参附注射液联合连续性血液滤过治疗难治性心力衰竭疗效观察

发布时间：2018-04-10 03:36

本文选题：难治性心力衰竭　切入点：参附注射液　出处：《新乡医学院》2017年硕士论文

【摘要】：背景据欧洲心脏病学会统计,全世界范围内的成人慢性心力衰竭多因冠状动脉缺血及心肌炎所致,两者累积高达2600万,每年新发入院确诊并且伴有心力衰竭的患者约260万,一年内死亡率高达17%-45%。由于心力衰竭患者多因感染等多种因素导致急性发作需要反复住院,给社会造成沉重的医疗负担,其治疗费用约占所有医疗支出的1%-2%。然而,心力衰竭的治疗目前仍是一个难题,许多心衰患者虽然用了多种手段进行治疗,效果仍然不理想。连续性血液滤过是目前临床上常用的一项治疗技术,被广泛应用到各种原因所致的低心排的难治性心力衰竭的治疗中。这项治疗技术对水肿严重的患者进行持续稳定的脱水排炎症因子治疗,可明显减轻体内液体容量超负荷,从而改善利尿剂抵抗。可是,部分患者在经过超滤治疗后会出现乏力、畏寒、肺水肿及胸腔积液引起呼吸用难、小便次数多及肢体无力等症状,这些属于中医气阳两虚的表现,倘若能够给予适当的回阳救逆、益气摄血治疗,就能够促进血液滤过后心衰患者身体状况快速恢复,症状得到改善与缓解。来源于《重订严氏济生方》收录的参附汤的参附注射液就因具有此特殊功效被常用于临床治疗,它能够增强心脏收缩能力和改善心功能,提高心脏血液输出量,改善患者血压,起到调节血压的作用,而且能够通过降低心脏前后负荷、调节血压和保护心肌细胞的作用,许多研究证实明显优于西医单纯治疗。目的观察心力衰竭基础治疗上给予参附注射液联合连续性血液滤过(CRRT)治疗难治性心力衰竭的疗效。方法1.选取2015年12月至2016年12月入住河南省人民医院住院病人诊断为难治性心力衰竭的病42例,随机分成对照组和试验组,即每组各21例。两组均给予心力衰竭指南基础药物治疗(洋地黄、血管紧张素转化酶抑制剂、β受体阻滞剂、醛固酮拮抗剂、利尿剂)及在此基础上的连续性血液滤过治疗。试验组另给予参附注射液静脉输注,对照组则给予相同剂量的5%葡萄糖注射液作为安慰剂。两组患者均治疗7天。2.监测治疗前后2组患者体重、收缩压、心率、24小时尿量;抽血监测血浆氨基-末端脑利钠肽原(NT-proBNP)水平;彩超观察患者左室射血分数(LVEF)变化;中医证候积分评估症状、明尼苏达心力衰竭生活质量问卷表评分情况。结果1.治疗后晨起测血压、心率、体重均较同组治疗前下降,24小时尿量较前增多,差异性有统计学意义(P0.05);两组间对比,试验组血压、心率下降更明显(P0.05),差异具有统计学意义,而两组间体重及24小时尿量变化不明显(P0.05)。2.治疗后两组患者NT-proBNP水平均较同组治疗前明显下降(P0.05),且试验组较对照组下降更明显(P0.05);而在LVEF方面,两组治疗后较同组治疗前有升高,而试验组较对照组升高更为明显(P0.05)。3.各组治疗后患者明尼苏达心力衰竭生活质量问卷表评分较治疗前下降(P0.05);与对照组相比,试验组下降更明显(P0.05)。结论在心力衰竭基础药物治疗上应用参附注射液联合血液滤过能够使难治性心力衰竭患者NT-proBNP水平明显持续下降、左室射血分数得到改善,生活质量得到提高,病人治疗依从性更好,获得更大收益,具有重要的临床意义。
[Abstract]:According to the background of the European Society of Cardiology statistics, worldwide adult coronary artery ischemia and chronic heart failure due to myocarditis caused by the accumulation of up to 26 million, annual new cases diagnosed with heart failure and about 2 million 600 thousand patients, one year mortality rate as high as 17% -45%. due to heart failure patients with bacterial infection and other factors lead to acute attack repeatedly the hospital, causing heavy burden to the society, the treatment costs accounted for all medical expenses 1%-2%.. However, the treatment of heart failure is still a problem, a lot of heart failure patients while using a variety of means of treatment, the effect is still not ideal. Continuous hemofiltration is a common clinical treatment technology, treatment refractory heart failure has been widely applied to various reasons caused by the low cardiac output. The treatment technique for patients with severe edema For sustained dehydration and discharging of inflammatory factors in the treatment, can significantly reduce the fluid volume overload, thereby improving the diuretic resistance. However, some patients appear weak, after ultrafiltration treatment will chills, pulmonary edema and pleural effusion caused by respiratory, urinary frequency and limb weakness and other symptoms, which belongs to the Chinese medicine Qi and yang two virtual performance, if can give appropriate Yang deficiency, tonifying qi and blood treatment, can promote the rapid recovery of the physical condition of patients with heart failure after hemofiltration, symptoms improved with ease. From the Re < Yan Ji Sheng Fang > included Shenfu Decoction of Shenfu injection is due to the special effects is commonly used in clinical treatment, it can enhance the capacity