中国心力衰竭患者的药物以及植入器械治疗现状  

Current status of medication and implantable device treatment for heart failure patients in China

作　　者：吕游[1] 赵静[2] 蒋瑞辉 王华[1] 袁凤仪 Lyu You;Zhao Jing;Jiang Ruihui(Department of Cardiology,National Clinic Research Center of Geratology,Beijing Hospital,Beijing 100730,China)

机构地区：[1]北京医院&国家老年医学中心心血管内科,北京100730 [2]解放军总医院第二医学中心呼吸与危重症医学科 [3]中办警卫局卫生保健处 [4]不详

出　　处：《中华保健医学杂志》2024年第3期286-289,共4页Chinese Journal of Health Care and Medicine

摘　　要：目的 调查并分析总结我国住院心力衰竭(HF)患者的病因、合并症、临床特点、植入器械以及药物治疗情况。方法 本研究为横断面调查,选取中国心力衰竭中心注册研究2017年1月~2022年8月169家医院的住院心力衰竭患者,筛选左心室射血分数(LVEF)≤35%的患者,分析其中接受植入器械治疗的患者情况。收集患者的临床资料,包括人口学信息、诊断、心电图、超声心动图、实验室指标、心力衰竭病因、合并症和治疗等。结果 共纳入LVEF≤35%的32 777例患者中接受器械治疗的患者3 646例(11.1%),其中植入心律转复除颤器(ICD)治疗1 494例,占全部病例的4.6%,植入心脏再同步化治疗起搏器(CRT-P)治疗642例,占全部病例的2.0%,植入CRT-D治疗1 510例,占全部病例的4.6%。心力衰竭的病因依次为扩张型心肌病[57.1%(1 881/3 297)]、冠心病[30.5%(1 007/3 297)]、高血压[7.5%(248/3 297)]及瓣膜性心脏病[4.3%(143/3 297)]。合并的心脑血管疾病主要为心房颤动/心房扑动[31.9%(1 163/3 646)]、卒中/一过性脑缺血发作[9.6%(348/3 536)]。合并的非心脑血管疾病的比例由高到低依次为糖尿病[28.7%(1 039/3 625)]、贫血[27.7%(973/3 520)]、慢性肾脏病[14.2%(518/3 640)]、低钠血症[9.0%(317/3 522)]、恶性肿瘤[2.2%(81/3 631)]。植入器械的心力衰竭患者在住院治疗期间,襻利尿剂的使用率为87.2%(3 163/3 627),静脉正性肌力药物的使用率为10.4%(378/3 640)。出院时,血管紧张素转化酶抑制剂(ACEI)使用率为31.5%(1 149/3 646),血管紧张素Ⅱ受体阻滞剂(ARB)使用率为23.9%(871/3 646),血管紧张素受体脑啡肽酶抑制剂(ARNI)使用率为29.5%(1 076/3 646)、B受体阻滞剂使用率为90.3%(3 239/3 642),醛固酮受体拮抗剂使用率为84.8%(3 087/3 642)。结论 我国心力衰竭患者的治疗现状仍以药物治疗为主,器械治疗的植入率偏低,与国内外指南推荐的差距仍较大;在接受植入器械治疗的心力衰竭患者中,�Objective To investigate and analyze the etiology,comorbidities,clinical characteristics,implantation of devices,and drug treatment of hospitalized patients with heart failure in China.Methods Research data were obtained from the Chinese Heart Failure Center Registration Study,which enrolled heart failure patients from 169 hospitals betweenn January 2017 and August 2022.This cross-sectional survey focused on patients with left ventricular ejection fraction(LVEF)≤35%,and specifically analyzed patients receiving implanted devices.Clinical data of patients,including neurological information,diagnosis,electroencephalogram,echocardiogram,laboratory indicators,etiology of heart failure,comorbidities,and treatment were collected.Results Among 32,777 patients LVEF≤35%,3646 patients(11.1%)received instrument therapy,with 1,494(4.6%)receiving ICD implantation,642(2.0%)receiving CRT-P implantation,and 1510(4.6%)patients receiving CRT-D implantation.The leading causes of heart failure were dilated cardiomyopathy[57.1%(18813297)],coronary heart disease[30.5%(10073297)],hypertension[7.5%(2483297)],and valvular heart disease[4.3%(1433297)].The main combined cerebrovascular diseases were atrial fibrillation atrial flutter 31.9%(11633646)and stroke transient ischemic attack 9.6%(3483536).Other comorbidities are diabetes[28.7%(10393625)],anemia[27.7%(9733520)],Chronic kidney disease[14.2%(5183640)],hyponatremia[9.0%(3173522)],malignant tumor[2.2%(813631)].During the hospitalization of heart failure patients,the rate of using loop Diuretic was 87.2%(31633627),and the rate of using positive muscle drugs was 10.4%(3783640).At discharge,the utilization rate of angiotensin converting enzyme inhibitor(ACEI)was 31.5%(11493646),that of angiotensinⅡreceptor blocker(ARB)was 23.9%(8713646),that of Angiotensin Receptor-Neprilysin Inhibitor(ARNI)was 29.5%(10763646),that ofβreceptor blocker was 90.3%(32393642),and that of Aldosterone receptor blocker was 84.8%(30873642).Conclusion Drug therapy remains the primary treatment for heart fail

关 键 词：心力衰竭 流行病学 器械治疗 药物治疗 

分 类 号：R541[医药卫生—心血管疾病]