80岁以上慢性心力衰竭患者临床特征和多重用药观察

Clinical characteristics and polypharmacy in patients with chronic heart failure over 80 years old

目的调查≥80岁以上高龄慢性心力衰竭(CHF)入院患者的临床特征及多重用药现状。方法收集340年龄≥80岁的CHF住院患者病例资料,记录一般人口资料、临床特征及出院带药种类和数量。结果 340例老年CHF住院患者中,男性160人(47.1%),女性180人(52.9%),年龄(80～97)岁,平均84.7±4.1岁;NYHAⅢ～Ⅳ居多,占73.0%;射血分数保留的心衰(HFpEF)所占比例较高为42.6%。CHF常见病因及合并疾病主要为冠心病(62.4%)、高血压(57.6%)、肺部感染(33.5%)、扩张性心肌病(30.0%)及房颤(26.8%)等;出现明显心影增大的患者仅为48.2%,其他辅助检查阳性表现更低。应用位于前五位的心血管药物依次为袢利尿剂(73.2%)、螺内酯(68.8%)、ACEI类(62.1%)、β受体阻滞剂(50.6%)、硝酸酯类(34.0%)及ARB类药物(34.0%);使用最多的非心血管药物中位于前五位的分别为通便剂(37.9%)、前列腺用药(30.3%)、质子泵抑制剂(28.2%)、苯二氮卓类(21.2%)及止痛药物(20.3%)。高龄心衰患者中多重用药较为严重,联合用药数目大于等于5种的占87.1%。结论 B≥80岁高龄心衰患者具有临床表现不典型、多重用药严重等临床特征,这对其功能状态产生深远影响。应对这一人群需进一步加强临床认识、规范诊疗行为。

Objective To investigate the clinical features and repeated drug use of patients with chronic heart failure(CHF) ≥ 80 years old. Methods 340 hospitalized patients with CHF age ≥ 80 years old were collected. The general population data, clinical data and the types and quantities of drugs discharged from hospital were recorded. Results Among 340 elderly patients with CHF, 160 were male(47.1%) and 180 were female(52.9%),aged 80-97 years, mean years were 84.7± 4.1 years old;Most patients were NYHA Ⅲ~Ⅳ,accounting for 73.0%;The proportion of retained heart failure ejection fraction(HFpEF) was 42.6%. Common causes and complications of CHF were coronary heart disease(62.4%), hypertension(57.6%), pulmonary infection(33.5%). dilated cardiomyopathy(30.0%) and atrial fibrillation(26.8%);The increase in the number of patients was only 48.2%, and the positive results of other auxiliary tests were lower. The top five cardiovascular drugs were loop diuretics(73.2%), spironolactone(68.8%), ACEI(62.1%), beta blockers(50.6%),nitrates(34.0%). And ARB drugs(34.0%);the top five most used non-cardiovascular drugs are laxatives(37.9%), prostatic drugs(30.3%), proton pump inhibitors(28.2%), benzene Nitrogen(21.2%) and analgesics(20.3%). In patients with advanced heart failure,multiple medications were more serious, and 87.1% of the combined medications were 5 or more. Conclusion Patients with ≥ 80 years old, who had heart failure, have clinical features such as atypical clinical manifestations and severe multiple medications, which have a profound impact on their functional status. To cope with this group of people, it is necessary to further strengthen clinical understanding and standardize the behavior of diagnosis and treatment.