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丹参多酚酸盐联合曲美他嗪治疗慢性心力衰竭的效果观察 被引量:10

The effect of salvianolate combined Qumei trimetazidine on chronic heart failure
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摘要 目的 探讨丹参多酚酸盐联合曲美他嗪对慢性心力衰竭患者心功能的影响.方法 慢性心力衰竭患者74例,应用随机数字表随机分为对照组37例和治疗组37例.对照组给予洋地黄制剂、利尿剂、扩张血管药物、血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体阻断剂(ARB)或β受体阻滞剂治疗,疗程24周;治疗组在常规治疗基础上加用丹参多酚酸盐0.2g加入5%葡萄糖注射液250 ml或0.9%氯化钠注射液250 ml中静脉滴注,每日1次;曲美他嗪20 mg口服,每日3次,疗程24周.观察两组患者治疗前后心功能及脑钠肽的变化.结果 对照组与治疗组治疗24周后心功能均明显好转,总有效率分别为70.3%(26/37)和91.9%(34/37),两组比较差异有统计学意义(x2 =5.638,P<0.05).治疗组治疗前左心室射血分数(LVEF)、每搏输出量(SV)、心输出量(CO)分别为(39±5)%、(46.53±12.14) ml、(4.79±1.02) L/min,治疗后分别为(52±7)%、(65.10±12.87) ml、(5.65±1.18) L/min,治疗前后比较差异均有统计学意义(t值分别为9.192、6.384、3.352,P均<0.01);治疗组治疗前收缩压、舒张压、心率、舒张末期左心室内径(Dd)、舒张期左心室后壁厚度(PWT)、舒张期室间隔厚度(IVST)、左心室质量(LVMW)、血浆脑钠肽分别为(134±12) mmHg、(84±8)mmHg、(118±11)次/min、(55.2±7.8) mm、(11.7±2.3) mm、(10.5±2.4) mm、(228±111)g、(568.7±179.5)ng/L,治疗后分别为(105±8) mmHg、(75±9) mmHg、(76±8)次/min、(48.7±3.7)mm、(9.1±1.4) mm、(8.7±1.2)mm、(170±59)g、(104.1±19.5) ng/L,治疗前后比较差异均有统计学意义(t值分别为-12.231、-4.546、-18.782、-4.579、-5.874、-4.080、-2.806、15.652,P均<0.01).对照组治疗前LVEF、SV分别为(38±6)%、(46.76±11.80) ml,治疗后分别为(43±8)%、(58.69±11.58) ml,治疗前后比较差异均有统计学意义(t值分别为3.041、4.389,P均<0.05);对照组治疗前收缩压、心率、PWT、血浆脑钠肽分别为(132±10) mmHg、(116±10)次/min、(11.5±2.6) mm、(570.2±177.3)ng/L,治疗后分别为(116±11) mmHg、(77±9)次/min、(10.4±2.0) mm、(211.6±21.2) ng/L,治疗前后比较差异均有统计学意义(t值分别为-6.546、-17.632、-2.039、12.215,P均<0.01).治疗组治疗后收缩压、舒张压、LVEF、SV、CO、Dd、PWT、IVST、LVMW、血浆脑钠肽均明显优于对照组(t值分别为-4.919、-2.867、5.150、2.252、2.851、-2.319、-3.238、-3.628、-2.231、-22.701,P<0.01或<0.05).结论 丹参多酚酸盐联合曲美他嗪治疗慢性心力衰竭效果显著,对左心室有逆转作用. Objective To explore the effect of salvianolate combined with Qumei trimetazidine on cardiac function in patients with chronic heart failure.Methods Seventy-four patients with chronic heart failure were randomly divided into treatment group and control group (37 cases per group).Patients in control group were treated with the regular treatment scheme including digitalis,diuretics,vasodilators,angiotensin converting enzyme inhibitor(ACEI),angiotensin receptor blockers (ARB) or β blocker therapy for 24 weeks treatment.Patients in treatment group were given the regular treatment scheme plus salvianolic acid and Qumei trimetazidine treatment,of which,the dose of salvianolic was 0.2 g into 5% glucose injection 250 ml or 0.9% sodium chloride injection 250 ml by intravenous injection,1 times/day,and Qumei trimetazidine for 20 mg,3 times/day,for 24 weeks.Cardiac function was observed in patients of two groups before and after treatment.The level of brain natriuretic peptide (BNP) was measured.Results Heart function were improved,the total effective rate in treatment group was 91.9% (34/37),higher than that of control group (70.3% (26/37),x2 =5.638,P < 0.05).In treatment group,left ventricular ejection fraction (LVEF),stroke volume (SV),cardiac output (CO) of patients after treatment were (52 ± 7) %,(65.10 ± 12.87) ml,(5.65 ± 1.18) L/min respectively,significant different from that before treatment ((39 ±5)%,(46.53 ± 12.14) ml,(4.79 ± 1.02) L/min,and the differences were statistic significant (t =9.192,6.384,3.352,P < 0.05).Meanwhile,in treatment group,systolic pressure,diastolic pressure,heart rate,left ventricular end diastolic diameter (Dd),left ventricular diastolic posterior wall thickness(PWT),interventricular septal thickness (IVST),left ventricular mass (LVMW),plasma brain natriuretic peptide of patients after treatment were (105 ± 8) mmHg,(75 ± 9) mmHg,(76±8) time/min,(48.7 ±3.7) mm,(9.1 ±1.4) mm,(8.7 ±1.2) mm,(170±59) g,(104.1 ±19.5) ng/L respectively,significant different from that of before treatment((134 ± 12) mmHg,(84 ±8) mmHg,(118 ±11) time/min,(55.2 ±7.8) mm,(11.7 ±2.3) mm,(10.5 ±2.4) mm,(228 ± 111) g,(568.7±179.5) ng/L t=-12.231,-4.546,-18.782,-4.579,-5.874,-4.080,-2.806,15.652,P < 0.01).The same trend was seen in control group in terms of LVEF,SV,systolic blood pressure,heart rate,PWT,plasma BNP before and after treatment(LVEF:(38 ±6)% vs.(43 ± 8)% ;:(46.76 ± 11.80) ml vs.(58.69 ± 11.58) ml; systolic blood pressure:(132 ± 10) mmHg vs.(116 ± 11) mmHg; heart rate:(116 ± 10) time/min vs.(77 ±9) time/min;PWT:(11.5 ±2.6) mm vs.(10.4 ±2.0) mm;plasma BNP:(570.2 ± 177.3) ng/L vs.(211.6 ± 21.2) ng/L;t =3.041,4.389;-6.546,-17.632,-2.039,12.21 ;P < 0.05 or P < 0.01).Moreover,after treatment,systolic pressure,diastolic pressure,LVEF,SV,CO,Dd,PWT,IVST,LVMW,plasma brain natriureticpeptide in treatment group were significantly better than that of control grouo (t =-4.919,-2.867,5.510,2.252,2.581,-2.319,-3.238,-3.628,-2.231,-22.701,P <0.01 or P < 0.05).Conclusion The effect of salvianolate combined Qumei trimetazidine on treating chronic heart failure is significant,and there is a reverse effect on the left ventricle.
出处 《中国综合临床》 2014年第3期231-235,共5页 Clinical Medicine of China
关键词 心力衰竭 丹参多酚酸盐 曲美他嗪 心功能 Heart failure Salvianolate Qumei trimetazidine Heart function
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