β受体阻滞剂在心力衰竭患者中的应用现状调查  

Survey on the application ofβ-blockers in patients with heart failure

作　　者：高东方 谭慧琼[1] 刘少帅 刘晓宁[1] 郭潇[1] 朱俊[1] 吕思奇 莫然 于丽天[1] Gao Dongfang;Tan Huiqiong;Liu Shaoshuai;Liu Xiaoning;Guo Xiao;Zhu Jun;Lv Siqi;Mo Ran;Yu Litian(Emergency and Critical Care Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Qilu Hospital of Shandong Unversity,Jinan 250063,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院急重症中心,北京100037 [2]山东大学齐鲁医院心内科,济南250063

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2022年第2期142-148,共7页Chinese Journal of Heart Failure and Cardiomyopathy

摘　　要：目的了解β受体阻滞剂在我国心力衰竭(心衰)患者中的应用现状。方法前瞻性入选2012年12月至2014年11月期间在我国不同地区、不同级别的24家医院门诊或住院确诊的左心室射血分数(LVEF)<50%的心衰患者,在6个月及1年时进行随访,了解我国心衰患者中β受体阻滞剂的使用率、使用剂量、剂量达标情况及其影响因素等。结果共纳入381例心衰患者,基线时有256例使用β受体阻滞剂(使用率为67.2%)。6个月及1年随访时β受体阻滞剂的总体使用率分别为69.8%和70.1%,与基线相比,差异均无统计学意义(P均>0.05)。随访期间合理应用β受体阻滞剂的患者占28.1%,不合理应用患者占71.9%。6个月及1年随访时,β受体阻滞剂的剂量总达标率分别为17.9%和16.8%,目标剂量达标率分别为8.3%和8.6%,最大可耐受剂量达标率分别为11.1%和9.4%。6个月随访和1年随访时。其中,琥珀酸美托洛尔的剂量总达标率最低(8.5%和11.1%),其次是酒石酸美托洛尔(15.8%和13.5%)、比索洛尔(18.8%和17.6%),卡维地洛的剂量总达标率最高(66.7%和61.1%)。以1年随访时剂量总达标为因变量进行多因素logistic回归分析结果显示,校正其他混杂因素后,三级医院剂量总达标率高于一级医院(比值比OR 4.818,95%可信区间CI 1.118~20.771,P=0.035),心衰病程>1年者剂量总达标率高于心衰病程≤1年者(OR 3.128,95%CI 1.110~8.814,P=0.031),高等文化水平人群剂量总达标率高于文盲人群(OR 5.416,95%CI 1.684~17.419,P=0.005)。结论我国心衰患者β受体阻滞剂整体使用率低,且剂量不调整,日剂量明显不足,医院级别、心衰病程及患者学历是影响β受体阻滞剂剂量达标的主要因素。Objective To investigate the current status ofβ-blockers use in patients with heart failure(HF)in China.Methods Outpatients and inpatients diagnosed with HF and left ventricular ejection fraction(LVEF)<50%presented in 24 hospitals from different regions across China between December 2012 and November 2014 were prospectively enrolled.All patients were followed up at 6-month and 1-year to investigate the usage rate,dose,rate of reaching target dose or maximum tolerated dose(MTD)and its influencing factors Results A total of 381 patients with HF were enrolled and 256(67.2%)cases usedβ-blockers at baseline.There was no significant differences in the usage rate at 6-month(69.8%)and 1-year(70.1%)follow-up compared with that at baseline(both P>0.05).During the follow-up,28.1%patients usedβ-blockers reasonably,while other 71.9%cases didn′t useβ-blockers reasonably.At 6-month and 1-year follow-up,the overall dose compliance rate was 17.9%and 16.8%,the target dose compliance rate was 8.3%and 8.6%,and the MTD dose compliance rate was 11.1%and 9.4%,respectively.Moreover,at 6-month and 1-year follow-up,the lowest overall dose compliance rate was in metoprolol succinate(8.5%and 11.1%),followed by metoprolol tartrated(15.8%and 13.5%)and bisoprolol(18.8%and 17.6%),and carvedilol showed the highest overall dose compliance rate(66.7%and 61.1%).Based on whether overall dose compliance or not at 1-year follow-up,multivariate logistic regression analysis demonstrated that the overall dose compliance rate was higher in tertiary hospitals than that in primary hospitals[odds ratio(OR)4.818,95%confidence interval(CI)1.118-20.771,P=0.035],in patients with longer HF duration>1 year than those with shorter duration≤1 year(OR 3.128,95%CI 1.110-8.814,P=0.031),and in patients with higher education levels than those with lower education levels(OR 5.416,95%CI 1.684-17.419,P=0.005).Conclusions The overall utilization rate ofβ-blockers in patients with HF in China is relatively low,and the dose is not adjusted,and the daily dose is obviou

关 键 词：心力衰竭 Β-受体阻滞剂 应用现状调查 指南依从性 

分 类 号：R541.6[医药卫生—心血管疾病]