左西孟旦治疗难治性心力衰竭的临床分析

发布时间：2018-05-28 13:42

本文选题：左西孟旦 + 难治性心力衰竭　；参考：《天津医科大学》2015年硕士论文

【摘要】：目的:分析左西孟旦治疗难治性心力衰竭的临床效果,为临床规范化应用左西孟旦提供依据。方法:选取天津市胸科医院CICU收治的难治性心力衰竭患者261例,其中缺血性心肌病者154例,非缺血性心肌病者107例,均接受标准心力衰竭治疗。根据是否应用左西孟旦,将缺血性心肌病致心力衰竭患者分为:对照组(n=59)与用药组(n=95);非缺血性心肌病致心力衰竭患者分为:对照组(n=54)与用药组(n=53)。将261例病人中应用左西孟旦治疗的患者,根据原发疾病不同分为:非缺血性心肌病(NICM)组(n=53)与缺血性心肌病(ICM)组(n=95);根据年龄分为:非老龄组(n=66)与老龄组(n=82)(中华医学会规定60岁老龄89岁)。监测指标:(1)患者用药前及用药结束48小时(对照组在观察的相同时间点)Na、K、Cl、Hb、Cre、BUN、UA、TnT、NT-pro BNP的变化;(2)患者用药前及用药结束48小时(对照组在观察的相同时间点)心脏彩色多普勒超声的相关数值:LV、PAP、LVEF;(3)患者用药前及用药开始后(对照组在观察的相同时间点)1小时、24小时、48小时及72小时血压;(4)患者用药结束后(对照组在观察的相同时间点)48小时及第7天的NYHA分级;(5)患者住院时间;(7)患者住院死亡率。结果:1、在缺血性心肌病致心力衰竭患者中,用药前后LV、LVEF、PAP、NT-proBNP、TnT、BUN、Cre、UA的差值及心功能NYHA分级的改善水平,用药组优于对照组,P0.05;用药前后K、Na及Hb降低程度,用药组大于对照组,P0.05;在用药后患者的住院时间及住院期间死亡率比较,两组无统计学差异,P0.05。2、在非缺血性心肌病致心力衰竭患者中,用药前后LVEF、NT-proBNP、TnT、UA的差值及用药结束后48小时心功能NYHA分级的改善水平,用药组优于对照组,P0.05;用药前后K及Hb的降低程度,用药组大于对照组,P0.05;用药前后LV、PAP、BUN、Cre、Na的差值及用药结束后第7天心功能NYHA分级改善水平及患者住院时间、住院死亡率,两组无统计学差异,P0.05。3、在NICM组与ICM组的患者中:在用药前后LVEF、LV、PAP、NT-proBNP、TnT、BUN、Cre的差值,心功能NYHA分级的改善水平及患者住院时间及患者住院死亡率,ICM组优于NICM组,P0.05;而UA及K的改变NICM组优于ICM组,P0.05;用药前后Na、Hb及血压变化,两组无统计学差异,P0.05。4、在非老龄组与老龄组的患者中:左西孟旦均可以提高患者的LVEF水平,降低PAP、NT-proBNP、TnT、BUN、UA及血压,改善LV及心功能NYHA分级水平;在治疗前后NT-proBNP、TnT、Cre的差值及用药结束后第7天心功能NYHA分级的改善水平,老龄组优于非老龄组,P0.05;在治疗前后LV、LVEF、PAP、BUN、UA、K、Na、Hb,血压变化、患者住院时间及住院死亡率之间,两组无统计学差异,P0.05。结论:1、左西孟旦可以明显改善难治性心力衰竭患者的LVEF、NT-pro BNP、TnT、UA与用药结束后48小时心功能NYHA分级水平,降低患者血压及血清K和Hb水平,能改善缺血性心肌病导致的难治性心力衰竭患者的LV、PAP、BUN、Cre及用药结束后第7天心功能NYHA分级水平,但对两种疾病所导致的心力衰竭患者的住院时间及住院死亡率无影响。2、与非缺血性心肌病导致的难治性心力衰竭患者相比,左西孟旦可以更好的改善缺血性心肌病导致的难治性心力衰竭患者的LVEF、NT-proBNP、TnT、BUN、Cre及用药结束后48小时心功能NYHA分级水平,降低患者住院时间及住院死亡率。3、与非老龄难治性心力衰竭患者相比,左西孟旦可以更好的改善老龄难治性心力衰竭患者的NT-proBNP、TnT、Cre及用药结束后第7天心功能NYHA分级的水平,但对老龄患者和非老龄患者住院时间及住院死亡率无影响。
[Abstract]:Objective: to analyze the clinical effect of levosimendan on refractory heart failure, and to provide a basis for clinical standardization of levosimendan. Methods: 261 patients with refractory heart failure treated in Tianjin Thoracic Hospital, CICU, including 154 patients with ischemic cardiomyopathy and 107 cases of non ischemic cardiomyopathy, were treated with standard heart failure. The patients with heart failure caused by ischemic cardiomyopathy were divided into the control group (n=59) and the medication group (n=95), and the patients with heart failure caused by non ischemic cardiomyopathy were divided into two groups: the control group (n=54) and the drug group (n=53). The patients with 261 patients who were treated with Zuo Ximeng were divided into non ischemic myocardium according to the difference of the primary disease. Disease (NICM) group (n=53) and ischemic cardiomyopathy (ICM) group (n=95); according to age: non aging group (n=66) and aging group (n=82) (89 years old aged 60 years old in Chinese Medical Association). Monitoring indexes: (1) patients before and 48 hours of drug use (control group at the same time point of observation) Na, K, Cl, Hb, Cre, BUN, wasting, (2) patients The correlation values of color Doppler echocardiography before and after 48 hours at the same time of the control group (the control group were observed at the same time point): LV, PAP, LVEF; (3) the patient's blood pressure was 1 hours, 24 hours, 48 hours and 72 at the same time point of the control group (the control group was observed at the same time); (4) after the use of the control group (the control