左西孟旦注射液治疗心肌梗死后心力衰竭的疗效观察

发布时间：2018-04-26 15:48

本文选题：左西孟旦 + 心肌梗死　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:本研究旨在观察应用左西孟旦注射液治疗心肌梗死后心力衰竭患者的临床疗效以及安全性。方法:选取在青岛大学附属医院心内科及山东大学齐鲁医院(青岛)中医内科住院的心肌梗死后心力衰竭患者一共80例开展研究,将患者随机分成40例的对照组以及40例的治疗组,治疗组再随机分为治疗A组20例及治疗B组20例。对照组:给予患者常规治疗,包括利尿,扩血管,稳定斑块,抑制肾素-血管紧张素-醛固酮系统,从而控制患者的血压,在限钠和限水的同时,维持他们的水电解质平衡和酸碱平衡等,然后对心律失常情况进行纠正,给予他们抗感染相关治疗。治疗组患者在采用常规治疗基础上给予左西孟旦注射液,剂量为12.5毫克,加5%葡萄糖45毫升配成微量泵,最开始左西孟旦的应用负荷量是12微克/千克,注射的时间在10分钟以上,然后按0.1微克/(千克.分)泵入,1小时后逐渐提升至0.2微克/(千克.分),同时维持24小时,治疗A组应用左西孟旦一次,治疗B组在首次应用左西孟旦一周后再次应用左西孟旦,方法、剂量同首次使用。在患者进行治疗时给予其血压监测、心率监测、尿量测定以及心电图监测等,在负荷量及维持给药开始30-60分钟内密切观察患者反应,如出现低血压、心动过速等反应,则将输注速度减至0.05微克/(千克.分),甚至停药。观察测量患者治疗前后的临床症状、体征、6分钟步行实验、NT-pro BNP结果、左室舒张末内径(LVEDD)、左室射血分数(LVEF)进行分析比较。结果:对照组、治疗A组、治疗B组治疗前呼吸困难程度评分以及全身临床状况评分、运动耐量评价(6分钟步行实验)、血浆NT-pro BNP水平、左室舒张末内径、左室射血分数差别不大;各组患者治疗后,呼吸困难程度评分以及全身临床状况评分、6分钟步行距离、血浆NT-pro BNP水平、左室舒张末内径、左室射血分数与治疗前比较均有所改善,差异有统计学意义(均P0.05);治疗A组、治疗B组治疗后呼吸困难程度评分以及全身临床状况评分、6分钟步行距离、NT-pro BNP水平、左室舒张末内径、左室射血分数与对照组治疗后比较改善更明显,差异有统计学意义(均P0.05);治疗B组治疗后呼吸困难程度评分以及全身临床状况评分、6分钟步行距离、NT-pro BNP水平、左室舒张末内径、左室射血分数与治疗A组治疗后相比较均有所改善,但差异无统计学意义(P0.05)。结论:对于心肌梗死后心力衰竭患者,在常规治疗基础上使用左西孟旦能够更好的改善心功能,有较好的临床疗效。对于该类患者,首次使用左西孟旦一周后再次使用左西孟旦与使用一次左西孟旦相比更有助于改善心功能。左西孟旦不良反应较少,安全性良好。
[Abstract]:Objective: to observe the clinical efficacy and safety of levosimendan injection in the treatment of heart failure after myocardial infarction. Methods: a total of 80 patients with heart failure after myocardial infarction were selected from Department of Cardiology, affiliated Hospital of Qingdao University and Department of traditional Chinese Medicine, Qilu Hospital of Shandong University (Qingdao). The patients were randomly divided into control group (n = 40) and treatment group (n = 40). The treatment group (n = 20) was divided into two groups: group A (n = 20) and group B (n = 20). Control group: patients were given routine treatment, including diuretic, vasodilator, plaque stabilization, inhibition of renin-angiotensin-aldosterone system to control the patient's blood pressure, while limiting sodium and water, Maintain their water-electrolyte balance and acid-base balance, then correct arrhythmias and give them anti-infection related treatment. Patients in the treatment group were given levosimendan injection, 12.5 mg, plus 5% glucose 45 ml to form a micropump on the basis of routine treatment. The initial load of levosimendan was 12 渭 g / kg. The injection took more than 10 minutes, and then 0.1 渭 g / r (kg). The pump gradually rose to 0.2 渭 g / r (kg) after 1 hour of pumping. Group A was treated with levosimendan once, group B was treated with levosimendan again one week after the first application of levosimendan, method, dose was the same as the first time. The patients were given blood pressure monitoring, heart rate monitoring, urine volume monitoring and electrocardiogram monitoring when they were treated. Patients' reactions such as hypotension, tachycardia and so on were closely observed within 30-60 minutes of loading and maintenance administration. The infusion speed was reduced to 0.05 渭 g / r (kg). Even stop taking medicine. The clinical symptoms and signs of the patients before and after treatment were observed and compared with the results of NT-pro BNP, left ventricular end-diastolic diameter (LVEDDN) and left ventricular ejection fraction (LVEF). Results: compared with control group, treatment group A, group B had dyspnea score and systemic clinical status score before treatment, exercise tolerance evaluation and 6-minute walking test, plasma NT-pro BNP level, left ventricular end-diastolic diameter. There was no significant difference in left ventricular ejection fraction (LVEF). After treatment, the scores of dyspnea and systemic clinical status were 6 minutes walking distance, plasma NT-pro BNP level, left ventricular end-diastolic diameter. Left ventricular ejection fraction (LVEF) was significantly improved compared with that before treatment (all P 0.05), and the score of dyspnea after treatment in group A and the score of systemic clinical status were measured at 6 minutes walking distance and NT-pro BNP level in group A and group B, respectively. Left ventricular end-diastolic diameter, left ventricular ejection fraction (LVEF) were significantly improved after treatment compared with control group (all P 0.05), the score of dyspnea after treatment and the score of systemic clinical status in group B were significantly higher than those in control group (P < 0.05), and the 6-minute walking distance and the level of NT-pro BNP in group B were significantly higher than those in the control group (P < 0.05). Left ventricular end-diastolic diameter and left ventricular ejection fraction were improved compared with group A, but the difference was not statistically significant (P 0.05). Conclusion: for patients with heart failure after myocardial infarction, levosimendan on the basis of routine treatment can improve cardiac function better and has better clinical effect. For this group of patients, reusing levosimendan a week after the first use of levosimendan was more helpful in improving cardiac function than using levosimendan once. The adverse reaction of levosimendan is less and the safety is good.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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