左西孟旦治疗老年顽固性心力衰竭临床疗效及安全性分析

发布时间：2018-05-26 10:43

本文选题：老年人 + 顽固性心力衰竭　；参考：《延安大学》2014年硕士论文

【摘要】：目的心力衰竭是一种严重威胁人类健康的疾病，与其他疾病相比具有很高的致残率、致死率，明显影响患者的生活质量，流行病学调查显示，65岁以上人群中内科住院治疗的最主要原因为心力衰竭。左西孟旦作为一种新型钙离子增敏剂问世已有十余年。左西孟旦作用机制不同于传统抗心衰药物，左西孟旦增加心肌收缩力的主要机制是钙离子选择性的与肌钙蛋白C结合，在不改变心肌细胞内钙离子浓度的情况下增加心肌收缩力。近年来，左西孟旦治疗顽固性心力衰竭成为心衰药物治疗的研究热点，左西孟旦已被心衰指南推荐为心力衰竭药物治疗的重要组成部分但其有效性及安全性研究尚少，故本研究正是为了观察该药在老年顽固性心力衰竭临床治疗中的疗效及安全性。方法本研究纳入样本量总共72例，选自2012年11月-2013年4月陕西省人民医院心内科72例住院患者(高血压、扩张型心肌病、冠状动脉粥样硬化性心脏病)，心功能分级为III-IV级（NYHA分级），均符合纳入标准，分实验组（左西孟旦组）与对照组（传统抗心衰药物组），各36例，接受左西孟旦及传统抗心衰治疗。两组患者入院后分别给予心电监护、卧位休息、氧疗、同时洋地黄类、利尿剂、AECI/ARB、血管扩张剂治疗，在上述药物治疗基础上，一组加用左西孟旦治疗，另一组继续抗心衰药物治疗。用药期间，持续24小时心电监测两组患者的血压与心率变化。用药后1天及3天评估呼吸困难症状及心衰分级有无好转。观察两组治疗前后氨基末端脑钠肽前体（NT-proBNP）水平、同时检测血液生化（肝功能、肾功能、电解质）等实验室观察指标。行心脏B超分别观察两组用药前及治疗后1天及3天左室射血分数（LVEF）、左室短轴缩短率（FS）、左室舒张末期容积（LVEDD）等指标。结果1.基本资料特征：所选入组患者年龄73-88岁之间，平均值80.4±7.1岁，，两组间的年龄差异不具有统计学意义(P0.05)，两组间性别差异不具有统计学意义(P0.05)。2.治疗3天后，左西孟旦组和对照组的呼吸困难好转率分别为94.4%与75%，左西孟旦组的呼吸困难改善情况好于对照组（P0.05）。左西孟旦组的呼吸困难好转最少达到有效的可能性是对照组的5.7倍。治疗3天后，心功能有效达33例，总有效率89%，优于对照组的72%（P0.05）,左西孟旦组心功能分级提高至少达到有效的可能性是对照组的4.2倍。3.与治疗前相比，左西孟旦组LVEF（49.8±7.9%），FS（30.6±4.8%）和对照组的LVEF（45.0±9.0%）,FS(28.1±3.6%）均明显增高（P0.05）。左西孟旦组LVEF和FS值与对照组比较有统计学意义（P0.05）,左西孟旦组的LVEF和FS值增高较明显。4.与治疗前相比，左西孟旦组的NT-proBNP数值（1675.5±446.8pg/ml）与对照组（1955.1±404.4pg/ml）均显著回落（P0.05）；左西孟旦组NT-proBNP降低较对照组具有统计学意义（P0.05）。5.安全性评价：治疗期间，左西孟旦组频发室性早搏出现2例，对照组3例（P0.05）。治疗后，两组患者心率数值轻度降低，两组之间的降低幅度无统计学差异，两组患者均未出现严重肝肾功能不全等情况。左西孟旦组患者均无收缩压90mmHg。结论1.左西孟旦药物老年顽固性心力衰竭患者疗效显著，能快速缓解心功能衰竭临床症状。2.左西孟旦能明显改善老年顽固性心力衰竭患者的血流动力学参数，提高左室射血分值，改善患者心功能。3.左西孟旦短期应用于治疗老年顽固性心衰患者临床观察安全可行。
[Abstract]:Objective heart failure is a serious threat to human health. Compared with other diseases, it has a high rate of disability and mortality, which obviously affects the quality of life of the patients. Epidemiological investigation shows that the most important reason for the hospitalization of internal medicine in the population over 65 years old is the exhaustion of Internal Medicine. The mechanism of left Simendan action is different from that of traditional anti heart failure drugs. The main mechanism of left Simendan's increase of myocardial contractility is the combination of calcium ion selectively and troponin C, which increases myocardial contractility without changing the intracellular calcium concentration. In recent years, levosimendan has been used to treat refractory heart failure. For the research hotspot of drug therapy for heart failure, left Simendan has been recommended as an important component of heart failure drug treatment, but the study of its effectiveness and safety is few. Therefore, this study is to observe the efficacy and safety of the drug in the clinical treatment of senile refractory heart failure.
Methods a total of 72 samples were selected from 72 hospitalized patients (hypertension, dilated cardiomyopathy, coronary atherosclerotic heart disease) in the Department of Cardiology, Shaanxi People's Hospital, November 2012 -2013, and the cardiac function classification was III-IV grade (NYHA grade), which were all conformed to the inclusion criteria and divided into the experimental group (Zuo Simendan group) and the control group. The anti heart failure drug group), 36 cases were treated with levosimendan and traditional anti heart failure. The two groups were given ECG monitoring, recumbent rest, oxygen therapy, and rehmannia, diuretic, AECI/ARB, vasodilator treatment. On the basis of the