老年心力衰竭住院患者6 288例的病因变迁

Etiological changes in 6 288 hospitalized elderly patients with heart failure

摘要:

目的 回顾性地分析老年心力衰竭住院病例的病因变迁，探讨老年心力衰竭的防治对策。方法 从住院病历数据库中检索出1993年1月至2010年12月首次因心力衰竭住院的老年患者6 288例，以6年为时间段分成A，B和C组，分析比较3组不同性别、年龄患者病因学和住院30d病死率的变迁。结果 （1）18年间住院患者数逐年增多，性别构成方面男性下降，女性上升；年龄构成方面60～69岁下降，≥80岁上升。（2）高血压病和糖尿病比例增多；冠心病、陈旧性心肌梗死和肺心病比例下降；急性心肌梗死、风湿性心脏病、先天性心脏病、贫血和甲亢性心脏病无显著性变化。（3）诱因中肺炎、房颤的比例上升，室性心动过速/心室颤动的比例下降。（4）两种病因、3种及3种以上病因的比例随年龄增高而上升，但3个时间段间差异无统计学意义。（5）18年间住院30d病死率逐渐降低，男性中下降更明显。结论 18年间，老年心力衰竭首次住院患者的病因、诱因或伴随疾病构成比中，高血压病和糖尿病增多，冠心病、肺心病比例下降；肺炎、房颤比例上升；住院期病死率下降，其原因值得深入研究。

Abstract:

Objective To analyze the etiological changes in the elderly hospitalized patients with heart failure (HF) and investigate the strategies to prevent and treat HF. Methods A retrospective study was performed on 6 288 patients (4 001 males and 2 287 females) with a primary diagnosis of validated HF who were consecutively admitted to our hospital during the years of 1993 to 2010. The patients were divided into groups A, B and C with 6 years as interval. The etiological features and 30-day in-hospital mortality were compared in different genders and ages from the above 3 groups. Results During the period of 18 years, the number of the inpatients was increased year by year, with the proportion of women increased and men decreased, and the percentage of age 60 to 69 years old declined and over 80 years old risen. Of the 6 288 patients, the proportion of accompanied hypertension and diabetes was increased, but that with coronary artery diseases, prior myocardial infarction and cor pulmonale decreased. There was no significant change in the proportions of acute myocardial infarction, rheumatic heart disease, congenital heart disease, anemia and hyperthyroid heart disease. In the inducing factors, the rate of pneumonia and atrial fibrillation was increased, but the rate of ventricular tachycardia and ventricular fibrillation reduced. The ratio of double, triple or more etiological factors was increased with aging, but there was no significant difference over the 3 different periods. The 30-day in-hospital mortality was decreased gradually, especially in males (P＜0.01). Conclusion During the 18 years, the proportions of patients with hypertension and diabetes as etiological factors are increased significantly, but those of coronary artery disease and cor pulmonale are decreased obviously, and those of pneumonia and atrial fibrillation risen in the elderly patients with heart failure at first hospitalization. There is a significant decline in the 30-day in-hospital mortality among the cohort. The reasons of these findings are worth of further study.