前列地尔治疗老年高血压所致良性小动脉性肾硬化症临床疗效观察

发布时间：2018-01-06 09:09

本文关键词：前列地尔治疗老年高血压所致良性小动脉性肾硬化症临床疗效观察　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:研究前列地尔注射液在治疗老年高血压引起的良性小动脉性肾硬化症的临床疗效;观察前列地尔注射液对肾脏的保护作用;观察前列地尔注射液治疗良性小动脉性肾硬化症的安全性。方法:选择2013年11月到2014年11月在承德市中心医院老年病科住院的老年原发性高血压所致良性小动脉性肾硬化症患者,入选病例共100例,随机分为试验组与对照组。入选患者均符合以下三项诊断标准:一、良性小动脉性肾硬化症的诊断标准,即:①符合原发性高血压诊断标准。②高血压病程一般大于10年。③尿常规提示有轻至中度蛋白尿,尿镜检有形成份少。④常伴随视网膜动脉硬化改变。⑤排除原发、继发性肾脏疾病。二、入选患者均符合2010年由中国高血压联盟和国家心血管病中心颁布的《中国高血压防治指南2010》为依据的高血压诊断标准。三、入选患者均符合我国老年人的诊断标准,即大于60岁。入选前需排除继发性高血压患者;原发、继发肾脏疾病患者;严重心功能不全患者;青光眼及高眼压患者;既往有胃溃疡及消化道出血患者;间质性肺炎患者;糖尿病肾病患者;对前列地尔制剂有过敏史患者;有其他危及生命的严重疾病(如恶性肿瘤等)患者。剔除中途要求停止用药以及未按照试验设计方法用药者;剔除因感染或其他因素,在治疗过程导致肾功能损害者。所有入选病人均给予常规的控制血压治疗,首先给予生活方式干预:控制体重,合理运动,戒烟限酒,调整心态,保持乐观情绪;选择降压药物时需首选ACEI类药物如依那普利,如果因不良反应等不能耐受则选择ARB类药物如厄贝沙坦,根据血压水平必要时辅以钙离子拮抗剂如氨氯地平或β受体阻滞剂如比索洛尔治疗,尽量避免使用利尿剂,以免干扰观察指标。试验组在常规治疗方法上给予静脉泵入0.9%氯化钠注射液50毫升+前列地尔注射液10微克,每日一次治疗,治疗14天后判断前列地儿对良性小动脉性肾硬化症的治疗效果及安全性。结果:两组患者在性别比例、年龄分布、既往吸烟饮酒史、用药前血压水平、用药前肾功能水平(包括血尿素氮、血肌酐、血尿酸)、24小时尿蛋白定量、尿微量白蛋白排泄率等指标方面均无显著的统计学差异,具有可比性(P0.05)。两组入选患者经过14天的治疗后,试验组的总有效率达到96.00%,明显高于对照组的有效率52%(P0.05);两组患者的肾功能情况包括血尿素氮、血肌酐、血尿酸水平及患者的24小时尿蛋白定量、尿微量白蛋白排泄率均有下降,而试验组治疗后的上述指标明显低于对照组(P0.05),具有统计学意义;治疗前后两组患者血压水平无统计学差异,治疗后两组患者血压均达标,均在130/80mm Hg以下;同时试验组及对照组治疗过程中均未发现患者不能耐受的明显不良反应,实验组有两例患者用药过程中出现输液局部皮肤发红、疼痛,但患者可以耐受,治疗过程不受影响。治疗后检测肝功能、血常规等未发现与应用药物损伤相关的异常变化。结论:前列地尔注射液可以用于治疗老年高血压所致良性小动脉性肾硬化症,并能改善患者肾脏的损害情况,起到保护肾功能作用,疗效显著,副作用小,值得推广。
[Abstract]:Objective: To study the clinical curative effect caused by Alprostadil Injection in the treatment of hypertension in the elderly benign arteriolar nephrosclerosis; observe the Alprostadil Injection protective effect on the kidney; to evaluate the safety of Alprostadil Injection for the treatment of benign arteriolar nephrosclerosis. Methods: from November 2013 to November 2014 in the Department of geriatrics in elderly hospitalized in Chengde Central Hospital in patients with primary hypertension caused by benign arteriolar nephrosclerosis, a total of 100 selected patients were randomly divided into experimental group and control group. All patients met the following criteria: three, diagnostic criteria, benign arteriolar nephrosclerosis is: consistent with the diagnosis of primary hypertension. The general hypertension duration greater than 10 years. The urine routine suggestive of mild to moderate proteinuria, microscopic examination of urine visible components. The less often associated with retinal arteriosclerosis. The change in primary, Secondary kidney disease. Two patients conformed to 2010 promulgated by the China hypertension alliance and the National Center for cardiovascular disease: guidelines for prevention and treatment of hypertension 2010> Chinese hypertension diagnostic criteria. Three patients were accorded with the diagnostic standard of the elderly in China, which is more than 60 years old. Selected before secondary hypertension were excluded; primary and secondary kidney disease; severe heart failure patients and patients with high intraocular pressure; glaucoma; patients with a gastric ulcer and gastrointestinal bleeding; interstitial pneumonia; diabetic nephropathy; patients with a history of allergy to alprostadil preparation; other life-threatening serious diseases (such as cancer and patients) excluding the half-way stop medication. And not in accordance with the experimental design method of the drug; removed due to infection or other factors that lead to the loss of renal function in the course of treatment. All the patients were given often Control blood pressure gauge, given lifestyle intervention first: weight control, reasonable exercise, quit alcohol limit, attitude adjustment, optimistic mood; be preferred ACEI drugs such as enalapril choose antihypertensive drugs, if because of adverse reaction of intolerance to select ARB drugs such as irbesartan, according to blood pressure levels when necessary with calcium ion antagonists such as amlodipine or beta blockers such as bisoprolol treatment, to avoid the use of diuretics, so as not to interfere with the observation index. The experimental group was given intravenous infusion of 50 ml of 0.9% Sodium Chloride Injection + Alprostadil Injection 10 micrograms in the conventional treatment methods, treatment once a day, 14 days after treatment of Alprostadil in benign arteriolar nephrosclerosis treatment the effect and safety of judgment. Results: the age distribution of patients in the two groups in sex ratio, smoking history, drinking history, blood pressure level before treatment, before treatment of kidney Function level (including blood urea nitrogen, serum creatinine, blood uric acid), 24 hour urinary protein, showed no significant statistical difference of urinary albumin excretion rate and other indicators, comparable (P0.05). Two groups of patients after 14 days of treatment, the experimental group's total effective rate reached 96%. The effective rate was significantly higher than the control group 52% (P0.05); renal function in the patients of the two groups including blood urea nitrogen, serum creatinine, blood uric acid level of patients and 24 hour urinary protein, urinary albumin excretion rate decreased, and the index of experimental group after treatment was significantly lower than the control group (P0.05), with statistical significance; no statistical difference between the two groups in the level of blood pressure before and after treatment, after treatment, the blood pressure of the two groups are standard, all in the 130/80mm below Hg; at the same time, the experimental group and the control group in the course of treatment without obvious adverse reaction in patients intolerant of the experiment Group infusion of local skin redness, appeared in two patients during the treatment of pain, but patients can be tolerated, the treatment process is not affected. The detection of liver function after treatment, blood routine changes were found associated with the application of drug injury. Conclusion: Alprostadil Injection can be used in the treatment of senile hypertension caused by benign arteriolar nephrosclerosis, and patients can improve the kidney damage, to protect renal function, obvious curative effect, little side effect, it is worthy of promotion.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1;R692

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