treatment, one group was treated with levosimendan, and the other continued anti heart failure medication. During the medication, the blood pressure and heart rate of the two groups were monitored for 24 hours. The symptoms of dyspnea and the grade of heart failure were evaluated at 1 and 3 days after the medication. The level of the amino terminal brain natriuretic peptide (NT-proBNP) before and after treatment in the two groups was observed, and the blood biochemistry (liver function, renal function and electrolyte) were measured at the same time. The left ventricular ejection fraction (LVEF), left ventricular short axis shortening (FS) and left ventricular end diastolic volume (LVEDD) were observed before and after 1 and 3 days after treatment in two groups.
Results 1. basic data characteristics: the age of the selected group was 73-88 years old, the average value was 80.4 + 7.1 years old. The age difference between the two groups was not statistically significant (P0.05). The gender differences between the two groups did not have statistical significance (P0.05).2. treatment for 3 days, and the improvement rate of dyspnea in left Simendan and control groups was 94.4% and 75%, respectively, left Simendan. The improvement of respiratory difficulty in the group was better than that of the control group (P0.05). The respiratory difficulty of the left Simendan group was 5.7 times more effective than the control group. 3 days after the treatment, the heart function was effective in 33 cases, the total effective rate was 89%, superior to the control group (72% (P0.05)), and the improvement of the cardiac function classification at least in the left Simendan group was at least the effective possibility. The 4.2 times.3. of the group was LVEF (49.8 + 7.9%), FS (30.6 + 4.8%) and LVEF (45 + 9%) in the control group and FS (28.1 + 3.6%) in the left Simendan group (P0.05). The value of LVEF and FS in Zuo Simendan group was statistically significant compared with the control group (P0.05), and the LVEF and FS value of the left Simendan group was higher than that before and before the treatment, left Simendan. The NT-proBNP values of the group (1675.5 + 446.8pg/ml) and the control group (1955.1 + 404.4pg/ml) were all significantly decreased (P0.05), and the NT-proBNP reduction in the left Simendan group was statistically significant (P0.05).5. security evaluation: during the treatment, 2 cases of frequent ventricular premature beat appeared in the left Simendan group and 3 cases in the control group (P0.05). After treatment, the heart rate of the two groups was in the two group. There was no statistical difference between the two groups. There was no severe liver and renal dysfunction in the two groups. There was no systolic pressure of 90mmHg. in the left Simendan group.
Conclusion 1. levosimendan drugs in elderly patients with intractable heart failure are effective, and can quickly relieve the clinical symptoms of heart failure.2. left Simendan can significantly improve the hemodynamic parameters of elderly patients with refractory heart failure, improve the value of left ventricular ejection, and improve the short-term application of.3. left Simendan in the treatment of senile obstinacy. The clinical observation of patients with heart failure is safe and feasible.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.6

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