左西孟旦治疗老年重度心力衰竭的疗效评价

发布时间：2018-05-27 10:04

本文选题：左西孟旦 + 老年患者　；参考：《山东大学》2017年硕士论文

【摘要】：目的:研究分析老年重度心力衰竭患者应用左西孟旦治疗的临床效果。方法:参与本次实验的老年重度心力衰竭患者共138例,所有患者均为我院2014年1月-2015年12月期间收治的,按照随机数字表法将其分成两组,分别为研究组(n=68)和参照组(n=70)。研究组中,有冠状动脉粥样硬化性心脏病的患者49例,老年性退行性心脏瓣膜病患者15例,扩张性心肌病患者4例;参照组中,有冠状动脉粥样硬化性心脏病的患者51例,老年性退行性心脏瓣膜病患者16例,扩张性心肌病患者3例。对两组患者均行常规心衰治疗方法,与此同时研究组患者给予一次左西孟旦(悦文,规格:5ml,12.5mg/支,齐鲁制药)注射治疗,初始10min给予负荷量为12μg/kg静脉推注,继而以0.1μg/(kg·min)微量泵入,1h后将输注速率增至0.2μg/(kg·min)持续24h;参照组加用米力农注射液治疗7d。治疗前、用药第8d及出院1个月分别进行临床症状评估,并抽血化验NT-proBNP,超声检查LVEF和FS及安全性评价。结果:(1)两组呼吸困难改善及心衰定量标志物NT-proBNP水平比较结果:①治疗前研究组与参照组呼吸困难Borg评分分别为(8.2±1.3)、(8.3±1.4),经治疗第8天呼吸困难症状均有所改善,Borg评分分别为(1.2±0.5)、(2.6±0.7),均明显低于治疗前,差异存在统计学意义(P0.05);治疗后两组间比较,研究组更低,差异具有统计学意义(P0.05),提示研究组对呼吸困难的改善效果更好;②治疗前研究组的NT-proBNP水平为(26842.6±411.4),参照组的为(26783.3±488.4),两组对比并无明显差异(P0.05)。治疗第8天,研究组的 NT-proBNP 水平(10274.6±445.7),参照组为(12956.2士403.5)。均较治疗前明显降低,差异存在统计学意义(P0.05);两组间比较,研究组NT-proBNP水平更低于参照组,差异存在统计学意义(P0.05)。出院1个月复查研究组(n=55)的 NT-proBNP 水平(7012.6±415.3),参照组(n=56)为(9526.2±423.5),均较入院时明显降低,差异存在统计学意义(P0.05);组间比较研究组NT-proBNP水平更低于参照组,差异存在统计学意义(P0.05)。(2)两组超声检查指标的比较结果:①在治疗前,研究组的LVEF为(35.06±4.9),参照组的为(34.07±4.8),两组比较无明显差异(P0.05)。用药治疗第8天,研究组LVEF为(36.67±4.8),参照组为(35.53±4.6)。两组左室射血分数较治疗前改善不明显(P0.05);两组间比较,亦无明显差异(P0.05)。出院1个月复查研究组(n=55)的LVEF为(41.06±4.2),参照组(n=56)的LVEF为(38.07±4.3),均较治疗前改善,差异存在统计学意义(P0.05),两组间比较研究组LVEF高于参照组,差异存在统计学意义(P0.05)。②研究组与参照组治疗前左心室短轴缩短率(FS)分别为(17.63±2.8)、(17.42±2.7),用药治疗第8天研究组FS为(22.66±2.7),参照组FS为(20.02±2.5),两组与治疗前相比,差异均存在统计学意义(P0.05)。两组间相比,研究组改善效果更明显,差异具有统计学意义(P0.05);出院1个月复查研究组(n=55)与参照组(n=56)FS分别为(26.63±2.8)、(22.42±2.7),均较治疗前改善,差异存在统计学意义(P0.05),两组间比较研究组FS高于参照组,差异存在统计学意义(P0.05)。(3)安全性对比情况:在用药7天内参照组中出现2例低血钾、1例头痛头晕、2例低血压、3例室性心律失常,不良反应发生率为11.42%(8/70),除了1例低血钾患者给予补钾、1例低血压患者减慢输液速度、1例室速和1例室早二联律患者,经抗心律失常治疗后恢复,其余不良反应都较轻,无需处理;研究组中出现1例头痛、1例低血压,不良反应发生率为2.94%(2/68),且不良反应均较轻,未特殊治疗自行恢复。出院1个月复查肝功、肾功两组均未见明显异常,研究组(n=55)无不良反应发生,参照组(n=56)有1例低血钾,考虑服用利尿剂所致。结论:左西孟旦可有效改善老年重度心力衰竭患者的呼吸困难等症状,安全性高。
[Abstract]:Objective: To study and analyze the clinical effect of levosimendan on elderly patients with severe heart failure. Methods: 138 cases of elderly patients with severe heart failure were enrolled in this experiment. All the patients were treated in our hospital during December -2015 December. They were divided into two groups according to the random digital table method, which were the study group (n=68) and reference, respectively. Group (n=70). In the study group, there were 49 patients with coronary atherosclerotic heart disease, 15 cases of senile degenerative heart valvular disease, 4 cases of dilated cardiomyopathy, 51 cases with coronary atherosclerotic heart disease, 16 cases of senile degenerative heart valvular disease, 3 cases of dilated cardiomyopathy in the reference group, and 3 cases of dilated cardiomyopathy. Two The patients in the group were treated with conventional heart failure treatment. At the same time, the patients in the study group were given an injection of levosimendan (Yue Wen, specification: 5ml, 12.5mg/ branch, Qilu pharmaceutical). Initial 10min was injected with a load of 12 mu g/kg, then 0.1 micron g/ (kg. Min) was injected, and the infusion rate was increased to 0.2 u g/ (kg. Min) after 1h, and the reference group added Before treatment with Milrinone Injection for 7d. treatment, the clinical symptoms were evaluated by 8D and 1 months discharged from hospital, and NT-proBNP, LVEF and FS and safety evaluation were examined by ultrasonography. Results: (1) the results of two groups of dyspnea and the comparison of the level of NT-proBNP in the heart failure: (1) the pre treatment group and the reference group of the dyspnea Borg The scores were (8.2 + 1.3) and (8.3 + 1.4). The symptoms of dyspnea after eighth days were improved. The Borg score was (1.2 + 0.5) and (2.6 + 0.7), respectively. The difference was statistically significant (P0.05). The study group was lower and the difference was statistically significant (P0.05) after the treatment of the treatment group (P0.05), suggesting that the study group had difficulty in breathing. The NT-proBNP level of the study group was (26842.6 + 411.4) and the reference group was (26783.3 + 488.4), and there was no significant difference between the two groups (P0.05). The level of NT-proBNP in the study group (10274.6 + 445.7) and the reference group were (12956.2 403.5). The difference was significantly lower than that before the treatment (P0.05 Compared with the two groups, the NT-proBNP level of the study group was lower than the reference group, the difference was statistically significant (P0.05). The level of NT-proBNP in the study group (n=55) was 1 months after discharge (7012.6 + 415.3), and the reference group (n=56) was (9526.2 + 423.5), and the difference was significantly lower than that of the admission group (P0.05); the NT-proBNP level of the study group was compared with the group (P0.05). More than the reference group, the difference was statistically significant (P0.05). (2) the comparison of the two groups of ultrasound examination indexes: (35.06 + 4.9) before the treatment, the reference group was (34.07 + 4.8), the two groups had no significant difference (P0.05). The treatment group was treated for eighth days, the study group was (36.67 + 4.8), and the reference group was (35.53 + 4.6). The two group left ventricular ejection. The blood fraction was not significantly improved before the treatment (P0.05), and there was no significant difference between the two groups (P0.05). The LVEF of the 1 month reexamination study group (n=55) was (41.06 + 4.2), and the LVEF in the reference group (n=56) was (38.07 + 4.3), and the difference existed statistically significant (P0.05), and the LVEF in the two groups was higher than the reference group, and the difference existed in the group. Study significance (P0.05). (2) the short axis shortening rate of left ventricle (FS) in the study group and the reference group was (17.63 + 2.8), (17.42 + 2.7), and FS in the study group was (22.66 + 2.7) for eighth days, and FS in the reference group was (20.02 + 2.5). The difference was statistically significant (P0.05) compared with the treatment group (P0.05). Compared with group two, the improvement effect of the study group was more obvious, The difference was statistically significant (P0.05); the 1 month reexamination study group (n=55) and the reference group (n=56) FS were respectively (26.63 + 2.8) and (22.42 + 2.7), respectively, compared with before treatment, the difference was statistically significant (P0.05). The difference between the two groups was higher than the reference group, the difference was statistically significant (P0.05). (3) the safety contrast: within 7 days of drug use In the reference group, there were 2 cases of hypokalemia, 1 cases of headache and dizziness, 2 cases of hypotension, 3 cases of ventricular arrhythmia, the incidence of adverse reaction was 11.42% (8/70). Except 1 cases of hypokalemia patients were given potassium supplementation, 1 cases of hypotension were slowed down, 1 cases of ventricular tachycardia and 1 cases of ventricular early two were recovered, and the other adverse reactions were mild. In the study group, there were 1 cases of headache, 1 cases of hypotension, the incidence of adverse reaction was 2.94% (2/68), and the adverse reactions were all mild and no special treatment was recovered. There were no obvious abnormalities in the two groups of the two groups in the 1 months of discharge. The study group (n=55) had no adverse reactions, and the reference group (n=56) had 1 cases of hypokalemia and considered taking diuretics. Conclusion: Levosimendan can effectively improve dyspnea and other symptoms in elderly patients with severe heart failure, and has high safety.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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