954例肺心病心力衰竭住院病例回顾性分析

Retrospective Analysis of 954 Patients with Heart Failure of Pulmonary Heart Disease

目的:分析肺心病心力衰竭住院患者临床特点和治疗情况。方法:整理两所医院确诊的成人肺心病心力衰竭住院病例,按每10年建立数据库,对临床特点进行分析。结果:入选954例,占同期心力衰竭住院病例的24.73%(954/3858),此比例逐年代减少(P<0.01)。平均年龄(66.26±9.30)岁,呈老龄化趋势(P<0.01)。≥60岁占79.4%(757/954),而且其比例基本逐年代增加(P<0.01)。入院心功能以NYHAⅢ、Ⅳ级为主,占92.2%(880/954)。合并冠心病、房颤、高血压病和呼吸衰竭的比例逐年代增多(均P<0.01)。应用较多的药物有利尿剂(53.4%)、洋地黄制剂(37%)、硝酸酯制剂(58.2%)、α-受体阻滞剂(52.5%)、茶碱类(78.6%)、钙拮抗剂(23.4%)、β-受体兴奋剂(5.2%)、血管紧张素转换酶抑制剂(ACEI,10.8%)、β-受体阻滞剂(2.3%)。利尿剂、硝酸酯制剂、洋地黄制剂、ACEI的应用逐年代增加,β-受体兴奋剂逐年代减少,α-受体阻滞剂和茶碱类以20世纪80年代应用比例最少。总的住院病死率为13.9%(133/954),以20世纪70年代最低,其次是90年代,80年代最高。因肺性脑病、呼吸功能衰竭等所导致的死亡居多,占94.7%(126/133)。结论:高龄、合并冠心病和心功能较差可能成为肺心病心力衰竭的流行特点;肺心病心力衰竭治疗以利尿剂、硝酸酯制剂、洋地黄制剂、α-受体阻滞剂为主。

Objective： To investigate the clinical characteristics of pulmonary heart disease in patients with heart failure. Methods： All data were collected from the hospitalized chronic heart failure cases in the 2 hospitals, and the data were divided into 3 groups according to every 10 years. The clinical characteristic and therapy were analyzed. Results： Nine hundreds and fifty-four cases were enrolled. The mean age was （66.26 ± 9.30） years old. The inpatients＇ age became bigger in the past 3 decades （P 〈 0.01）. Percentage of 79.4 inpatients were older than or equal to 60 years old （757/954）, and the proportion increased decade by decade （P〈 0.01）. Cardiac functions on admission were mostly grade NYHA Ⅲ or Ⅳ, accounted for 92.2 %（880/954）. The proportion of coronary heart disease, atrial fibrillation, hypertension and respiratory failure increased decade by decade （P 〈 0.01）. The major medication included diuretics （53.4%）, digitalis （37%）, nitride （58.2%）, α-blockers （52.5%）, aminophylline （78.6%）, calcium antagonists （23.4%）, β-activators （5.2%）, angiotensin conversion enzyme inhibitors （ACEI,10.8%） and β-blockers （2.3%）. Moreover the medication-use frequency of diuretics, digitalis, nitride and ACEI essentially increased decade by decade. The administration frequency of β-activators decreased decade by decade. The administration frequency of aminophylline and α-blockers was the lowest in 1980s. The total mortality during hospitalization was 13.9% （133/954）and the lowest in 1970s, the next in 1990s and the highest in 1980s. The death cause dominatingly distributed on no cardiac reasons such as pulmonary encephalopathy and respiratory failure,94.7% （126/133）. Conclusion： Coexistences of ageing, coronary heart disease and the poor heart function were the most important characteristics of the pulmonary heart failure. The drugs such as diuretic, nitrates, digitalis and α-blockers still dominate the majority therapy for the pulmonary heart failure.