超多药治疗对射血分数保留型心力衰竭患者预后的影响  

Effect of hypermultidrug therapy on the prognosis of patients with ejection fraction preserved heart failure

作　　者：余海忠 窦增花 李虎业 马占青 夏文英 YU Hai-zhong;DOU Zeng-hua;LI Hu-ye;MA Zhan-qing;XIA Wen-ying(Pharmacy Department,The Fourth People’s Hospital of Qinghai Province,Xining 810000,China;Hypertension Department,The Cardiovascular and Cerebrovascular Disease Specialized Hospital of Qinghai Provincial,Xining 810099,China)

机构地区：[1]青海省第四人民医院药剂科,青海省西宁市810000 [2]青海省心脑血管病专科医院高血压科

出　　处：《中国心血管病研究》2024年第5期454-460,共7页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨多药治疗和射血分数保留型心力衰竭(HFpEF)患者预后的关系。方法通过电子病历获取患者既往药物治疗状况。根据患者应用药物数量将其分为3组:组1为应用<5种药物的患者;组2为应用5~9种药物的患者;组3为应用≥10种药物的患者。对比分析3组患者的基线资料和随访期间的心血管疾病死亡、全因死亡、HF住院、心血管疾病住院、全因住院状况。结果1038例HFpEF患者中,应用<5种药物的患者占7.32%;应用5~9种药物的患者占36.51%;应用≥10种药物的患者占56.17%。组2组3(即以较多的药物进行治疗),导致了全因住院率的上升,是其不利/危险影响因素(P<0.05,OR分别为1.229、1.342)。男性、血红蛋白低、LHFQ评分高、共病数目多是HFpEF患者多药治疗的危险影响因素(P<0.05,OR分别为1.289、1.273、1.604、2.105);临床医师管理是HFpEF患者多药治疗的保护因素(P<0.05,OR=0.729)。高龄、纽约心脏病协会(NYHA)心功能分级≥Ⅲ级、高脂血症、糖尿病、心肌梗死史、左心室射血分数<50%、应用药物≥5种是HFpEF患者全因住院的危险因素(P<0.05,OR分别为1.829、2.045、1.991、1.674、2.176、1.733);应用β受体阻滞剂是HFpEF患者全因住院的保护因素(P<0.05,OR=0.806)。结论在HFpEF患者中,超多药治疗非常常见,并和患者住院风险和任何严重不良事件的增加相关,但不会影响患者病死率。Objective To investigate the relationship between multi drug therapy and the prognosis of patients with heart failure with preserved ejection fraction(HFpEF).Methods The past medication status of patients was obtained through electronic medical records.The patients were divided into 3 groups according to the number of drugs used:group 1 was patients who used<5 drugs;Group 2 was treated with 5-9 drugs;Group 3 was the patients with≥10 drugs.The baseline data of the three groups and the status of cardiovascular disease death,all-cause death,HF hospitalization,cardiovascular disease hospitalization and all cause hospitalization during the follow-up period were compared and analyzed.Results Among 1038 patients with HFpEF,7.32%were treated with less than 5 drugs;36.51%of the patients were treated with 5-9 drugs;56.17%of the patients were treated with more than 10 drugs.The group 2 and group 3(i.e.treated with more drugs)led to the increase of all cause hospitalization rate,which was an adverse/risk factor(P<0.05,OR were 1.229 and 1.342 respectively).The low hemoglobin,high LHFQ score and more comorbidities were the risk factors of multi drug therapy in HFpEF patients(P<0.05,OR were 1.289,1.273,1.604,2.105,respectively);Clinical physician management was a protective factor for multi drug treatment in HFpEF patients(P<0.05,OR=0.729).Older age,New York Heart Association(NYHA)≥GradeⅢ,hyperlipidemia,diabetes,history of myocardial infarction,left ventricular ejection fraction<50%,and drug use≥5 were risk factors for all-cause hospitalization of HFpEF patients(P<0.05,OR were 1.829,2.045,1.991,1.674,2.176,1.733,respectively);applicationβReceptor blockers were a protective factor for all-cause hospitalization in HFpEF patients(P<0.05,OR=0.806).Conclusion Hypermultidrug therapy is very common in HFpEF patients and is associated with an increased risk of hospitalization and any serious adverse events,but does not affect mortality.

关 键 词：预后 射血分数 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]