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目的总结、归纳慢性心力衰竭患者的临床特点、药物治疗及《慢性心力衰竭诊断和治疗指南》(以下简称《指南》)的实施情况。方法回顾2011年1月—2014年12月于兰大一院东岗院区住院的830例CHF患者的临床特点及药物治疗情况(包括口服药物及静脉用药治疗),口服药物有利尿剂、血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、β-受体阻滞剂、硝酸酯制剂、洋地黄制剂、醛固酮受体拮抗剂,静脉用药有硝酸酯制剂、硝普钠、利尿剂、心肌营养药物、洋地黄制剂,分析上述药物的应用情况及与《指南》的符合情况。结果慢性心力衰竭病因中冠心病居首位,共508例,占61.2%;住院患者以Ⅲ级、Ⅳ级心衰为主,Ⅲ级396例(47.7%),Ⅳ级234例(28.2%);临床心衰阶段(C期)719例(86.6%),难治性终末心衰阶段(D期)111例(13.4%);口服药物中,利尿剂及醛固酮受体拮抗剂的使用与《指南》要求相符,β-B及ACEI/ARB的应用仍不理想;静脉药物均应用于Ⅲ级及Ⅳ级心功能不全的患者,利尿剂应用率逐年上升,硝酸酯制剂、心肌营养药应用率相似,硝普钠、洋地黄制剂应用率逐年下降。结论目前对于慢性心力衰竭的治疗与《指南》差距较大,需进一步规范治疗心衰药物的应用,以切实提高临床疗效。
Objective To summarize and summarize the clinical features of patients with chronic heart failure, medical treatment and the implementation of the Guide to Diagnosis and Treatment of Chronic Heart Failure (the “Guide”). Methods From January 2011 to December 2014, 830 patients with CHF admitted to the Donggang Hospital of Lanzhou University First Hospital were enrolled in the study. Clinical characteristics and medication (including oral and intravenous drugs), oral diuretics, blood vessels Angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blockers, nitrates, digitalis preparations, aldosterone receptor antagonists, intravenous nitrates, Sodium nitroprusside, diuretic, cardiotropic drugs, digitalis preparations, analysis of the application of the above drugs and compliance with the Guide. Results CHD was the first place in the etiology of chronic heart failure, with a total of 508 cases (61.2%). Grade III and IV heart failure were the mainstay of inpatients, with grade Ⅲ 396 (47.7%) and grade Ⅳ 234 (28.2%), ; 111 cases (13.4%) were clinical stage of heart failure (C stage), 719 cases (86.6%) and refractory terminal heart failure stage (D stage); among the oral drugs, diuretics and aldosterone receptor antagonists The guidelines require consistency, the application of β-B and ACEI / ARB is still not ideal; intravenous drugs are used in patients with grade Ⅲ and Ⅳ heart failure, diuretic application rate increased year by year, nitrate preparations, myocardial nutrition drugs Similar rates, sodium nitroprusside, digitalis application rate decreased year by year. Conclusion Currently, there is a big gap between the treatment of chronic heart failure and the Guideline, and the application of the drug for treating heart failure needs to be further standardized so as to effectively improve the clinical efficacy.