發(fā)布時間：2018-05-03 23:29

  本文選題：心力衰竭 + 老年人��； 參考：《鄭州大學》2017年碩士論文

【摘要】：背景和目的:在全球人口老齡化的時代,心力衰竭普遍流行,其患病率隨著年齡增長而增加。心衰已是發(fā)達國家、并逐漸成為發(fā)展中國家的沉重醫(yī)療負擔。最近30年,一個毋庸置疑的事實是心血管疾病的治療進展,特別是ST段抬高型心肌梗死(STEMI)和高血壓的治療進步,使罹患這些疾病的非老年患者存活進入老年期的數(shù)量增加,從而使老年心衰的人口數(shù)量進一步擴大。在此背景下,心血管疾病危險因素和合并癥如2型糖尿病、肥胖、高脂血癥和氧化應激也促進心衰、終末期心臟病和死亡的發(fā)生。當前的心衰管理指南都認為,心衰是各種結構性和功能性心臟疾病導致心室充盈和射血功能受損的結果。美國心臟病學學會基金會/美國心臟協(xié)會、歐洲心臟病學學會和中華醫(yī)學會心血管病學分會發(fā)表的現(xiàn)行心衰管理指南均推薦綜合性治療。重要的是這些指南都是基于心血管疾病藥物治療的隨機臨床試驗(RCT)數(shù)據(jù),而這些試驗的研究對象多數(shù)為非老年的男性患者。盡管年齡較大的人群中心血管疾病的患病人數(shù)多,但卻缺乏專門針對老年人群射血分數(shù)降低的心衰(HF/REF)或射血分數(shù)保留的心衰(HF/PEF)治療的RCT數(shù)據(jù)。雖然存在上述憂慮和RCT的局限性,各指南依然對非老年和老年心衰患者的藥物治療和非藥物治療提供了推薦。除了要小心與老化相關的事宜,其治療沒有顯著差別。本研究評價分析優(yōu)化藥物治療對老年心衰患者的療效,為老年心衰優(yōu)化藥物治療提供研究基礎。研究對象和方法:選取2014年7月至2016年7月于我院進行診治的老年慢性心力衰竭患者45例,進行優(yōu)化心力衰竭藥物治療,在治療前和達到藥物目標劑量后第6個月時分別進行一次心臟超聲檢查測量左室射血分數(shù)記錄數(shù)據(jù),并使用明尼蘇達心力衰竭生活質量量表(MinnesotaLiving with Heart Failure Questionnaire,MLHFQ)對患者臨床療效進行評價,進行統(tǒng)計學分析。結果:進行優(yōu)化治療前后45例老年心衰患者收縮壓(systolic blood pressure,SBP)、舒張壓(diastolic blood pressure,SDP)、心率、紐約心臟病學會(New York Heart Academy,NYHA)分級、心臟超聲指標左室舒張末內經(Left Ventricular End Diastolic diameter,LVEDd)均顯著下降,心臟超聲指標左室射血分數(shù)顯著提高,MLHFQ綜合得分、身體領域得分、情緒領域得分均顯著降低,差異均具有統(tǒng)計學意義(P均0.05)。優(yōu)化治療治療6個月后19(42.22%)例患者顯效,20(44.44%)例患者有效,其余6(13.33%)例患者無效。亞組分析顯示,不同年齡、性別和心力衰竭類型的老年慢性心衰患者的臨床療效差異均無統(tǒng)計學意義(P均0.05),而不同NYHA分級的老年慢性心衰患者的臨床療效差異有統(tǒng)計學意義(P0.05)。結論:老年心力衰竭優(yōu)化藥物治療能夠使老年心衰患者心功能顯著提高,改善生活質量,具有應用價值。年齡、性別和心力衰竭類型不是影響老年心力衰竭臨床療效的影響因素,而NYHA分級是影響老年心力衰竭臨床療效的影響因素。
[Abstract]:Background and objective: heart failure is prevalent in an aging global population, and the prevalence rate increases with age. Heart failure has become a heavy medical burden in developed countries and gradually in developing countries. In the last 30 years, there is no doubt that advances in the treatment of cardiovascular diseases, especially St segment elevation myocardial infarction (STEMI) and hypertension, have led to an increase in the number of non-elderly patients with these diseases surviving into old age. As a result, the number of elderly heart failure population further expanded. In this context cardiovascular disease risk factors and complications such as type 2 diabetes obesity hyperlipidemia and oxidative stress also contribute to heart failure end-stage heart disease and death. Current guidelines for the management of heart failure suggest that heart failure is the result of ventricular filling and impaired ejection function due to various structural and functional heart diseases. The American Cardiology Society Foundation / American Heart Association, the European Cardiology Society and the Chinese Medical Association Cardiovascular Society all recommend comprehensive treatment for current heart failure management guidelines. Importantly, these guidelines are based on data from randomized clinical trials of cardiovascular drug therapy, mostly in non-elderly male patients. Although the number of cardiovascular diseases in the older population is high, there is a lack of RCT data for the treatment of HF / REF- or HF- / PEF- for elderly patients with reduced ejection fraction. Despite these concerns and the limitations of RCT, the guidelines provide recommendations for drug and non-drug therapy in non-elderly and elderly patients with heart failure. There is no significant difference in treatment except for matters related to aging. The purpose of this study was to evaluate the efficacy of optimized drug therapy in elderly patients with heart failure, and to provide a basis for optimizing drug therapy in elderly patients with heart failure. Subjects and methods: 45 elderly patients with chronic heart failure who were treated in our hospital from July 2014 to July 2016 were selected to receive optimized drug therapy for heart failure. Left ventricular ejection fraction (LVEF) was measured by echocardiography before treatment and 6 months after the target dose was reached. The clinical efficacy of patients with heart failure was evaluated with Minnesotaliving with Heart Failure questionnaire (MLHFQ) and statistically analyzed. Results: systolic blood pressure, diastolic blood pressure, heart rate, New York York Heart Academy NYHA, left ventricular end-diastolic function (Left) and left ventricular diastolic (LVEDd) were significantly decreased in 45 elderly patients with heart failure before and after optimal treatment. Left ventricular ejection fraction (LVEF) significantly increased the scores of MLHFQ, the scores of physical and emotional fields were significantly decreased, and the differences were statistically significant (P < 0.05). After 6 months of optimal treatment, 19m 42.22) were effective and the remaining 613.33) were ineffective. Subgroup analysis showed that there was no significant difference in the clinical efficacy of elderly patients with chronic heart failure (CHF) with different age, sex and type of heart failure (P < 0.05), but there was a significant difference in the clinical efficacy of the elderly patients with CHF with different NYHA grades (P 0.05). Conclusion: optimization of drug therapy for elderly patients with heart failure can significantly improve cardiac function and improve quality of life in elderly patients with heart failure. Age, sex and type of heart failure were not the influencing factors for the clinical efficacy of heart failure in the elderly, while NYHA classification was the influencing factor for the clinical efficacy of heart failure in the elderly.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.6

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