培哚普利对血压偏低心力衰竭患者心功能及预后影响的研究

发布时间：2018-01-14 01:06

  本文关键词：培哚普利对血压偏低心力衰竭患者心功能及预后影响的研究　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 培哚普利 心力衰竭 缺血性心脏病 心功能 血压 预后

【摘要】：目的:心力衰竭是各种心血管疾病的终末阶段,其诊疗是21世纪心血管领域的一项重要课题。据统计,心衰患者中约15%~25%合并低收缩压,且这部分心衰患者预后较差。近年来,国内外指南均将ACEI推荐为心衰药物治疗的基石。但研究发现,缺血性心脏病作为心衰的主要病因之一,其心血管事件发生率与血压之间存在“J型曲线”关系。因此,对于血压偏低的缺血性心脏病心衰患者,应用ACEI类药物对血压的进一步影响及其和预后的关系值得特别关注,目前国内外相关文献和报道不多。本研究旨在观察培哚普利对血压偏低的缺血性心脏病心力衰竭患者心功能及近期预后的影响。方法:收集2015年12月至2016年12月于河北医大二院心血管内科住院,经治疗达到稳定状态的缺血性心脏病心力衰竭患者142例,其中男性71例,女性71例,患者血压(90mmHgSBP≤110mmHg),心功能NYHAⅡ~Ⅳ级,LVEF≤45%。随机分为培哚普利组和常规治疗组,两组患者均给予心衰常规治疗,培哚普利组患者在常规治疗基础上加用培哚普利2mg,1次/日,无特殊不适在服药2周后增至4mg,1次/日,若出现低血压、咳嗽等不良反应则改为2mg,1次/日,或酌情停药。随访周期为3个月,分别观察两组患者治疗前后NT-Pro BNP、LVEF和NYHA分级,记录心血管事件,并统计出院1个月和3个月的再住院率。结果:1两组患者性别、年龄、病史和服药情况等基线资料差异均无统计学意义(P0.05),具有可比性。2两组患者治疗后NT-Pro BNP水平均显著下降,两组间下降程度差异无统计学意义(F=0.154,P=0.696)。3两组患者治疗后LVEF均略有升高,提示心功能有所改善,两组间升高程度差异无统计学意义(F=0.835,P=0.362)。4培哚普利组治疗后NYHA心功能分级有所改善,与常规治疗组比心功能改善差异有统计学意义(Z=-1.363,P=0.037)。5两组患者的1个月再住院率差异无统计学意义(X~2=1.225,P=0.268,连续性校正)。培哚普利组患者3个月再住院率为3.9%,明显低于常规治疗组的13.8%,二者差异具有统计学意义(X~2=4.510,P=0.034),提示培哚普利有利于降低心衰患者3个月再住院率,改善近期预后。6所有142例患者无一失访,培哚普利组和常规治疗组在随访期间发生急性心肌梗死各有2例,因心衰加重再住院分别有3例(3.9%)和9例(13.8%)。培哚普利组患者发生咳嗽5例(6.17%),症状性低血压1例(1.23%)。结论:培哚普利对于血压偏低的缺血性心脏病心力衰竭患者,有利于改善心脏功能,降低再住院率,从而改善近期预后,未增加冠脉事件。
[Abstract]:Objective: heart failure is the terminal stage of various cardiovascular diseases, its diagnosis and treatment is an important subject in the field of cardiovascular in 21th century. According to statistics, about 15% of patients with heart failure associated with low systolic blood pressure. In recent years, ACEI has been recommended as the cornerstone of drug therapy for heart failure in China and abroad. However, it has been found that ischemic heart disease is one of the main causes of heart failure. There is a "J curve" relationship between the incidence of cardiovascular events and blood pressure. Therefore, in patients with ischemic heart failure with low blood pressure. The further effects of ACEI on blood pressure and its relationship with prognosis deserve special attention. The purpose of this study was to observe the effects of perindopril on heart function and short-term prognosis in patients with ischemic heart disease with low blood pressure. From December 2015 to December 2016, we were hospitalized in Department of Cardiovascular Medicine, second Hospital of Hebei Medical University. 142 patients (71 males and 71 females) with stable ischemic heart failure (SBP 鈮，

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