利尿剂对慢性心力衰竭住院患者预后影响的回顾性分析

A Retrospective Analysis of the Effect of Diuretic on Clinical Outcomes in Patients with Chronic Heart Failure

目的:分析不同种类利尿剂对慢性心力衰竭住院患者病死率的影响。方法:采用回顾性病例研究方法,整理天津医科大学第二医院心脏科1980年1月—2007年8月住院的心功能NYHAⅢ、Ⅳ级慢性心力衰竭患者1860例,按照利尿剂使用与否及是否合用醛固酮拮抗剂分为未用利尿剂组(A组)、合用保钾利尿剂组(非保钾利尿剂与醛固酮拮抗剂合用,B组)及非保钾利尿剂组(C组)。结果:C组与B组患者比较,各项临床特征及治疗药物基本相似。B组、C组与A组患者相比入院血钠水平偏低,血尿素氮、肌酐水平更高,心功能NYHA分级较差,提示病情较重。β-受体阻滞剂在C组应用率最低,洋地黄制剂在B组、C组的使用率明显高于A组(均P<0.05),其他药物3组间差异无统计学意义。C组患者住院病死率明显高于A组、B组,分别为15.1%、5.8%、6.9%(均P<0.01),B组患者病情虽然比A组严重,但2组病死率差异无统计学意义。结论:在非保钾利尿剂治疗基础上合用保钾利尿剂即醛固酮拮抗剂可以明显降低慢性心力衰竭患者住院病死率。

Objective： To investigate the relationship between different diuretics and in-hospital mortality in patients with chronic heart failure （CHF）. Methods： This study is a respective view of single center cases. The study population consisted of 1 860 patients with CHF （NYHA class m and Ⅳ） came from the department of cardiovascular medicine in second hospital of Tianjin Medical University, from Jan 1980 to Aug 2007. The patients were divided into three groups on the basis of diuretic only and diuretic with potassium-sparing diuretic （PSD）, group A, no diuretic use; group B, both types of diuretic （PSD and non-PSD）; group C, non-PSD. Results： The clinical features and medical treatment were similar between group C and group B. It was found that lower serum sodium level, higher serum blood urea nitrogen and creatinine levels and a low ejection fraction in group B and C compared with those of group A. The β-blocker use was lowest in group C compared with other two groups. The use of digitalis was higher in group C and B than that in group A（P 〈 0.05 ）. There were no statistically differences in other drugs among three groups. Compared with group A and B, in-hospital mortality was increased in group C （15.1%, 6.9% and 5.8%, P 〈 0.01）. Although the patients in group B seemed more severe than group A, there were no statistically differences in mortality between these two groups. Conclusion： The in-hospital mortality in patients taking non-PSD was increased significantly than those in other two groups, which imply that taking PSD with non-PSD may decrease in-hospital mortality in patients with CHF.