167例老年人心力衰竭的循证治疗实践

The evidence-based medicine treatment for 167 elderly patients with congestive heart fialure

目的:探讨老年人充血性心力衰竭(CHF)的循证医学(EBM)标准化治疗。方法:167例确诊为CHF的住院患者,年龄60￣90岁,平均(74.38±6.84)岁,按照循证医学的基本原理,在病因、诱因和改善心衰症状的基础上,强调能改善预后的神经内分泌拮抗剂的应用。结果:本组167例CHF患者,显效96例(57.5%),有效62例(37.1%),总有效率94.6%,死亡9例(5.4%)。神经内分泌拮抗剂践行率分别为:ACEI类119例(71.3%),β受体阻滞剂69例(41.32%),醛固酮拮抗剂88例(52.7%);随访6￣36个月,平均(16.25±9.30)个月;107例(67.7%)再入院1￣5次,院外死亡6例。结论:按照EBM原理对老年CHF患者制定的个体化治疗方案,效果理想。在老年CHF患者中,神经内分泌拮抗剂践行率较低,可能是再住院次数多的原因之一。

Objective：To study the method of evidence-based medieine（EBM） in the treatment of elderly patients with congestive heart failure （CHF）. Methods：According to the basic principle of EBM,the neuroendocrine antagonist was used in 167 elderly congestive heart failure patients ranging in age from 60 to 90 years with an average age of 74.38±6.84 years. Results：The total effective rate was 94.6%（96 cases were remarkably effective,62 cases effective）and the death rate was 5.4%（4 cases died）.The practice rate of ACEI,β-blocker and aldosterone receptor antagonist was 71.3%（119 cases）,41.32%（69 cases） and 52.7%（88 cases） respectively. All patients were followed up for 6 to 36 months with an average 16.25±9.30 months. There were 107 cases returning to the hospital by 1～5 times and 5 cases died out of hospital. Conclusion：This study suggests that EBM is an effective method for the treatment of elderly patients with CHF by its short-term effective rate（94.6%）. The lower practice rate of neuroendocrine antagonist is the important reason of re-hospitalization of patients.