慢性心力衰竭住院病例药物治疗的回顾性调查

Retrospective analysis of drug treatment on inpatients with chronic heart failure

目的了解慢性心力衰竭（心衰）住院病例治疗药物在30年来的应用情况。方法采用两中心、回顾性研究。对药物治疗在年代、性别、年龄、心功能和病因等的分布进行分析。结果入选5189例次，男女比为1：1．02（P〉0．05）。平均年龄（62．93±13．49）岁。临床诊断依次是冠心病（44．2％）、风湿性心脏病（24．1％）、肺心病（19．0％）、扩张型心肌病（4．8％）等。入院时心功能以纽约心功能分级（NYHA）Ⅲ级、Ⅳ级为主，分别为40．6％和44．5％。治疗药物总体应用比例为硝酸酯类80．0％、利尿剂71．8％、洋地黄制剂68．1％、血管紧张紊转换酶抑制剂（ACEI）52．2％和β-受体阻滞剂19．5％，上述药物的应用逐年代增加。肺心病心衰病例的主要治疗药物也是硝酸酯类、利尿剂、洋地黄制剂。男性应用ACEI多于女性，≥60岁患者应用ACEI和血管紧张紊受体拮抗剂（ARB）的比例多于〈60岁年龄组，β-受体阻滞剂的应用则无性别和年龄差异。结论慢性心衰住院病例的治疗药物以利尿剂、硝酸酯制剂和洋地黄制剂等为主；ACEI和β-受体阻滞剂的应用增加迅速，虽未达到“指南”的要求，但显示了治疗观念的变化。

Objective To investigate drug treatment of inpatients with chronic heart failure（CHF） during the past 30 years in some areas and to provide more information on the treatment strategy of CHF. Methods In two centers a retrospective study was conducted. All data were taken from the hospitalized cases with chronic heart failure. The medication distributions in different decade, gender, age heart function grade and etiology were analyzed. Results 5189 cases were enrolled with the ratio of male to female as 1 ： 1.02. The mean age was （62.93 ± 13.49） years old. The general causes of chronic heart failure were as follows： coronary heart disease （ 44.2 % ）, rheumatic heart disease （ 24.1% ）, pulmonary heart disease （ 19.0 % ） and cardiomyopathy （4.8 % ）. The admission cardiac function was mostly seen as grade NYHA Ⅲ and Ⅳ, and their proportions were 40.6% and 44.5 %. Major medication would include nitride （80.0 % ）, diuretics （ 71.8 % ）, digitalis （ 68.1% ）, angiotensin conversion enzyme inhibitors （ ACEI ） （52.2 % ） and β-blockers （ 19.5 % ） etc. Moreover the frequency of above used medication was essentially increasing decade by decade. The major drug treatment of pulmonary heart disease also included diuretics, nitride, digitalis. ACEI was more commonly used in male than in female cases. The frequency of ACEI and ARB were more commonly used in the group ≥60 years old than that in the group 〈 60 years old. The administration frequency of β-blockers had no significant difference among different age and sexes. Conclusion The conventional drugs such as nitride,diuretics,digitalis were still dominated the treatment of CHF.Although the administration frequency of ACEI and β-blockers increased quickly, there had been a great gap between the optimal medical strategy and clinical practice in the management of CHF. Data showed the treatment strategy was changing.