神经内分泌抑制剂在慢性射血分数降低的心力衰竭患者中应用现状调查分析

目的 调查安徽省妇幼保健院慢性射血分数降低的心力衰竭（heart failure with reduced ejection fraction，HFrEF）患者神经内分泌抑制剂——血管紧张素转换酶抑制剂（angiotensin converting enzyme inhibitor，ACEI）或血管紧张素Ⅱ受体阻滞剂（angiotensin Ⅱ receptor blocker，ARB）、b受体阻滞剂（b-blocker，BB）和醛固酮受体拮抗剂（mineralocorticoid receptor antagonist，MRA）使用现状及其与指南的差距。方法 搜集并分析2018年1月—12月慢性HFrEF住院患者基本资料和3类神经内分泌抑制剂使用情况。结果 纳入研究的301例慢性HFrEF患者中，ACEI/ARB、BB和MRA使用率分别为77.4%，60.5%和94.0%，剂量达标率分别为44.2%，22.5%和100%。48.8%患者采用指南推荐的联合用药，包括1.3%两药联合（ACEI/ARB+BB）和47.5%三药联合（ACEI/ARB+BB+MRA）。结论 笔者所在医院慢性HFrEF患者神经内分泌抑制剂应用现状与指南仍有差异，ACEI/ARB和BB的使用率、剂量达标率和两药联合用药率均不足，而MRA使用过度，需进一步提高医师对指南的依从性。

Investigation and Analysis on Current Status of Neuroendocrine Inhibitors in Patients with Chronic Heart Failure with Reduced Ejection Fraction

OBJECTIVE To investigate the use of neuroendocrine inhibitors‒‒angiotensin converting enzyme inhibitor (ACEI) or angiotensin Ⅱ receptor blocker(ARB), b-blocker(BB) and mineralocorticoid receptor antagonist(MRA) in patients with chronic heart failure with reduced ejection fraction(HFrEF) in Anhui Women and Child Health Care Hospital and the gap between the use and the guideline. METHODS Basic data of chronic HFrEF inpatients and the use of 3 types of neuroendocrine inhibitors were collected and analyzed from January to December 2018. RESULTS Among the 301 patients with chronic HFrEF included in this study, the usage rates of ACEI/ARB, BB and MRA were 77.4%, 60.5% and 94.0%, respectively. The rates of reaching standard dose were 44.2%, 22.5% and 100%, respectively. The 48.8% of patients received the recommended combination of drugs, including 1.3% of two-drug combination(ACEI/ARB+BB) and 47.5% of three-drug combination(ACEI/ARB+BB+MRA). CONCLUSION There is still a certain gap between clinical practice and guideline in the usage of three neuroendocrine inhibitors in patients with chronic HFrEF in author’s hospital. The usage rate, the rates of reaching standard dose and the rate of combined use of ACEI/ARB and BB are insufficient, while MRA is overused, which requires further improvement of physician’s adherence to guideline.