的治疗目前与指南逐渐符合,但仍有一定差距,脑钠肽作为新的改善心功能不全药物日益受到重视,但因条件限制还不能普遍应用,对于慢性心功能不全的治疗还需要继续规范化,加强医师培训及患者的教育.

Analysis of clinical characteristic and drug therapy in elderly chronic heart failure patients

Objective To explore the clinical characters and the circumstance of drug＇s application in elderly chronic heart failure patients.Methods From January 2008 to December 2012 in the General Hospital of Shenyang Region,3909 elderly heart failure patients,the clinical characters,the oral drugs （diuretics,ACEI/ARB,β-blocker,nitrates,digitalis and aldosterone receptor antagonist） and intravenous drugs （nitrates,sodium nitroprusside,diuretics,cedilanid injection,lyophilized recombinant human brain natriuretic peptide booster injection,myocardial nutrition medicine） of the patients were collected and analyzed.Results Coronary heart disease was still the first cause of chronic heart failure.NYHA grade Ⅲ and NYHA grade Ⅳ patients were the major.NYHA grade Ⅲ were 1673 （42.8％）,NYHA grade Ⅳ were 1165 （29.8％）; clinical cardiac heart phase （C stage） were 3227 （82.5％）,refractory terminal heart failure phase （D stage） were 682 （17.5％）.The usage rates of diuretics,ACEI/ARB,and β-blocker showed that they rose than the year before,the usage rates of aldosterone receptor antagonist showed that they declined in 2011,but rose in 2012.The application was conform to guidelines gradually,diuretices was the best,the aldosterone receptor antagonist was the next,ACEI/ARB and β-blocker were not good.Nitrates and digitalis was still indispensable.Intravenous drugs were used for patients at grade Ⅲ and grade Ⅳ.The usage rates of diuretics,nitrates,and myocardial nutrition medicine were the similar,the usage rates of sodium nitroprusside and cedilanid injection were declined gradually,the usage rates of lyophilized recombinant human brain natriuretic peptide booster injection were increased gradually.Conclusion The treatment in elderly chronic heart failure conforms to guidelines gradually,but there is still gap between the reality and guideline,the application of lyophilized recombinant human brain natriuretic peptide is limited by the condition.It need more standardized in the treatment of elderly heart failure patients,and more train for doctor and more education for patients.