肥厚型梗阻性心肌病的不合理用药分析

Inappropriate Drug Therapy for Hypertrophic Obstructive Cardiomyopathy

目的:分析肥厚型梗阻性心肌病(HOCM)患者的药物治疗现状,促进临床合理用药。方法:观察303例门诊及住院HOCM患者β受体阻滞剂、钙通道阻滞剂(CCB)、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体阻滞剂(ARB)、利尿剂、洋地黄类、硝酸酯类等药物的使用分布情况,并分析其不合理用药。结果:①β受体阻滞剂与钙通道阻滞剂使用状况:单用β受体阻滞剂者91例(30.0%),单用钙通道阻滞剂者33例(10.9%),β受体阻滞剂合用钙通道阻滞剂者166例(54.8%),β受体阻滞剂或钙通道阻滞剂均未使用者13例(4.3%)。在199例使用钙通道阻滞剂的患者中,苯烷胺类钙通道阻滞剂(维拉帕米)占54例(27.1%),地尔硫类钙通道阻滞剂(硫氮酮)占106例(53.3%),二氢吡啶类钙通道阻滞剂(如硝苯地平)占39例(19.6%)。②其他药物使用状况:血管紧张素转换酶抑制剂及血管紧张素Ⅱ受体阻滞剂125例(41.3%),利尿剂70例(23.1%),洋地黄类17例(5.6%),硝酸酯类64例(21.1%),乙胺碘肤酮15例(5.0%)。不合理使用血管紧张素转换酶抑制剂及血管紧张素Ⅱ受体阻滞剂、利尿剂、洋地黄类或硝酸酯类药物合计102例(33.7%)。结论:肥厚型梗阻性心肌病的药物治疗以β受体阻滞剂、钙通道阻滞剂为主,但仍存在不规范用药。

Objective： To investigate the medical treatment of hypertrophic obstructive cardiomyopathy （HOCM）. Methods： Three hundred and three patients of HOCM in Fu Wai hospital from January 1992 to December 2006 were studied. The prescriptions of adrenergic beta-antagonists, calcium channel blockers, angiotensin-converting enzyme inhibitors （ ACE inhibitors）/angiotensin Ⅱ receptor blockers （ARB） , diuretics, digoxin, nitrates were collected and evaluated. Results：①Ninety-one（30.0% ） patients were given single adrenergic beta-antagonists, 33 （10. 9% ） patients were given single calcium channel blockers,and 166 （54.8%） patients were given adrenergic beta-antagonists combined with calcium channel blockers. The other 13 （4. 3% ） were given neither adrenergic beta-antagonists nor calcium channel blockers. In 199 patients who received calcium channel blockers, 54 （27.1%） patients were given verapamil, 106 （53.3%） were given diltiazem, 39 （ 19.6% ） were given dihydropyridines. ②One hundred and twenty-five （41.3%） patients were given ACE inhibitors/ARB, 70 （23. 1% ） patients were given diuretics, 17 （5.6%） patients were given digoxin, 64 （21.1%） patients were given nitrates, 15 （5.0%） patients were given amiodarone. One hundred and two （33.7%） patients were inappropriately treated with ACE inhibitors/ARB diuretics, digoxin, or nitrates. Conclusion： The most popular agents of HOCM were still adrenergic beta-antagonists and calcium channel blockers, but sometimes ACE inhibitors/ARB, diuretics, digoxin or nitrates, were inappropriately prescribed.