75岁及以上冠心病心衰患者用药规范化比较

发布时间：2019-07-21 07:01

【摘要】：目的调研不同年龄段冠心病心衰患者临床特征和出院医嘱用药情况。方法调取2011年1月至2015年12月从该院心内科出院明确诊断为冠心病并慢性心衰病例208例,回顾性分析其临床特点,并对比研究不同年龄段药物应用与性别、纽约心脏病(NYHA)心功能分级、射血分数的关系。结果既往并发症前三位为高血压130例(62.5%),心肌梗死112例(53.8%),2型糖尿病90例(43.3%);治疗药物总体应用比例为:他汀类88.9%,硝酸酯类78.8%,阿司匹林73.1%,β受体阻滞剂62.0%,利尿剂67.3%,醛固酮拮抗剂(MRA)57.2%,地高辛36.1%,其中神经内分泌拮抗剂血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ拮抗剂(ARB)、β受体阻滞剂、MRA三类药物两者合用比例40.4%,三者合用仅18.8%。年龄75岁组阿司匹林使用率高于年龄≥75岁组,而氯吡格雷、ARB、利尿剂、钙离子拮抗剂(CCB)均在年龄≥75岁组使用率更高,除利尿剂女性应用多于男性,其余各药物使用率在性别上无显著差异;阿司匹林、他汀类在NYHAⅠ/Ⅱ级组使用率高,氯吡格雷、利尿剂、MRA、地高辛的使用率在NYHAⅢ/Ⅳ级组高,ARB、CCB在射血分数正常组应用高于射血分数减低组(LVEF50%),MRA、地高辛在射血分数减低组应用偏多。结论抗血小板聚集类、他汀、利尿剂、硝酸酯在冠心病合并慢性心衰患者使用率高,总体应用规范,尤其是≥75岁者更规范,但是β受体阻滞剂、ACEI/ARB、MRA神经内分泌拮抗剂使用比例低,与指南有差距,对于冠心病合并慢性心衰的治疗仍需要继续规范化,加强医师培训及患者依从性的教育。
[Abstract]:Objective to investigate the clinical characteristics and discharge orders of patients with coronary heart disease and heart failure in different age groups. Methods 208 patients with coronary heart disease complicated with chronic heart failure were diagnosed from the Department of Cardiology from January 2011 to December 2015. The clinical features were analyzed retrospectively, and the relationship between drug use and sex, (NYHA) cardiac function grade and ejection fraction in New York heart disease was compared. Results the first three complications were hypertension in 130 cases (62.5%), myocardial infarction in 112 cases (53.8%) and type 2 diabetes mellitus in 90 cases (43.3%). The overall proportion of therapeutic drugs was as follows: statins 88.9%, nitrate 78.8%, aspirin 73.1%, 尾 receptor blockers 62.0%, diuretics 67.3%, aldosterone antagonist (MRA) 57.2%, digoxin 36.1%, neuroendocrine antagonist angiotensin converting enzyme inhibitor (ACEI) / angiotensin II antagonist (ARB), 尾 receptor blocker, The proportion of MRA three kinds of drugs was 40.4%, and that of the three drugs was only 18.8%. The utilization rate of aspirin in 75-year-old group was higher than that in 鈮，

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