老龄慢性心力衰竭患者的临床特点和治疗原则

Clinical features and management principles in aged patients with chronic heart failure

老龄慢性心力衰竭患者的比例越来越高,而且与非老龄患者比较,基础心脏病的结构发生了改变,女性患者所占比例上升,收缩功能保存的心力衰竭患者比例较高,患者其他系统和器官也存在老化现象,合并症也增加。目前专门针对老年心力衰竭患者的大规模随机对照研究不多,在临床治疗上对老龄患者,需要在遵循指南基本原则的同时,根据患者身体的综合状况,制订个体化治疗方案。本文就药物治疗,包括血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂、β受体阻滞剂、醛固酮受体拮抗剂、非保钾利尿剂、洋地黄;非药物治疗,包括心脏再同步化治疗和置入式心律转复除颤器、运动训练;收缩功能尚存和有合并症的老龄心力衰竭患者的处理等方面的特殊性予以阐述,为临床医生提供参考,更好地为老龄慢性心力衰竭患者服务,提高生活质量、延长生存时间和减少临床终点事件。

Aged patients with chronic heart failure are increasing. They have their own characteristics comparing with young patients. They have different spectrum of underlying heart diseases. Percentages of woman, heart failure with preserved systolic function （HFPSF） and with complications are more than young patients. Aged patients usually have deterioration of main organs. So we need to make an individualized principle of treatment for each aged patient in order to increase their life quality, decrease events and prolong their life span. In this paper, it will be reviewed in the following respects, choice of medicine, including angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker, bata blocker, aldosterone antagonist, diuretics, digitalis; choice of non-drug therapy, including cardiac resynchronization therapy, implantable cardiac defibrillator, and exercise recipe. And we also need to pay much attention to aged patient of chronic heart failure with complications and preserved systolic function.