老年冠心病慢性心力衰竭住院患者回顾性分析

Retrospective Analysis on Elder Inpatients with Coronary Chronic Heart Failure

目的:调查分析≥60岁冠心病慢性心力衰竭患者的临床情况。方法:入选对象为近30年确诊的≥60岁的冠心病慢性心力衰竭住院患者1426例,按有无心肌梗死分为冠心病有心肌梗死(A)组和冠心病无心肌梗死(B)组进行分析。结果:入选患者占同期总的冠心病心力衰竭住院患者的82.6%(1426/1606)。年龄60～98岁,平均(71.95±6.97)岁。A组519例(36.4%),B组907例(63.6%),B组多于A组(χ2=105.571,P<0.01)。A组吸烟、糖尿病、心功能NYHA(Ⅲ+Ⅳ)级的比例高于B组。B组患心房颤动、高血压的比例高于A组。B组的好转率高于A组,A组的病死率高于B组。A组舒张末期左室内径(LVEDD)大于B组,B组以左室射血分数(LVEF)>0.45和E/A≤1的比例居多,而且各自的比例均高于A组。A组LVEF则以≤0.45的比例居多。A组应用利尿剂、洋地黄制剂、硝酸酯制剂、血管紧张素转换酶抑制剂、αβ-受体阻滞剂和多巴胺类药物的比例高于B组,B组应用钙拮抗剂比例高于A组。结论:老年冠心病住院患者以无心肌梗死型居多,但不论是何种类型,由于其总体临床情况复杂,都应给予足够重视。

Objective： To investigate the clinical characteristic of inpatients aged 60 years and over with coronary chronic heart failure. Methods： One thousand four hundred and twenty-six hospitalized cases with chronic heart failure equal to and older than 60 years were taken from two hospitals in Tianjin since being established till December 2002. The data were divided into 2 groups （group A and B） according to with or without myocardial infarction. Results： One thousand four hundred and twenty-six cases which was 82.6% of all the coronary heart failure cases during that time （1 426/1 606） were enrolled. The mean age was （71.95±6.97） years old with a range from 60 to 98. There were 519 （36.4%） cases in group A and 907 （63.6%） cases in group B. The cases of group B were more than that of group A （X^2=105.571, P 〈 0.01）. The cases with smoking, diabetes mellitus and heart function （Ⅲ ＋Ⅳ） in group A were more than those in group B. Cases with fibrillation and hypertension in group B were more than those in group A. The improvement rate of group B was higher than that of group A, and the mortality rate of group A was higher than that of group B. The left ventricle end-diastolic diameter （LVEDD）of group A were larger than that of group B. The proportion of left ventricle ejection fraction （LVEF）〉0.45 and E/A ≤ 1 in group B was more than that of group A irrespectively. The proportion of LVEF ≤0.45 was higher in group A. The medications of diuretics, digitalis, nitrides, angiotensin converting enzyme inhibitors （ACEIs） and otiS-blockers administered in group A were more than those in group B. The medication of calcium channel blockers in group B was more than that in group A. Conclusion： The most cases of all the coronary disease in elderly patients were cases without myocardial infarction. The clinical conditions were severe and complicated. The elderly patients should be regarded importantly without reference to any type of coronary heart disease.