and improve the heart function of heart contraction, increase heart output, improve blood pressure, to adjust the blood pressure, but also can reduce the heart before and after negative The load, regulating blood pressure and protect myocardial cells. Many studies have demonstrated significantly better than simple treatment of Western medicine. Objective To observe the treatment of heart failure based on the given Shenfu injection combined with continuous hemofiltration (CRRT) treatment of refractory heart failure. 42 patients were selected from December 2015 to December 2016 1. in Henan Province People's Hospital inpatients diagnosed with refractory heart failure, were randomly divided into control group and experimental group, 21 cases in each group. The two groups were given the heart failure guideline based drug treatment (digitalis, angiotensin converting enzyme inhibitors, beta blockers, aldosterone antagonists, diuretics) and continuous hemofiltration therapy on the basis of the experimental group was given Shenfu. Intravenous injection of 5% Glucose Injection, the control group were given the same dose as placebo. Two patients were treated for.2. monitoring for 7 days 2 groups of patients before and after weight, systolic blood pressure, heart rate, 24 hour urine volume; monitoring blood plasma amino terminal brain natriuretic peptide (NT-proBNP) level; color Doppler ultrasound observation of patients with left ventricular ejection fraction (LVEF) changes; TCM syndrome integral evaluation of heart failure symptoms, Minnesota quality of life questionnaire score. Results 1. after treatment the early morning blood pressure, heart rate, body weight decreased significantly compared with the group before treatment, 24 hour urine volume increased more than before, has a statistically significant difference (P0.05); the comparison between the two groups, the experimental group blood pressure, heart rate decreased significantly (P0.05), the difference was statistically significant, but the change of weight between the two groups and 24 hour urine volume is not obvious (P0.05) after.2. treatment in patients with NT-proBNP levels of two groups were significantly decreased compared with before treatment (P0.05), and the test group decreased more significantly than the control group (P0.05); but in LVEF, the two groups after treatment compared with the group before treatment increased, while the experimental group than in the control Group increased more significantly (P0.05) in.3. group after treatment of patients with heart failure in Minnesota quality of life questionnaire score decreased (P0.05); compared with the control group, the test group decreased significantly (P0.05). Conclusion the application of Shenfu injection combined with hemofiltration in heart failure therapy based on the level of NT-proBNP in patients with refractory to congestive heart failure was significantly decreased, left ventricular ejection fraction was improved, and improve the quality of life of patients, better treatment compliance, and get more profits, has important clinical significance.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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