老年慢性心力衰竭住院患者2656例的回顾性分析

Retrospective analysis of etiology factors and drug treatment of 2656 inpatients aged 60 years and over with chronic heart failure

目的分析老年慢性心力衰竭(心衰)患者的病因和药物治疗的变化。方法选择1973年7月至2002年12月确诊的老年慢性心衰住院患者2656例,以每10年为一组分3组,对病因、临床特征和治疗药物情况进行回顾性分析。结果老年患者占同期慢性心衰住院总病例(3858例)的68．8％。男:女为1:1。入院时心功能以纽约心功能分级标准(NYHA)心功能Ⅲ和Ⅳ级居多(89．7％)。3组患者的病因均以冠心病、肺心病和风湿性心脏病为主。随时代变迁,首位病因由肺心病(3组的病因构成比分别为62．8％、41．5％和21．1％)演变为冠心病(分别为24．3％、35．8％和62．5％)。应用较多的药物依次是硝酸酯类(83．7％)、利尿剂(69．3％)、洋地黄类(59．6％)、血管紧张素转换酶抑制剂(ACEI,53．7％)和p_受体阻滞剂(18．4％)。ACEI和β-受体阻滞剂主要用于冠心病治疗(分别为75．2％和80．8％),且在冠心病患者治疗中有逐年增加的趋势,其次是风湿性心脏病和肺心病。肺心病应用ACEI和β-受体阻滞剂分别为11．6％和2．0％。结论老年慢性心衰住院患者首位病因从肺心病演变为冠心病;利尿剂、洋地黄制剂和硝酸酯类仍为主要治疗药物,但ACEI、β-受体阻滞剂的应用也逐年增加。

Objective To investigate the etiology factors and drug treatment of inpatients aged 60 years and over with chronic heart failure. Methods All data were taken from the hospitalized chronic heart failure cases from July 1973 to December 2002. The data were divided into 3 groups according to every 10 years. The etiology distribution, drug treatment and clinical characteristics were analyzed. Results Two thousand six hundred and fifty-six cases were enrolled and the proportion of the elderly cases to all heart failure cases was 68.8% （2656/3858）. The age range was 60-98 years old and the mean age was （70.5±6. 9） years old. The ratio of male to female was 1 ： 1. Cardiac functions on admission were mostly NYHAⅢ and Ⅳ, accounted for 89. 7%. The major causes were coronary heart disease, pulmonary heart disease and rheumatic heart disease in the 3 groups. The top cause of chronic heart failure had changed from pulmonary heart disease （the proportion of the 3 groups was 62.8%, 41.5% and 21.1%, respectively） to coronary heart disease （24.3%, 35.8% and 62.5%, respectively） . The major medication included nitrates （ 83.7%）, diuretics （ 69. 3%）, digitalis （59. 6%）, ACEI （53.7%）, and β-blockers（18.4%）. Moreover the use frequencies of the above medicine were essentially increased. The ACEI and β-bocker were mostly used in coronary heart disease, the proportions were 75.2% and 80.8%, respectively . And their use frequencies increased by decade. Especially, the use frequencies of ACEI and β-blockers in pulmonary heart disease were 11.6% and 2.0%. Conclusions The top cause of chronic heart failure of inpatients aged 60 years and over has shifted from pulmonary heart disease to coronary heart disease during the past 30 years. The conventional drugs still dominate the major therapy for the heart failure , but the uses of ACEI and β-blocker are increased significantly.