摘要
目的探讨扩张型心肌病心力衰竭患者血管紧张素转换酶抑制剂(ACEI)、β受体阻滞剂应用情况及影响应用的相关因素。方法 2004年1月—2008年12月就诊于我院的扩张型心肌病心力衰竭患者218例,其中187例完成了3年随访,随访率为85.78%,患者明确诊断为扩张型心肌病心力衰竭,心功能NYHAⅢ～Ⅳ级者入选本研究。入选后患者均行超声心动图,记录左室舒张末期内径,并给予患者ACEI(卡托普利片)、β受体阻滞剂(卡维地洛片)、氢氯噻嗪片/呋塞米片、螺内酯片、地高辛片、阿司匹林肠溶片等药物常规治疗。经过治疗后,所有患者心功能恢复至NYHAⅠ～Ⅱ级后出院。随访患者出院后1年、2年、3年ACEI(卡托普利片)、β受体阻滞剂(卡维地洛片)应用情况(是否继续应用及应用剂量)。并记录患者3年内再入院情况(入院次数)、3年后的左室舒张末期内径左室射血分数及心血管不良事件情况。结果对入选患者进行3年随访后,ACEI(卡托普利片)、β受体阻滞剂(卡维地洛片)的平均剂量较出院时有所上升,平均左室舒张末期内径较出院时有所下降。在完成随访的187例患者中,3年后ACEI(卡托普利片)、β受体阻滞剂(卡维地洛片)剂量达标率分别为29.72%、33.86%;ACEI(卡托普利片)、β受体阻滞剂(卡维地洛片)剂量均达标率为13.86%。按ACEI、β受体阻滞剂应用情况进行分组,A组为ACEI(卡托普利片)或β受体阻滞剂(卡维地洛片)达到应用靶剂量,或两者均达到靶剂量;B组为ACEI(卡托普利片)、β受体阻滞剂(卡维地洛片)均未达到应用靶剂量;B组患者随访3年后左室舒张末期内径较A组扩大。A组患者较B组左室射血分数高、6min步行试验结果长,3年内再入院次数少。对影响ACEI、β受体阻滞剂的应用可能因素进行赋值,得出影响ACEI、β受体阻滞剂应用的因素依次为是否门诊随访、随访频率、是否了解疾病用药的相关知识、用药不良反应及相关检查是否清楚。其中,是否了解疾病用药的相关知识是影响患者应用上述两种药物的最主要因素,其OR=3.394。结论加强扩张型心肌病心力衰竭患者疾病用药的相关知识的讲解,有利于达到ACEI、β受体阻滞剂应用的靶剂量,改善患者预后。
Objective To survey and study the related factors of the application with ACEI,β-blockers in heart failure patients with dilated cardiomyopathy.Methods From January 2004 to December 2008,218 heart failure patients with diagnosed dilated cardiomyopathy received treatments in our hospital,of which 187 patients were followed up in three years,follow up rate was 85.78%.The patients with NYHA Ⅲ～Ⅳ grade enrolled in the study.Selected patients accepted conventional treatments including ACEI（captopril tablets）,β receptor blockers（carvedilol tablets）,tablets hydrochlorothiazide/furosemide tablets,spironolactone tablets,digoxin tablets,enteric-coated aspirin tablets and other drugs.After treatment,all patients recovered cardiac function NYHA Ⅰ～Ⅱ level and discharged.The applications of ACEI（captopril tablets） and β receptor blockers（carvedilol tablets）,Echocardiography（left ventricular diastolic diameter and left ventricular ejection fraction）,major adverse cardiac events and 6-minute walk test were followed up in three years.Results The selected patients were followed up for 3 years,the average ACEI（captopril tablets）,β blockers（carvedilol tablets） dose increased and an average of left ventricular diastolic diameter declined.In the 187 patients,the ACEI（captopril tablets）,β blockers（carvedilol tablets） dose compliance rates were 29.72%,33.86%;ACEI（captopril tablets）,β blockers（carvedilol tablets） dose compliance rates were 13.86%.The patients were divided into two groups by ACEI,β blocker application.Group A was the target dose of application of ACEI（captopril tablets） or β blocker（carvedilol tablets）,or both meet target dose.Group B was the application of ACEI（captopril tablets）,β blockers（carvedilol tablets） did not meet the target dose.The patients in group B were followed up for 3 years,the left ventricular diastolic diameter were more expanded than group A.Left ventricular ejection fraction high,6-minute walk test,re-admissions of patients in group A were better than group B.whether the patient followed up frequency,whether the understanding of disease medication knowledge,medication-related adverse reactions and check clear,whether the understanding of disease-related medications were the main factors of the application with the two drugs,OR=3.394.Conclusion Heart failure patients with dilated cardiomyopathy accepted drug knowledge related the disease are helpful to increase dose compliance rates and improve the prognosis.
出处
《实用心脑肺血管病杂志》
2012年第5期780-782,共3页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
