舒张性与收缩性心力衰竭患者临床特征的对比研究

摘要

目的 探讨舒张性心力衰竭(DHF)与收缩性心力衰竭(SHF)临床特征的差异.方法 回顾性分析苏州大学附属第一医院因心力衰竭住院的826例患者的临床资料,根据左室射血分数(LVEF)及相关指标分为DHF组385例与SHF组441例,分析两组患者各参数之间的差异.结果 DHF组患者385例(占46.6%),多见于年长、女性患者,高血压心脏病和冠心病分别是DHF的第一、二位病因.SHF组左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)增大,QRS时限延长;而DHF患者心室腔无明显扩大,但室壁增厚明显,且房颤发生率高.DHF组NYHA分级Ⅳ级、肝肾功能受损、住院死亡率及1年内再次住院率均显著低于SHF组,血管紧张素转化酶抑制剂(ACEI)、地高辛、血管活性药物、利尿剂、β-受体阻滞剂、他汀类药物、安体舒通的应用明显低于SHF患者.结论 与SHF患者相比,DHF患者病情严重程度较轻,住院死亡率及1年内因心力衰竭再次入院的事件发生率低,预后相对较好.利尿剂是改善DHF症状的有效药物,肾素-血管紧张素系统(RAS)阻滞剂和β-受体阻滞剂能改善DHF患者的预后.%Objective To probe into the difference in clinical characteristic between patients with diastolic heart failure ( DHF ) and systolic heart failure ( SHF ) . Methods The clinical data of 826 inpatients with congestive heart failure in our department, who were divided into DHF group ( n =385 ) and SHF group ( n =441 ) according to their left ventricular ejection fraction ( LVEF ) and the relative indicators, were retrospectively analyzed to to find the differences in parameters between the two groups. Results DHF was diagnosed in 385 patients ( 46. 6% ), who were mostly older and of females. And the first two etiologies for them were hypertensive heart disease and coronary heart disease respectively. In SHF group, left ventricular end - diastolic diameter ( LVEDD ) and left ventricular end systolic diameter ( LVESD ) were increased, and QRS duration was prolonged; while in DHF group no markble enlargement of ventricular chamber was found, but remarkable hypertrophy of ventricular wall was presented, and a higher prevalence of atrial fibrillation was found. Compared with SHF group, in the DHF group the New York Heart Association ( NYHA ) ]V class, hepatic and renal function impairment, mortality during hospitalization and rate of recurrent hospitalization in one year were all decreased significantly; and the medication of angiotensin - converting enzyme inhibitors, digoxin, vasoactive agents, diuretics, β - receptor blockers, statins, and antisterone were obviously reduced. Conclusion Compared with patients with SHF, the patients with DHF have milder conditions, lower mortality of hospitalization and the ratio of recurrent hospitalization in one year, with a relative good prognosis. Diuretics are the effective medication for improvement DHF symptoms, and renin - angiotensin system ( RAS ) and p - receptor blockers can improve the prognosis of DHF patients.