急诊抢救室心力衰竭患者病因分析及治疗现状

Etiologies and treatment of heart failure in Emergency Department

目的:了解江苏省人民医院急诊抢救室心力衰竭患者病因分布特点及治疗现状。方法:回顾性分析江苏省人民医院急诊抢救室2011-2013年收治的心力衰竭患者,对其病因分布及治疗现状进行统计学分析。结果:共有1 190例心力衰竭患者入选,占同期所有病例的11.20%,其中男性768(76.54%)例,女性422(35.46%)例。常见病因主要有:高血压(27.23%)、冠心病(25.38%)、肺心病(18.74%)、尿毒症(9.66%)、老年性心瓣膜病(6.64%)等。不同病因年龄分布有差异,以高血压、冠心病、肺心病和老年性瓣膜病为病因的患者呈老年化,以心肌病、心包积液、风心病和先心病为病因的患者呈年轻化(P<0.01)。除风心病所致心力衰竭外,其余所有不同病因心衰患者,男性的患病率平均是女性的1.82倍,其中心肌病、冠心病和尿毒症所致心力衰竭患者中男性分别是女性的4.14、3.72、2.19倍。急诊抢救室心力衰竭的治疗以利尿、扩血管、强心、醛固酮受体拮抗剂为主,主要措施有血液透析脱水、呼吸机辅助通气等。结论:江苏省人民医院急诊抢救室心力衰竭患者所占比例较高,男性发病率高,主要病因是高血压、冠心病和肺心病等,不同病因年龄分布有差异。治疗除常规药物治疗,还应根据病情需要,使用呼吸机辅助正压通气和血液净化脱水等非药物治疗途径。

Objective：To investigate the etiological factors and treatment of heart failure in Emergency Department of Jiangsu Provincial Hospital.Method：The heart failure patients in Emergency Department of Jiangsu Provincial Hospital from 2011 to 2013were included,the clinical data about etiological distribution and condition of therapy was analyzed.Result：A total of 1 190 patients diagnosed with heart failure enrolled,making up 11.20%of all cases,768（76.54%）were male and 422（35.46%）were female.The etiologies included hypertension（27.23%）,coronary heart disease（25.38%）,pulmonary heart disease（18.74%）,uremia（9.66%）,senile valvular disease（6.64%）,cardiomyopathy（6.05%）,pericardial effusion（3.02%）,and rheumatic heart disease（2.69%）.Patients with hypertension,coronary heart disease,pulmonary heart disease and senile valvular disease showed a trend of aging,whereas patients with cardiomyopathy,pericardial effusion,rheumatic heart disease and congenital heart disease showed more in younger ones.The prevalence of male was larger than female other than rheumatic heart disease,and the average male incidence was 1.82 times as much as female,specifically,the male prevalence in cardiomyopathy,coronary heart disease and uremia was 4.14,3.72 and 2.19 times as much as female.Drug treatment included dieresis,vasodilator,cardiotonic and aldosterone receptor antagonist,hemodialysis and mechanical ventilation were necessary for serious patients.Conclusion：Common causes of heart failure in Emergency department include hypertension,coronary heart disease and pulmonary heart disease,et al.Age distribution is different among different causes.Heart failure accounts for larger in emergency department and male prevalence is even higher.In addition to regular drug therapy,hemodialysis and mechanical ventilation are also important when necessary.