优化药物治疗在老年心力衰竭患者中的应用分析

发布时间：2018-05-03 23:29

本文选题：心力衰竭 + 老年人　；参考：《郑州大学》2017年硕士论文

【摘要】：背景和目的:在全球人口老龄化的时代,心力衰竭普遍流行,其患病率随着年龄增长而增加。心衰已是发达国家、并逐渐成为发展中国家的沉重医疗负担。最近30年,一个毋庸置疑的事实是心血管疾病的治疗进展,特别是ST段抬高型心肌梗死(STEMI)和高血压的治疗进步,使罹患这些疾病的非老年患者存活进入老年期的数量增加,从而使老年心衰的人口数量进一步扩大。在此背景下,心血管疾病危险因素和合并症如2型糖尿病、肥胖、高脂血症和氧化应激也促进心衰、终末期心脏病和死亡的发生。当前的心衰管理指南都认为,心衰是各种结构性和功能性心脏疾病导致心室充盈和射血功能受损的结果。美国心脏病学学会基金会/美国心脏协会、欧洲心脏病学学会和中华医学会心血管病学分会发表的现行心衰管理指南均推荐综合性治疗。重要的是这些指南都是基于心血管疾病药物治疗的随机临床试验(RCT)数据,而这些试验的研究对象多数为非老年的男性患者。尽管年龄较大的人群中心血管疾病的患病人数多,但却缺乏专门针对老年人群射血分数降低的心衰(HF/REF)或射血分数保留的心衰(HF/PEF)治疗的RCT数据。虽然存在上述忧虑和RCT的局限性,各指南依然对非老年和老年心衰患者的药物治疗和非药物治疗提供了推荐。除了要小心与老化相关的事宜,其治疗没有显著差别。本研究评价分析优化药物治疗对老年心衰患者的疗效,为老年心衰优化药物治疗提供研究基础。研究对象和方法:选取2014年7月至2016年7月于我院进行诊治的老年慢性心力衰竭患者45例,进行优化心力衰竭药物治疗,在治疗前和达到药物目标剂量后第6个月时分别进行一次心脏超声检查测量左室射血分数记录数据,并使用明尼苏达心力衰竭生活质量量表(MinnesotaLiving with Heart Failure Questionnaire,MLHFQ)对患者临床疗效进行评价,进行统计学分析。结果:进行优化治疗前后45例老年心衰患者收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,SDP)、心率、纽约心脏病学会(New York Heart Academy,NYHA)分级、心脏超声指标左室舒张末内经(Left Ventricular End Diastolic diameter,LVEDd)均显著下降,心脏超声指标左室射血分数显著提高,MLHFQ综合得分、身体领域得分、情绪领域得分均显著降低,差异均具有统计学意义(P均0.05)。优化治疗治疗6个月后19(42.22%)例患者显效,20(44.44%)例患者有效,其余6(13.33%)例患者无效。亚组分析显示,不同年龄、性别和心力衰竭类型的老年慢性心衰患者的临床疗效差异均无统计学意义(P均0.05),而不同NYHA分级的老年慢性心衰患者的临床疗效差异有统计学意义(P0.05)。结论:老年心力衰竭优化药物治疗能够使老年心衰患者心功能显著提高,改善生活质量,具有应用价值。年龄、性别和心力衰竭类型不是影响老年心力衰竭临床疗效的影响因素,而NYHA分级是影响老年心力衰竭临床疗效的影响因素。
[Abstract]:Background and objective: heart failure is prevalent in an aging global population, and the prevalence rate increases with age. Heart failure has become a heavy medical burden in developed countries and gradually in developing countries. In the last 30 years, there is no doubt that advances in the treatment of cardiovascular diseases, especially St segment elevation myocardial infarction (STEMI) and hypertension, have led to an increase in the number of non-elderly patients with these diseases surviving into old age. As a result, the number of elderly heart failure population further expanded. In this context cardiovascular disease risk factors and complications such as type 2 diabetes obesity hyperlipidemia and oxidative stress also contribute to heart failure end-stage heart disease and death. Current guidelines for the management of heart failure suggest that heart failure is the result of ventricular filling and impaired ejection function due to various structural and functional heart diseases. The American Cardiology Society Foundation / American Heart Association, the European Cardiology Society and the Chinese Medical Association Cardiovascular Society all recommend comprehensive treatment for current heart failure management guidelines. Importantly, these guidelines are based on data from randomized clinical trials of cardiovascular drug therapy, mostly in non-elderly male patients. Although the number of cardiovascular diseases in the older population is high, there is a lack of RCT data for the treatment of HF / REF- or HF- / PEF- for elderly patients with reduced ejection fraction. Despite these concerns and the limitations of RCT, the guidelines provide recommendations for drug and non-drug therapy in non-elderly and elderly patients with heart failure. There is no significant difference in treatment except for matters related to aging. The purpose of this study was to evaluate the efficacy of optimized drug therapy in elderly patients with heart failure, and to provide a basis for optimizing drug therapy in elderly patients with heart failure. Subjects and methods: 45 elderly patients with chronic heart failure who were treated in our hospital from July 2014 to July 2016 were selected to receive optimized drug therapy for heart failure. Left ventricular ejection fraction (LVEF) was measured by echocardiography before treatment and 6 months after the target dose was reached. The clinical efficacy of patients with heart failure was evaluated with Minnesotaliving with Heart Failure questionnaire (MLHFQ) and statistically analyzed. Results: systolic blood pressure, diastolic blood pressure, heart rate, New York York Heart Academy NYHA, left ventricular end-diastolic function (Left) and left ventricular diastolic (LVEDd) were significantly decreased in 45 elderly patients with heart failure before and after optimal treatment. Left ventricular ejection fraction (LVEF) significantly increased the scores of MLHFQ, the scores of physical and emotional fields were significantly decreased, and the differences were statistically significant (P < 0.05). After 6 months of optimal treatment, 19m 42.22) were effective and the remaining 613.33) were ineffective. Subgroup analysis showed that there was no significant difference in the clinical efficacy of elderly patients with chronic heart failure (CHF) with different age, sex and type of heart failure (P < 0.05), but there was a significant difference in the clinical efficacy of the elderly patients with CHF with different NYHA grades (P 0.05). Conclusion: optimization of drug therapy for elderly patients with heart failure can significantly improve cardiac function and improve quality of life in elderly patients with heart failure. Age, sex and type of heart failure were not the influencing factors for the clinical efficacy of heart failure in the elderly, while NYHA classification was the influencing factor for the clinical efficacy of heart failure in the elderly.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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