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目的:了解慢性心力衰竭(心衰)患者临床变迁,为该病防治策略提供依据。方法:将单中心20年连续住院的心衰患者分两个时段比较,分析病因、治疗变化和死亡方式。结果:①共入选3 260例患者,第一时段即1984年-1993年1205例,第二时段即1994-2003年2055例,第二时段患者年龄显著增加(54．27±15．21 vs 66．23±13．73,P<0．01),风湿性心脏瓣膜病心衰明显下降(47．8％vs 21．4％,P< 0．01),冠心病显著增加(31．4％vs 64．1％,JP<0．01);②合并高血压、糖尿病的比例第二时段显著增加(17．8％vs 35．6％,P<0．01;8．9％vs 14．0％,P<0．05);③硝酸酯(77．8％vs 85．5％,P<0．001)、血管紧张素转换酶抑制剂(55．3％vs 65．2％,P<0.001)和β受体阻滞剂(18．4％vs 23．2％,P<0．05)使用率第二时段明显上升;④心衰患者死亡冬季多。结论:过去的20年间,住院慢性心衰患者临床特征发生了明显变化,临床防治策略应做出相应改变。
Objective: To understand the clinical changes in patients with chronic heart failure (HF) and provide the basis for the prevention and treatment of this disease. Methods: The patients with heart failure who were hospitalized in a single center for 20 years were divided into two periods to analyze the etiology, treatment changes and death patterns. Results: ① A total of 3 260 patients were enrolled. The first period was 1205 cases in 1984-1993, the second stage was 2055 cases in 1994-2003, and the age was significantly increased in the second period (54.27 ± 15.21 vs 66 .23 ± 13.73, P <0.01). Heart failure was significantly decreased in rheumatic valvular heart disease (47.8% vs 21.4%, P <0.01) and coronary heart disease was significantly increased (31.4% vs 64.1%, JP <0.01); ②The proportion of hypertension and diabetes increased significantly in the second period (17.8% vs 35.6%, P <0.01; 8.9% vs 14. 0%, P <0.05); ③ nitrate (77.8% vs 85.5%, P <0.001), angiotensin converting enzyme inhibitor <0.001) and β-blockers (18.4% vs 23.2%, P <0.05). The second period of usage increased significantly. Conclusion: In the past 20 years, clinical characteristics of hospitalized patients with chronic heart failure have undergone significant changes, and clinical strategies should be changed accordingly.