培哚普利在慢性缺血性心力衰竭合并血压偏低患者中的安全性及耐受性的研究

发布时间：2018-06-08 10:13

  本文选题：培哚普利 + 慢性缺血性心力衰竭　； 参考：《河北医科大学》2017年硕士论文

【摘要】：目的:心力衰竭的高发病率及高死亡率已经严重威胁到了人类的生命与健康,心力衰竭的治疗依然是全世界疾病治疗中的难题,近些年来心力衰竭的循证医学证明ACEIs是心衰治疗的基石,但同时ACEIs又影响心衰患者的血压,而血压作为反应全身血流动力学的指标,跟心血管疾病预后又有着密切的联系,据流行病学统计有15%-25%的心衰患者合并低收缩压,且血压偏低的心衰患者死亡率明显升高,特别是冠心病患者可能存在血压J点,本临床实验旨在观察慢性缺血性心力衰竭合并血压偏低患者在应用小剂量培哚普利期间的血压变化情况及安全性。方法:收集2015年12月至2016年12月就诊于河北医科大学第二医院心内三科的缺血性心脏病心力衰竭患者81例,其中男性42例(51.9%),女性39例(48.1%),平均年龄60.52±7.62岁,NYHA分级Ⅱ-Ⅳ级,LVEF≤45%,其中Ⅱ级37例(45.7%),Ⅲ级28例(34.6%),Ⅳ16例(19.7%)。经过休息、限制钠盐与水量摄入以及应用抗血小板聚集、降脂、扩冠、利尿剂等基础治疗后收缩压≤110mmHg,除外应用ACEIs类药物的禁忌症。给予培哚普利2mg,1次/天,14天后若无不良反应发生,且SBP≥90mmHg,则增至4mg,1次/天,若不能耐受,退至上次剂量。随访时间30天。观察指标:诊室血压、家庭血压、24小时动态血压、血肌酐、血钾水平等指标的变化情况。结果:1 69名受试者能耐受培哚普利4mg,1次/天,无低血压发生,用药前后血压下降不明显,出院时收缩压(102mmHg)较入院时收缩压(106mmHg)下降了4mmHg,家庭平均收缩压(100mmHg)较出院时收缩压(102mmHg)下降了2mmHg,统计学上有差异(106(6)vs 102(4)vs 100(4),F=91.838,P0.001),入院时、出院时、家庭平均舒张压比较(67(6)vs 64(7.5)vs 62(6),F=25.223,P0.001),用药前后只下降了2mmHg,且无心绞痛等冠脉事件或血管神经性水肿等不良反应。用药前及用药30天后24小时动态血压监测结果比较:24hSBP(102.0(6.0)vs 100.0(4.5),F=7.562,P=0.008),统计学上有差异,治疗后较治疗前下降2mmHg;24hDBP比较(65.0(7.5)vs 63(4.5),F=3.922,P=0.052),统计学上无差异。血肌酐及血钾水平(Cr 67.4ummol/l vs 70.1ummol/l,P=0.058;K+4.2mmol/l vs 4.2mmol/l,P=0.192)用药前后统计学上无差异。2 8名受试者能耐受2mg,1次/天;1名受试者应用2mg培哚普利期间出现症状性低血压而终止服用培哚普利。3 5名受试者出现干咳反应(6.2%),其中3名出现严重干咳不能耐受培哚普利的治疗,且多为老年女性,平均年龄≥74岁。结论:1大多数血压偏低的慢性心衰患者能耐受小剂量培哚普利,未发生明显低血压相关症状。2长时间应用小剂量培哚普利对于血压偏低的慢性心衰患者的远期预后尚待进一步研究。
[Abstract]:Objective: the high incidence and high mortality rate of heart failure have seriously threatened human life and health. The treatment of heart failure is still a difficult problem in the treatment of diseases all over the world. In recent years, evidence-based medicine for heart failure has proved that ACEIs are the cornerstone of heart failure treatment, but at the same time, ACEIs also affect the blood pressure of patients with heart failure, and blood pressure, as an indicator of systemic hemodynamics, is closely related to the prognosis of cardiovascular disease. According to epidemiological statistics, 15% to 25% of patients with heart failure complicated with low systolic blood pressure, and the mortality rate of patients with heart failure with low blood pressure was significantly increased, especially in patients with coronary heart disease, who may have blood pressure J points. The purpose of this clinical trial was to observe the changes and safety of blood pressure in patients with chronic ischemic heart failure complicated with hypotension during the use of low dose perindopril. Methods: from December 2015 to December 2016, 81 patients with heart failure with ischemic heart disease were collected from the second Hospital of Hebei Medical University. The mean age was 60.52 卤7.62 years old. The LVEF of NYHA grade 鈪，

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