group was observed at the same time. Points) NYHA grade of 48 hours and 7 days; (5) patients' hospitalization time; (7) patient mortality. Results: 1, in patients with heart failure induced by ischemic cardiomyopathy, the difference of LV, LVEF, PAP, NT-proBNP, TnT, BUN, Cre, UA, and the improvement of cardiac function NYHA grades were better than those of the control group, P0.05; K, K, and decreased degrees before and after medication, The medication group was larger than the control group, P0.05. The two groups had no statistically significant difference in hospitalization time and hospitalized mortality rate after medication, P0.05.2. In patients with heart failure caused by non ischemic cardiomyopathy, the difference between LVEF, NT-proBNP, TnT, UA before and after medication and the level of NYHA grade of cardiac function 48 hours after the end of drug use were better than those in the treatment group. The reduction of K and Hb before and after the use of P0.05 was greater than that of the control group, P0.05, the difference between LV, PAP, BUN, Cre, Na, and the level of cardiac function NYHA grading seventh days after the drug use and the hospitalization time, the mortality of the patients, the two groups were not statistically different, P0.05.3, in the NICM group and the patients before and after the drug use. The difference between AP, NT-proBNP, TnT, BUN, Cre, the improvement of the cardiac function NYHA grade and the patient's time of hospitalization and patients' hospitalization mortality, ICM group was better than the NICM group, P0.05, while UA and K were better than those in the group, and the two groups were not different in the old group and the aged group: Zuo Ximeng Dan can improve the LVEF level of patients, reduce PAP, NT-proBNP, TnT, BUN, UA and blood pressure, improve the level of LV and cardiac function NYHA grading, and the improvement level of NT-proBNP, TnT, Cre, and seventh days after the treatment, and the aging group is better than the non aging group. There was no statistical difference between the two groups in the two groups. 1, levosimendan could significantly improve the LVEF, NT-pro BNP, TnT, UA and the NYHA grade of cardiac function at 48 hours after the end of drug use, reducing the blood pressure and serum K and Hb levels in the patients, and improving the cause of ischemic cardiomyopathy. LV, PAP, BUN, Cre, and seventh days of cardiac function NYHA grading after the end of drug use in patients with refractory heart failure, but the time of hospitalization and mortality in patients with heart failure caused by two diseases have no effect on.2, and left Simendan can better improve ischemia compared to those with refractory heart failure caused by non ischemic cardiomyopathy. LVEF, NT-proBNP, TnT, BUN, Cre, and 48 hours cardiac NYHA grading levels after the end of drug use in patients with sexual cardiomyopathy, lower hospitalization time and hospitalized mortality.3, and compared with non aged patients with refractory heart failure, levosimendan can better improve NT-proBNP in elderly patients with refractory heart failure. TnT, Cre and the NYHA grading of cardiac function at seventh days after the end of treatment, but had no effect on the hospitalization time and mortality of elderly and non elderly patients.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.6

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