摘要目的 回顾分析慢性心力衰竭(心衰)住院患者病因学及近期预后的变迁.方法 从住院病历数据库中检索出1993年1月1日-2007年12月31日出院的心衰住院患者7319例,以5年为期分成1993-1997、1998-2002、2003-2007三个时间段,分析比较三个时间段心衰住院患者病因、诱因、并存疾病以及30 d病死率的变迁.结果 (1)7319例心衰患者中,男性占62.07%(P<0.01).1993-1997、1998-2002、2003-2007三个时问段平均住院年龄依次为(56.0±17.5)岁、(57.8±17.6)岁、(62.7±15.5)岁,逐渐增大(P<0.01).平均住院时间分别为(31.3±17.4)d、(22.7±14.1)d、(20.1±15.2)d,呈逐渐缩短(P<0.01).(2)心衰病因主要是冠心病、高血压病、风湿性心脏瓣膜病(风心病)、糖尿病.从1993-1997至2003-2007时间段,冠心病从37.2%升至46.8%,高血压病从23.3%增至46.7%,糖尿病由12.3%升至21.1%,风心病由35.2%减至16.6%(均为P<0.05).(3)心衰主要诱因或并存疾病主要是心房颤动、心肌梗死(心梗)、肺炎、慢性阻寒性肺病和肾功能衰竭.从1993-1997至2003-2007时间段,心房颤动始终是心衰最常见的诱因(23.2%、23.2%和20.6%),心梗、肺炎、肾功能衰竭分别从11.0%、8.9%及5.2%增至14.7%、14.5%和9.1%,而慢性阻寒性肺病由12.9%降至8.4%(均为P<0.05).(4)三个时间段住院30 d病死率依次为7.0%、4.5%、5.1%,其中近10年的两个时间段心衰病死率均低于1993-1997时间段(均为P<0.05).50～79岁之间的三个年龄段心衰病死率减少最明显(分别从4.5%、8.O%和11.9%降为1.6%、3.1%和6.6%,均为P<0.05).男性病死率较女性下降明显(分别从7.2%、6.8%降为5.0%、5.2%,P<0.05).不同心衰病因中,由冠心病、高血压病、肺心病引起的病死率呈逐渐下降趋势,其中由冠心病引起的病死率下降最为明显,三个时间段依次为9.3%、5.O%和3.8%(均为P<0.05).不同诱因或并存疾病中仅有合并心梗的心衰患者30 d病死率有明显降低(P<0.05),三个时间段病死率依次为21.8%、18.3%和11.1%.合并4～5种疾病的心衰患者30 d住院病死率下降最明显(P<0.05).结论 15年来,心衰病因以冠心病、高血压病、糖尿病、风心病为主,前L二者呈递增趋势,而风心病呈递减趋势.心衰合并多种疾病的比例增加.30 d住院病死率呈下降趋势,其中以冠心病为病因或合并心梗的心衰患者30 d病死率下降最明显.

abstractsObjective To investigate the etiological and prognostic changes of hospitalized patients with chronic heart failure.Methods This retrospective study analyzed 7319 hospitalized patients (male 62.07%)with validated primary discharge diagnosis of chronic heart failure in Chinese PLA General Hospital in Beijing from January 1,1993 to December 31,2007.Etiological characteristics,comorbidities and 30-day hospitalized mortality in the following three periods:1993-1997(n=1623),1998-2002 (n=2444),and 2003-2007(n=3252)were compared.Results (1) The patient age increased[(56.0 ±17. 5) years, (57. 8 ± 17.6) years and (62. 7 ± 15.5) years, P <0. 01 ] and hospital stay time decreased [ (31.3 ± 17.4) days, (22. 7 ± 14. 1 ) days and (20. 1 ± 15.2) days, P <0. O1 ] from 1993 to 2007. (2)The common causes of heart failure were coronary heart disease, hypertension, rheumatic valvular heart disease and diabetes mellitus. From 1993 - 1998 to 2003 -2007, the proportion of patients with coronary heart disease,hypertension and diabetes mellitus rose from 37. 2% ,23.3% and 12. 3% to 46. 8%, 46. 7%and 21.1%, respectively (all P < 0. 05 ). Meanwhile the proportion of patients with rheumatic valvular heart disease fell from 35.2% to 16. 6% (P < 0. 05 ). (3) The main etiologies and comorbidities were atrial fibrillation, myocardial infarction, pneumonia, chronic obstructive pulmonary disease and renal failure.From 1993 -1998 to 2003 -2007, atrial fibrillation was the most common cause of heart failure, and the rate of myocardial infarction,pneumonia and renal failure rose from 11.0% ,8. 9% and 5.2% to 14. 7% ,14.5 % and 9. 1%, respectively ( all P < 0. 05 ) and the rate of COPD fell from 12. 9% to 8. 4% ( P < 0. 05 ).(4) The 30-day hospitalized mortalities in the three periods were 7.0% 、4. 5% and 5. 1%, respectively,and the mortalities in the 1998 -2002 and 2003 -2007 periods were lower than those of in the 1993 -1998period( all P < 0. 05 ). The mortality related to coronary heart disease decreased significantly from 1993 to 2007 ( 9. 3%, 5.0% and 3.8% in the three periods, respectively, P < 0. 05 ) . Conclusions It is demonstrated that the primary diseases causing heart failure were coronary heart disease, hypertension,diabetes mellitus and rheumatic valvular heart disease, and the former three diseases exhibited a upward trend and the later one exhibited a downward trend. Moreover, the proportion of comorhidities in patients with heart failure increased over the study period. The 30-day hospital mortality exhibited a downward trend and decreased significantly in patients with coronary heart disease or myocardial infarction.