摘要
目的 了解我国 2 0年来慢性心力衰竭 (心衰 )住院患者在一般情况、病因、药物治疗、转归及死亡等流行病学演变 ,为今后我国心衰的预防和治疗策略提供资料。方法 先后对国内 4 2家医院 1980、1990、2 0 0 0年 3个全年段住院病历进行回顾性分析和比较。结果 (1)共 10 714例心衰患者入选 ,占住院心血管病患者的 16 3%～ 17 9% ,其中男性占 5 6 7% (男性多于女性 ,P <0 0 0 1) ;平均年龄为 (6 3 1± 16 1)岁～ (6 7 8± 16 5 )岁 ,>6 0岁以上患者超过 6 0 % ;1980、1990、2 0 0 0年心衰病程分别为 (12 8 9± 12 5 7)、(88 1± 98 6 )、(46 6± 77 4 )个月 ,P <0 0 0 1,住院时间分别为 (35 1± 4 3 0 )、(31 6± 34 1)、(2 1 8± 2 5 6 )d ,P <0 0 0 1,呈逐年缩短。 (2 )心衰病种主要是冠心病、风湿性心瓣膜病、高血压病 ;1980～ 2 0 0 0年冠心病从 36 8%增至 4 5 6 % ,高血压从 8 0 %升至 12 9% ,风心病由 34 4 %减至18 6 % (均为P <0 0 0 1)。 (3) 3个年段入院时心功能都以Ⅲ级最多 (42 5 %～ 4 3 7% ) ,Ⅱ级心功能的患者有逐年递增的趋势 (分别为 2 4 5 %、2 6 7%、2 7 7% ) ,相反Ⅳ级心功能的患者有逐年递减的趋势(32 4 %、2 8 8%、2 7 5 % )。 (4)
Objective To evaluate the current status of heart failure in some parts of China and analyze the epidemiological evolution of its general condition,etiology,pharmaceutical therapy, outcome and mortality,and provide information on the prevention and treatment strategy of heart failure in China Methods Data on primary diagnosis of chronic heart failure were taken from 42 hospitals in different cities of China All patients were admitted to hospital in 1980, 1990 and 2000 Results (1) A total of 10 714 patients with heart failure were enrolled The majority (56 7%) were males and the average age was( 63 1±16 1)years to (67 8±16 5)years More than 60% were older than 60 years (2)The courses of the heart failure in 1980,1990 and 2000 were (128 9±125 7)months,(88 1±98 6)months and (46 6±77 4)months ( P <0 001), respectively,and in hospital durations were (35 1±43 0) days,(31 6±34 1) days, (21 8±25 6) days( P <0 001), respectively,with the trend of decreasing year by year (3) Common causes of heart failure were coronary heart disease, rheumatic valvular heart disease and hypertension From 1980 to 2000,the rate of coronary heart disease and hypertension rose from 36 8% and 8 0% to 45 6% and 12 9%, respectively Meanwhile the rate of rheumatic valvular heart disease fell from 34 4% to 18 6%(all P < 0 001 ) (4)The most patients′ heart functions before hospitalization of all the three years were graded as level Ⅲ (42 5%-43 7%),and patients with heart function of level Ⅱ increased year by year(24 5%, 26 7%, 27 7%, respectively); by contrast the patients of level Ⅳ heart function reduced at the same time (32 4%, 28 8%, 27 5%) (5)There was no distinct difference of the rate of thoracic X ray examination and the abnormal heart thoracic ratio among the three years; but proportion of UCG examination and the patients with low LVEF increased year by year,being 27 6%, 40 5%, 47 5%( P <0 001)and 40 1%, 45 0%, 53 5%( P <0 001), respectively (6)The diuretics, nitride and digitalis still dominated the drug therapy in hospital, with the total proportion of 55 4%, 43 2%, 48 2%, respectively The proportion of patients receiving digitalis decreased (51 7%, 45 5%, 40 3%);and the users of β blocker and ACEI increased from 8 5% and 14 0% in 1980 to 19 0% and 40 4% in 2000, respectively (7)The heart failure were obviously corrected during hospitalization, the improvement rate being 15 5%, 19 6% and 22 2% ( P <0 001), respectively, with significantly decreased mortality of 15 4%, 12 3%, 6 2%( P <0 001),but still higher than that of whole cardiac diseases at the same period (8 2%, 5 6% and 2 6% in the three years, respectively) The proportion of heart failure mortality to the whole cardiac deaths still remained unchanged (39 9%,37 7%,41 1%, respectively) (8)The causes of the heart failure were pump failure(59%),arrhythmia (13%),sudden death (13%), and others (14%) in turn Conclusions There was no decrease in the proportion of heart failure to the whole cardiac diseases hospitalized patients The primary diseases causing heart failure in the hospitalized patients shifted from the rheumatic heart disease to the coronary heart disease, and the conventional drugs still dominate the medical therapy for the heart failure, but the use of β blocker and ACEI increased significantly Although the mortality of heart failure decreased, the proportion of it to cardiac diseases mortality kept unchanged
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2002年第8期450-454,共5页
Chinese Journal of Cardiology
关键词
慢性心力衰竭
流行病学
药物疗法
死亡率
中国
Heart failure, congestive
Epidemiology
Drug therapy,combination
Mortality
