慢性射血分数降低的心力衰竭患者药物治疗现状云南单中心调查分析  

Current Status of Drug Treatment for Chronic Heart Failure Patients With Reduced Ejection Fraction in Yunnan:a Single-center Survey

作　　者：董丹红 王维雯 李德霞 杨军[1] 李娜[1] 马航 李琳[1] DONG Danhong;WANG Weiwen;LI Dexia;YANG Jun;LI Na;MA Hang;LI Lin(Dept.of Cardiology,The First Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032;Dept.of Cardiology,Yunnan Fuwai Cardiovascular Hospital,Kunming Yunnan 650102;Dept.of General Practice,Lijiang People’s Hospital,Lijiang Yunnan 674100,China)

机构地区：[1]昆明医科大学第一附属医院心内科,云南昆明650032 [2]云南省阜外心血管病医院心内科,云南昆明650102 [3]丽江市人民医院全科医学科,云南丽江674100

出　　处：《昆明医科大学学报》2023年第8期77-84,共8页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81560072);云南省科学技术厅-昆明医科大学应用基础研究联合专项基金项目[2019FE001(-056)];云南省心脑血管疾病临床医学中心建设项目(ZX2019-03-01);昆明医科大学研究生创新基金项目(2021S174,2022S210)。

摘　　要：目的探讨云南慢性射血分数降低的心力衰竭(HFrEF)患者药物治疗现状及影响药物规范化治疗的因素。方法采用单中心、前瞻性、观察性方法进行研究。入选2019年7月至2020年9月在昆明医科大学第一附属医院心内科住院的HFrEF患者110例,采集患者住院时、出院后3月和6月的ACEI/ARB/ARNI、β受体阻滞剂和MRA的使用率及剂量达标情况;并根据出院时药物剂量分为100%目标剂量组、50%~99%目标剂量组和<50%目标剂量组,对比分析影响药物规范化治疗的因素。结果入选的110例HFrEF患者年龄为(57.9±14.1)岁,其中男性65例(58.6%)。出院时ACEI/ARB/ARNI、β受体阻滞剂及MRA的使用率较高(分别为73.6%、82.1%、89.6%),但出院后3个月(分别为69.8%、79.2%、84.4%)和出院后6个月(分别为69.0%、78.6%、78.6%)的使用率持续降低。ACEI/ARB/ARNI和β受体阻滞剂使用100%目标剂量在出院时、出院后3个月、出院后6个月均较低,分别为12.8%和1.1%、14.9%和0%、15.5%和1.5%,其中β受体阻滞剂剂量达标率最低。100%目标剂量组、50%~99%目标剂量组和<50%目标剂量组3组间比较,ACEI/ARB/ARNI50%~99%目标剂量组患者的体质指数(25.5±3.4 vs 23.2±4.1,P=0.038)和收缩压(131.1±21.6 vs 109.7±14.9,P<0.001)均高于<50%目标剂量组,3组间NYHA心功能分级、BNP和血肌酐比较未见显著差异(P>0.05)。β受体阻滞剂50%~99%目标剂量组患者的年龄明显低于<50%目标剂量组(46.9±10.0 vs 64.4±13.2,P=0.005),3组间NYHA心功能分级、心率、收缩压比较未见明显差异(P>0.05)。在住院期间,医生未处方、药物不耐受和存在禁忌证是抗心衰药物未使用或剂量未达标的主要原因;而出院后除有禁忌证外,患者自行停药和医生未处方是药物未规范使用的主要原因。结论在云南部分地区HFrEF患者中,ACEI/ARB/ARNI和β受体阻滞剂的使用率和使用剂量均较低,随着出院时间延长,药物的使用率持续下降,使用剂量无�Objective To investigate the status quo of drug therapy and the factors affecting the standardized drug therapy in patients with heart failure with chronic ejection fraction reduction(HFrEF)in Yunnan province.Methods This is a single-center,prospective,and observational study.A total of 110 patients who were hospitalized in the Department of Cardiology in the First Affiliated Hospital of Kunming Medical University during July 2019 to September 2020 were enrolled.The utilization rate and dose of ACEI/ARB/ARNI,β-blocker and MRA were collected during hospitalization,3 and 6 months after discharge.According to the drug dose at discharge,patients were divided into 100%target dose group,50%~99%target dose group and<50%target dose group,and the factors affecting the standardized drug treatment were analyzed.Results The average age of 110 HFrEF patients was(57.9±14.1)years old,among which 65(58.6%)were males.The utilization rates of ACEI/ARB/ARNI,β-blocker and MRA at discharge(73.6%,82.1%,89.6%,respectively)were higher than that at 3 months(69.8%,79.2%,84.4%,respectively)and 6 months(69.0%,78.6%,78.6%,respectively)after discharge.Both of 100%target dose of ACEI/ARB/ARNI andβ-blocker were lower at the time of discharge,3 and 6 months after discharge,among which the 100%target dose rate ofβ-blocker was the lowest.ACEI/ARB/ARNI andβ-blocker usage at 100%target dose was lower at discharge,3 months after discharge,and 6 months after discharge,with rates of 12.8%and 1.1%,14.9%and 0%,and 15.5%and 1.5%respectively.Among them,the rate of reaching the target dose was the lowest forβ-blockers.When comparing the three groups of 100%target dose,50-99%target dose,and<50%target dose,patients in the ACEI/ARB/ARNI 50-99%target dose group had higher body mass index(25.5±3.4 vs.23.2±4.1,P=0.038)and systolic blood pressure(131.1±21.6 vs 109.7±14.9,P<0.001)than those in the<50%target dose group.There were no significant differences in NYHA functional classification,BNP,and serum creatinine among the three groups(P>0.05).The age of

关 键 词：射血分数降低的心力衰竭 药物治疗 影响因素 

分 类 号：R541.61[医药卫生—心血管疾病]