引入循证医学理念治疗老年心力衰竭患者的临床效果

Analysis of therapeutic effect of evidence-based medicine and its influence factors on 86 very old patients with chronic heart failure

目的分析老年慢性心力衰竭(CHF)患者的个性化治疗效果及其影响因素。方法选年龄在80岁以上的CHF患者86例,同时选65～79岁老年CHF患者作为对照。在对病因、诱因治疗的基础上,实践循证医学的标准治疗,分析个性化治疗效果及影响因素。结果高龄组和老年组治疗显效率分别为40.7%(35例)和65.9%(60例),差异有统计学意义(P=0.005)。两组总有效率分别为88.4%和95.6%,住院死亡率分别为5.8%和1.1%,差异无统计学意义;Logistic回归分析显示:老年CHF患者的疗效与年龄(P=0.047)、入院时心功能(P=0.000)、是否合并高血压(P=0.007)、心律失常(P=0.046)密切相关。结论年龄越大、入院时心功能越差,老年CHF的治疗效果就越差;老年CHF患者合并高血压、心律失常也是影响疗效的主要因素。

Objective To analyse the therapeutic effect of evidence-based medicine （EBM） and its influence factors on the very old patients with chronic heart failure （CHF）. Methods Patients aged over 80 were very old group, aged 65-79 were senile group, on the basis of the therapy of etiology and inducement, the standard of EBM ther- apy was used. To analyse the therapeutic effect of evidence-based medicine （EBM） and its influence factors. Results There were significant difference on effective rate between senile group and very old group （ P = 0. 005 ）, which were 40.7% and 65.9% ,respectively. There were difference in efficiency （88.4% ,95.6% ） and inpatient mortality （5.8% ,1.1% ） between two groups. Logistic regression revealed therapeutic effect of aged CHF patients was posi- tively associated with age （P = 0. 047 ）, heart function at admission （P = 0.000）, hypertension （P = 0.007 ） and ar- rhythmia （ P = 0. 046）. Conclusion Therapeutic effect significantly decline with age growth in elderly CHF patients. The older the patients and the lower heart function at admission, the worst therapeutic effect on aged CHF patients. Hypertension and arrhythmia were also important factors affecting therapy on CHF patients.