老年慢性心力衰竭患者临床特点分析

目的了解老年慢性心力衰竭(CHF)患者的心力衰竭病因、药物治疗及死亡原因构成情况。方法入选大连市中心医院2002年1月1日至2009年12月31日确诊的老年慢性心力衰竭住院患者518例,对入选患者病因、药物治疗及死亡方式情况进行统计分析。结果老年患者占同期慢性心力衰竭住院患者69.6%。男女比例为1.67:1。入院时(NYHA)心功能分级Ⅲ级(58.6%)和Ⅳ级(28.5%)患者居多。CHF病因构成由高至低依次为冠心病(63.7%),高心病(17.14%),风心病(8.5%)、扩心病(6.2%)。抗心衰药物使用率由高到低分别为:硝酸酯类(86.5%)、利尿剂(74.4%)、洋地黄类(58.6%)、血管紧张素转换酶抑制剂(45.2%),β受体阻滞剂(22.3%)和醛固酮受体拮抗剂螺内酯(20.8%)。死亡原因主要为泵衰竭(52.6%)。结论老年慢性心力衰竭住院患者首位病因为冠心病,硝酸酯类、利尿剂和洋地黄类仍为主要治疗药物,ACEI、β受体阻滞剂在基层医院应用仍不普遍。

Clinical characteristics of elderly patients with chronic heart failure

Objective To understand the etiology, drug therapies and death causes in elderly patients with chronic heart failure （CHF）. Methods The patients （n=518） diagnosed as CHF were chosen from the Center Hospital of Dalian City from Jan. 1, 2002 to Dec. 31, 2009. The status of etiology, drug therapies and manners of death was analyzed. Results Among all hospitalized patients with CHF, elderly patients accounted for 69.6%, and ratio of male patients to female ones was 1.67：1. The percentage of patients with grade III of NYHA was 58.6%and those with grade IV of NYHA was 28.5%. The causes of CHF were, in a descent order, coronary heart disease （63.7%）, hypertensive heart disease （17.14%）, rheumatic heart disease （8.5%） and dilated cardiomyopathy （6.2%）. The usage rate of anti-CHF drugs were, in a descent order, nitrates （86.5%）, diuretics （74.4%）, digitalis （58.6%）, ACEI （45.2%）,β-receptor blockers （22.3%） and aldosterone receptor antagonist spironolactone （20.8%）. The common cause of death was pump failure （52.6%）. Conclusion The first cause of CHF in hospitalized elderly patients is coronary heart disease, and the most common drugs are nitrates, diuretics and digitalis. The application of ACEI andβ-receptor blockers are not population in grass-roots hospitals.