热带地区老年慢性心力衰竭259例回顾性分析

Clinical analysis of 259 senile heart failure inpatients in tropical zone

目的分析老年慢性心力衰竭(心衰)患者的病因、死亡原因和药物治疗情况。方法选择热带地区1995年1月1日～2004年12月31日确诊的老年慢性心衰住院患者259例,对病因、临床特征、死亡原因和治疗药物情况进行分析。结果老年患者占同期慢性心衰住院总病例(372例)的69.6%。男:女为1.67:1。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56.6+28.5=85.1%。病因以冠心病、高血压性心脏病(高心病)、风湿性心脏病(风心病)和肺心病为主,首位病因为冠心病(63.7%),第二位病因为高心病(17.4%),以下分别是风心病(8.5%)、肺心病(6.2%)。死亡原因主要为泵衰竭(52.6%)。应用较多的药物依次是硝酸酯类(86.5%)、利尿剂(71.4%)、洋地黄类(56.8%)、血管紧张素转换酶抑制剂(ACEI,45.2%),醛固酮拮抗剂螺内酯(20.8%)和β-受体阻滞剂(15.4%)。ACEI和β-受体阻滞剂主要用于冠心病治疗(分别为75.2%和80.0%)。结论老年慢性心衰住院患者首位病因为冠心病,利尿剂、洋地黄制剂和硝酸酯类仍为主要治疗药物,但ACEI、β-受体阻滞剂在基层医院应用仍不普遍。

Objective To investigate the etiology and results of clinical treatment of senile patients with chronic heart failure. Methods All the data were obtained from 259 senile inpatients with chronic heart failure that were diagnosed from Jan 11, 1995 to Dec 31, 2004. The etiology, cause of death, drugs used and clinical characteristics were analyzed. Results The senile patients with CHF was accounted for 69.6% of the total inpatients with CHF （372 cases） in this period. The ratios of male to female was 1. 67 ： 1. Most of their cardiac functions on admission were classified as NYHA Ⅲ and Ⅳ, accounted for 85.1% of the total cases. Coronary heart disease, hypertensive heart disease, rheumatic heart disease and pulmonary heart disease were the common etiologies, which accounted for 63.7%, 17.4% , 8.5% and 6.2% respectively. The most common cause of death was pump failure. The common treatment drugs used were nitrates （ 86.5 % ）, diuretics （ 71.4% ）, digitalis （ 56.8 % ）, ACEI （45.2%）, aldosterone receptor antagonist spironolactone （20.8%）and β- blockers （15.4%）. Most of ACEI and β- blockers （75.2% and 80.0% respectively） were used for treatment of coronary heart disease. Conclusion The top cause of hospitalization of senile patients with chronic heart failure is coronary heart disease. Diuretics, digitalis and nitrates are still the major drugs used, while ACEI and β - blockers are not aidely used in hospitals at grassroots level.