中医药对慢性心力衰竭患者再院率影响的回顾性研究

【作者】 王春丽；

【导师】 霍艳明；

【作者基本信息】 北京中医药大学 ， 中医学， 2012， 硕士

【摘要】 目的：对望京医院心内科388例中西医结合治疗慢性心力衰竭(chronic heart failure, CHF)患者的临床资料、出院转归、院外中西医治疗等情况进行回顾性分析,了解我院收治的慢性心力衰竭患者的临床特征及中药对其预后的影响,探讨中医药对慢性心力衰竭患者再住院率的影响。方法：采集2006年3月至2011年3月望京医院心内科慢性心衰住院患者的信息。对经规范治疗缓解出院的CHF患者进行电话随访或预约病人门诊随访。应用SPSS统计软件进行数据分析。结果：421例慢性心衰患者,随访过程中有25例死亡(其中14例死于心脏疾病,11例死于非心脏疾病),8例因联系方式变更或其它原因未能随访到。故共有388例纳入本研究,其中男性患者158例,女性患者230例,男女比例为0.69：1,患者的平均年龄67.09岁。慢性心衰患者中主要病因为冠心病者265例(占总人数的68.30%,下同),高血压病者108例(27.84%),风湿性心脏病者4例(1.03%)。伴发疾病情况：合并2型糖尿病者148例(38.14%),高脂血症者113例(29.12%),严重心律失常者108例(27.84%),肺部疾病者54例(13.92%),肾功能不全者78例(20.10%),脑出血者48例(12.37%),脑梗塞者56例(14.43%)。本研究中心衰患者半年内再住院者192例,再住院率为49.48%。与再住院率相关的Logistic回归分析显示影响慢性心衰患者再住院率的因素有高龄、首次入院时为中重度心功能不全、左室射血分数降低、心脏增大、肾功能不全、严重心律失常、出院后未使用中药。结论：1、慢性心衰患者以老年人居多,具有老龄化的特征；主要病因以冠心病及高血压病为主；合并多系统疾病,内科基础较差。2、单因素分析结果显示患者高龄,首次入院时心功能状态差,伴有2型糖尿病、严重心律失常、肺部疾病及肾功能不全,B-型利钠肽(Brain natriuretic peptide, BNP)值升高,左室射血分数降低与心衰患者再住院率相关,出院后使用中药,规律复诊,服药依从性好能够降低再住院率。3、与再住院率相关的Logistic回归分析显示：影响慢性心衰患者再住院率的因素有高龄、首次入院时为中重度心功能不全、左室射血分数降低、心脏增大、肾功能不全、严重心律失常、出院后未使用中药。4、本研究提示对首次入院的老年中重度慢性心力衰竭患者,尤其是伴有严重心律失常及肾功能不全的患者早期进行干预,规律复诊,按时服药能够降低再住院率。5、积极规律辨证使用中药能够降低慢性心力衰竭患者的再住院率,提示我们不仅住院期间,而且院外亦需重视中药的使用。更多还原

【Abstract】 Objective: retrospective analysis the clinical data、discharge outcome、 Outside the hospital treatment on the patients which were treated combined with traditional Chinese and western medicine, understand the clinical characreristics and the use of Chinese medicine on388cases chroni heart failure (CHF)。Explore the Traditional Chinese medicine influence of the prognosis of patients with CHF outcome.Methods:Collect the data of Wangjing Hospital chronic heart failure from Mar.2006to Mar.2011。We will fol low-up phone or fol low-up appointment patient outpatient service for the chronic heart failure (CHF)which were standard for relief from the hospital. Establish clinical quest ionna ire (CRF)、entry database with the specialist and with SPSS statistical software for data analysis.Results:In the421CHF patients, there are25patients died in the follow-up process (14patients died of heart disease and11patients die from heart disease)。There are8patients for contact way change or other reason not to follow-up。So the388patients of clinical analysis, one male patients in158,230patients with women, men and women ratio is0.69:1. The average age of Chronic heart failure patients was67.09years。Chronic heart failure in patients with major disease for coronary heart disease in265cases (accounting for68.30%of the total number, the same below), hypertension in108cases (27.84%) rheumatic heart disease in4cases (1.03%). Comorbid illness:Type2diabetes in148cases(38.14%), hyperlipidemia in113cases(29.12%), serious arrhythmia in108cases (27.84%), the lung disease in54cases (13.92%), renal insufficiency in78cases (20.10%), the cerebral hemorrhage in48cases (12.37%), the cerebral infarction in56cases(14.43%). In this study, half a year192patients hospitalized again, readmission rates of49.48%. And readmission rates related Logistic regression showed that affect patients with chronic heart failure readmission rates factors are old-age、the first admission for moderate to severe cardiac function、lower left ventricular ejection fraction、increases heart、renal insufficiency、serious arrhythmia、no use of traditional Chinese medicine after discharge.Conclusion:1、Chronic heart failure patients with old people is in the majority, has the characteristics of aging; Major cause to coronary heart disease and high blood pressure disease for the Lord; with many system disease,and medical foundation is bad。2、Single factor analysis results are shown patients with high age, the first admission of heart function is poor, with type2diabetes、serious arrhythmia、 lung disease and renal insufficiency,high BNP value, low left ventricular ejection fraction are related with heart failure patients hospitalized again rates, use of Chinese medicine after discharge, regular visit, medication compliance good can reduce readmission rates.3、Readmission rates related Logistic regression showed that:old-age、 the first admission for moderate to severe cardiac function、lower left ventricular ejection fraction、increases heart、renal insufficiency、serious arrhythmia、no use of traditional Chinese medicine after discharge。4、This study suggests hospital cardiac function for the first time with moderate to severe primarily old chronic heart failure patients, especially associated with serious arrhythmia, and renal function in patients with early intervention, remind patients law appointment, medicine on time can be reduced readmission rates.5、Positive、regular and dialectical use traditional Chinese medicine can reduce chronic heart failure patients in hospital admission rates again, guidance we not only during be in hospital, And outside the hospital also need to pay attention to the use of traditional Chinese medicine.更多还原