摘要
目的探讨老年缺血性心肌病心力衰竭采用左西孟旦联合冻干重组人脑利钠肽治疗的效果研究。方法 120例缺血性心肌病所致急性失代偿性心力衰竭的患者(超声心动图检查左心室射血分数≤40%)作为研究对象,按照随机数字表法分为对照组和观察1组、观察2组、观察3组,每组30例,对照组给予常规基础药物治疗,在此基础上,观察1组给予左西孟旦治疗,观察2组给予冻干重组人脑利钠肽治疗,观察3组给予左西孟旦联合冻干重组人脑利钠肽治疗,3 d后评价疗效、左心功能[左心室舒张末期内经(LVEDD)、每搏输出量(SV)、心脏指数(CI)、左心室射血分数(LVEF)]、各项标志物水平[超敏C-反应蛋白(hs-CRP)、血清氨基末端脑钠肽(NT-proBNP)及胱抑素(CysC)]、生命体征[心率(HR)、呼吸频率(RR)、收缩压(SBP)、血氧饱和度(SaO_2)]变化。结果观察3组治疗有效率明显高于观察2组观察1组和对照组(P<0.05);治疗前4组LVEDD、SV、CI及LVEF比较差异均无统计学意义(P>0.05),治疗后4组LVEDD、SV、CI及LVEF均较治疗前明显升高,观察3组LVEDD、SV、CI和LVEF较对照组升高更明显(P<0.05);4组治疗后平均尿量均较治疗前增加,且观察3组增加更明显(P<0.05);4组治疗后NTproBNP、hs-CRP和CysC均较治疗前降低,且观察3组明显低于对照组(P<0.05);4组治疗前HR、RR、SBP、SaO_2比较差异无统计学意义(P>0.05),治疗后观察3组HR、RR、SBP、SaO_2较其他3组明显改善,差异有统计学意义(P<0.05)。结论左西孟旦联合冻干重组人脑利钠肽老缺血性心肌病老年难治性缺血性心肌病心力衰竭临床效果更明显,能促进心功能的改善,抑制心室重构,降低各心肌损伤标准物水平,具有积极的临床意义。
Objective To investigate the clinical effects of levosimendan combined with lyophilization of recombinant human brain natriuretic peptide in treatment of senile ischemic cardiomyopathy complicated by heart failure.Methods A total of 120 patients with acute decompensated heart failure due to ischemic cardiomyopathy(echocardiographic left ventricular ejection fraction≤40%)who were admitted and treated in our hospital from June 2015 to December 2016 were enrolled in the study.According to the random number table method,these patients were divided into control group,observation group 1,observation group 2 and observation group 3,with 30 cases in each group.The patients in control group were treated by conventional basic drugs,on this basis,the patients in observation group 1 were treated by levosimendan,and the patients in observation group 2 were treated by lyophilized recombinant human brain natriuretic peptide,however,the patients in observation group 3 were treated by levosimendan combined with lyophilized recombinant human brain natriuretic peptide.After 3-day treatment,the therapeutic effects,left heart function indexes imcluding LVEDD,SV,CI and LVEF,the other indexes levels including hs-CRP,NT-proBNP and CysC,and vital signs including HR,RR,SBP,SaO 2 were observed and compared among the four groups.Results The effective rate in observation group 3 was 93.33%,which was significantly higher than that(80%)in observation group 2 and that(76.67%)in observation group 1 as well as that(70%)in control group(P<0.05).Before treatment there were no significant differences in the levels of LVEDD,SV,CI and LVEF among the four groups(P>0.05).After treatment,the levels of LVEDD,SV,CI,and LVEF were significantly increased in the four groups,moreover,the the levels of these indexes in observation group 3 were significantly higher than those in control group(P<0.05).After treatment the average urine volume was increased in the four groups,moreover,the increase degree in observation group 3 was more significant(P<0.05).In addition after treatment the levels of NT-proBNP,hs-CRP,and CysC were decreased in the four groups,as compared with those before treatment,moreover,which in observation group 3 were significantly lower than those in control group(P<0.05).Before treatment there were no significant differences in the levels of HR,RR,SBP and SaO 2 among the four groups(P>0.05).After treatment,the levels of HR,RR,SBP and SaO 2 in observation group 3 were significantly improved,as compared with those in the other three groups(P<0.05).Conclusion The levosimendan combined with lyophilized recombinant human brain natriuretic peptide has obvious therapeutic effects on senile refractory ischemic cardiomyopathy complicated by heart failure,which can promote the improvement of cardiac function,inhibit ventricular remodeling,and reduce the levels myocardial injury markers,therefor,which has an active clinical significance.
作者
王伟红
李萍
陈雨
石奇松
WANG Weihong;LI Ping;CHEN Yu(The Second Hospital of Baoding City,Hebei,Baoding 071000,China)
出处
《河北医药》
CAS
2018年第14期2131-2134,共4页
Hebei Medical Journal
基金
保定市科学技术研究与发展计划项目(编号:17ZF021)
关键词
老年缺血性心肌病心力衰竭
左西孟旦
冻干重组人脑利钠肽
效果研究
enile ischemic cardiomyopathy
heart failure
levosimendan
lyophilized recombinant human brain natriuretic peptide
effect research
作者简介
通讯作者:石奇松,071000,河北省保定市第二医院,E-mail:shitou8088@sina.com。
