不同地区慢性心力衰竭患者药物治疗的回顾性调查

目的 对天津和新疆喀什两个地区的慢性心力衰竭(心衰)住院病例进行回顾性调查,分析不同地区心衰干预药物的应用情况,以及实际应用与指南的差距,旨在为临床更好地治疗心力衰竭提供借鉴.方法 对2005年6月至2006年6月天津医科大学第二医院心脏科及喀什第二人民医院心内科出院第一诊断为慢性心力衰竭,且心功能NYHA分级为Ⅱ～Ⅳ级的病例采用回顾性方法,分析两地区心衰干预药物的应用情况.结果 入选749例,天津组491例,喀什组258例.天津组平均年龄(70.39±10.84)岁,高于喀什组平均年龄(62.91±12.54)岁(t=8.488,P＜0.01).天津组≥65岁的构成比(75.6%)高于喀什组(51.2%)(X2=45.642,P＜0.01).天津组男性264例(53.8%),喀什组男性134例(51.9%),2组间性别分布差异无统计学意义(P＞0.05).天津组患者的前3位病因为冠心病(84.9%)、风心病(5.9%)和扩心病(3.3%),而喀什组则为冠心病(63.2%)、肺心病(19.8%)和扩心病(6.6%).入院时心功能NYHA Ⅱ、Ⅲ、Ⅳ级所占比率:天津组分别为29.7%、39.1%和31.2%,喀什组分别为15.5%、39.5%和45.0%,2组分布差异有统计学意义(X2=22.770,P＜0.01).天津组患者硝酸酯类和β-受体阻滞剂的使用率高于喀什组(P均＜0.01),而利尿剂、洋地黄制剂和醛固酮拮抗剂的应用则以喀什组较多(P均＜0.01),两组患者ACEI的使用率差别无统计学意义.但是天津组患者的ACEI种类多,多数剂量达到"指南"要求的靶剂量,而喀什组患者用药较单一,且剂量偏小,与"指南"要求差距较大.天津组患者β-受体阻滞剂在男性和＜65岁组应用较多(P均＜0.05).喀什组患者利尿剂和醛固酮拮抗剂在＜65岁组应用较多;硝酸酯类、ACEI、β-受体阻滞剂、钙拮抗剂和醛固酮拮抗剂男性使用率高于女性(P均＜0.05).随心功能级别的增加,天津组和喀什组患者利尿剂、洋地黄制剂、醛固酮拮抗剂的应用比例均增加,且差异有统计学意义(P均＜0.05).随心功能级另q增加,天津组患者ACEI应用减少,差异达到统计学意义;而喀什组则未表现出心功能级别与ACEI应用之间存在关联.结论 天津与新疆喀什地区的慢性心衰治疗有所不同,前者与指南接近,而后者与指南存在一定差距,尤其在剂量的掌握方面存在很大的距离.

Retrospective analysis of drug treatment of in-patients with chronic heart failure in different regions

Objective To compare drug therapy in patients suffering from chronic heart failure between Tianjin and Kashi region of Xinjiang autonomous region and to analyse their disparities in drug uses by guideline between the two regions.Methods All data were retrospectively taken from the hospitalized chronic heart failure cases from June 2005 to June 2006 in the 2nd Hospital of Tianjin Medical University and the 2nd People's Hospital of Kashi in Xinjiang respectively.The heart functions level NYHA Ⅱ-Ⅳ were recorded for analysis of drug use in the two regions.Results 749 cases were enrolled,491 from Tinajin and 258 from Kashi of Xinjiang.The average age of group Tianjin(70.39±10.84)yrs]was older than that(62.91±12.54)yrs]of group Kashi(t=8.488,P＜0.01).The distribution of≥165 cases in the group Tianjin(75.6%)was higher than that of group Kashi(51.2%)(X2=45.642,P＜0.01).The male cases in group Tianjinwere 264(53.8%)andthatwere 134(51.9%)in group Kashi with no significant differences in sex distribution between the two groups(P＞0.05).The first three etiological diseases were coronary heart disease(84.9%),rheumatic heart disease(5.9%)and dilated cardiomyopathy (3.3%)in group Tianjin,and that were coronary heart disease(63.2%),pulmonary heart disease(19.8%)and dilated eardiomyopathy(6.6%)in group Kashi respectively.The proportions of level NYHA Ⅱ,Ⅲ,Ⅳ on admission were 29.7%,39.1%and 31.2%in group Tianjin respectively,and that were 15.5%,39.5%and 45.0%in group Kashi respectively,with significant difference in heart function levels between the two groups(X2=22.770,P＜0.01).Theusages of nitrides and β-blockers in group Tianjin were more than that in group Kashi(both P＜0.01).The usages of diuretics,digitalis was more in group Kashi(all P＜0.01).There was no difference in ACEI usages between the two groups.The dosages of drugs in group Tianjin achieved the target dosages by the guideline and the dosages in group Kashi did not achieve the targets.The use frequency of β-blockers was more in male cases and＜65yrs respectively of group Tianjin.The usage frequency of uretics and aldosterone antagonist were more in＜65yrs cases of group Kashi and the usages of nitrides,ACEI,B-blockers,calcium antagonists,aldosterone antagonist of male cases were more than that of female cases(all P＜0.05)in this group.The usages of uretics,digitalis,aldostemne antagonist increased following the grading of heart function of the two groups(P＜0.05).Moreover the usage of ACEI decreased following the worsen heart function in group Tainjin and this was not the same in group Kashi.Conclusion There are differences in drug medications for chronic heart failure between Tianjin and Kashi.The majority of treatment drugs in Tianjin is approaching the guideline and there is a gap from guideline in Kashi of Xinjiang,especially on the dosage.