老年充血性心力衰竭住院患者不同年龄段病因、诱因和病死率调查

Etiology, predisposing cause and in-hospital mortality of congestive heart failure in elderly patients at different age group

目的回顾调查老年充血性心力衰竭住院病例,对比分析不同年龄段患者的病因、诱因和病死率,探讨防治对策。方法从住院病历数据库中检索出1993年1月至2004年12月出院和住院期间死亡的老年充血性心力衰竭病例4760例,以60～69岁,70～79岁和≥80岁分为3个年龄段,比较分析不同年龄段患者的临床特征。结果70～79岁和≥80岁年龄段与60～69岁年龄段相比,病因中冠心病随增龄增多(48.9%、51.6%比37.3%,P<0.001),风湿性心脏病和心肌病随增龄减少(分别为7.3%、2.1%比20.8%和4.3%、1.6%比8.7%,P<0.001),70～79岁年龄段肺心病比例最高;诱因中肺炎随增龄明显增多(17.3%、23.0%比13.8%,P<0.01与P<0.001);伴随疾病中高血压病、糖尿病随增龄增多(分别为51.9%、55.6%比41.7%和28.8%、28.0%比24.0%,P<0.05至P<0.001),心律失常无显著性差异(P>0.05);病死率随增龄显著增高(13.1%、14.7%比7.1%,P<0.001)。结论老年充血性心力衰竭住院患者的病因、诱因和伴随疾病构成比中,高血压病、冠心病、糖尿病和肺炎随增龄增多,风湿性心脏病、心肌病随增龄减少,心律失常无显著性变化,住院期病死率随增龄增高。

Objective To evaluate etiology, predisposing cause and outcome of elderly patients hospitalized for heart failure and to explore the strategy for prevention and treatment of congestive heart failure, Methods From January 1, 1993 to December 31, 2004, 4 760 elderly patients hospitalized for heart failure were included in Chinese PLA General Hospital. The patients were divided into three groups： younger （60-69 years old）, older （70-79 years old） and very old （≥80 years old） Results The proportion of patients with coronary heart disease or cor pulmonale increased with increasing age （37.3%, 48.9% and 51.6% or 6.8%, 11.3% and 8.6%, respectively, P〈 0.001）,but the rates of patients with rheumatic heart disease or cardiomyopathy decreased with increasing age （20.8%, 7.3% and 2. 1% or 8.7%, 4.3% and 1.6%, respectively, P〈0. 001） The morbidity rates of hypertension and diabetes also increased with increasing age （41.7%, 51.9% and 55.6% and 24.0%, 28.8% and 28.0%, respectively, P〈0.01）. The proportion of patients who had pneumonia increased with increasing age （13.8 %, 17.3 % and 23.0% ,respectively, P〈0. 001）, but the morbidity of arrhythmia was similar for the three groups. There was a higher in-hospital mortality rate with increasing age （7.1%, 13.1% and 14.7%, respectively, P〈 0. 001）. Conclusion The data of the elderly patients hospitalized for heart failure indicate that the proportion of patients with coronary heart disease, cor pulmonale, hypertension, diabetes and pneumonia increased with increasing age, but the rates of patients with rheumatic heart disease or cardiomyopathy decreased with increasing age. The incidence of inhospital mortality of elderly patients with heart failure increased with increasing age.