单硝酸异山梨酯注射液联合舒血宁治疗急性心肌梗死合并急性左心衰疗效分析被引量：29

Study on the efficacy of isosorbide mononitrate injection combined with Shuxuening injection in treatment of patients with acute myocardial infarction associated with acute left heart failure

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摘要目的探讨单硝酸异山梨酯注射液联合舒血宁治疗急性心肌梗死(AMI)合并急性左心衰患者的效果。方法前瞻性选取2014年3月至2017年8月首都医科大学附属北京友谊医院收治的82例AMI合并急性左心衰患者,按照随机数字表法分为两组,每组各41例。观察组采用单硝酸异山梨酯注射液、舒血宁联合治疗,对照组采用单硝酸异山梨酯注射液治疗。两组患者均给予吸氧、抗血小板聚集、拮抗心脏内分泌、调脂、抗凝、防止心脏重构、利尿等基础治疗。治疗3周后,比较两组患者的治疗效果、心功能及呼吸衰竭改善情况、影像学结果[左心室高峰充盈率(LVPFR)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]及用药安全性,并检测比较治疗前后两组心衰标志物[肌酸激酶(CK)、N端-前脑利钠肽(NT-pro BNP)、内皮素-1(ET-1)]及病情相关因子[血浆超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)]水平变化。结果观察组患者肺部啰音、呼吸困难及胸痛、心功能Killip分级改善效果优于对照组,总有效率为82. 93%,高于对照组的63. 41%(P <0. 05);治疗后两组平均动脉压、心率比较,差异无统计学意义(P> 0. 05),而与治疗前相比,两组心率明显降低(P <0. 05),平均动脉压无明显变化(P> 0. 05);治疗后观察组LVPFR、LVEDD、LVEF改善幅度大于对照组(P <0. 05);治疗后观察组CK(234. 20±24. 85)U/L、NT-pro BNP(527. 91±38. 44) ng/L、ET-1(16. 54±2. 86) ng/L、MDA(5. 02±0. 85) nmol/L、TNF-α(30. 28±3. 18)ng/L、IL-6(201. 48±21. 02) ng/L低于对照组CK(287. 47±28. 66) U/L、NT-proBNP(859. 24±63. 47) ng/L、ET-1(21. 69±3. 47) ng/L、MDA(7. 49±1. 57) nmol/L、TNF-α(42. 26±2. 47) ng/L、IL-6(275. 36±32. 18) ng/L(P <0. 05),SOD(261. 78±14. 44) n U/L高于对照组(210. 54±12. 83) n U/L(P <0. 05);两组患者恶心呕吐(2. 44%vs. 2. 44%)、头晕头痛(2. 44%vs. 7. 32%)、心源性休克(0. 00%vs. 2. 44%)、乏力(4. 88%vs. 2. 44%)等发生率比较,差异无统计学意义(P> 0. 05)。结论单硝酸异山梨酯注射液联合舒血宁治疗AMI合并急性左心衰患者在影像学、症状体征、心衰标志物、心功能等方面均具有显著改善效果,且能有效改善机体氧化应激状态,不影响患者血压,安全性较高。 Objective To explore the efficacy of isosorbide mononitrate injection combined with Shuxuening injection in treatment of patients with acute myocardial infarction(AMI)associated with acute left heart failure.Methods A total of 82 patients with AMI associated with acute left heart failure in this hospital during March 2014 to August 2017 were prospectively selected for this study,they were divided into two groups according to random number table method,41 cases in each group.Patients in control group were treated with isosorbide mononitrate injection,and patients in observation group were treated with isosorbide mononitrate injection and Shuxuening injection.Patients in these two groups were given with oxygen inhalation,anti-platelet aggregation,antagonizing cardiac endocrine,lipid regulation,anticoagulation,prevention of cardiac remodeling,diuresis and other basic treatment.After treatment for 3 weeks,the effect of treatment,improvements of cardiac function and respiratory failure,imaging results[left ventricular peak filling rate(LVPFR),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)]and the safety of drug administration were compared between these two groups.The changes in levels of markers of heart failure[creatine kinase(CK),N Terminal-natriuretic peptide(NT-proBNP),endothelin-1(ET-1)],and related factors of the disease[plasma superoxide dismutase(SOD),malondialdehyde(MDA),tumor necrosis factor-alpha(TNF-α)and interleukin 6(IL-6)]were detected and compared between these 2 groups before and after treatment.Results The improvement of pulmonary rales,dyspnea,chest pain and Killip classification of cardiac function in patieents of observation group were better than those of patients in control group,and the total effective rate(82.93%)was higher than that of control group(63.41)(P<0.05).After treatment,there was no significant difference in mean arterial pressure and heart rate between these two groups(P>0.05),while in comparison with those before treatment,the heart rate in patients of these two groups had been significantly decreased(P<0.05),and there was no significant change in mean arterial pressure(P>0.05).After treatment,the ranges of improvement in LVPFR,LVEDD and LVEF in patients of observation group were larger than those of patients in control group(P<0.05).After treatment,the levels of CK(234.20±24.85)U/L,NT-proBNP(527.91±38.44)ng/L,ET-1(16.54±2.86)ng/L,MDA(5.02±0.85)nmol/L,TNF-α(30.28±3.18)ng/L,and IL-6(201.48±21.02)ng/L in observation group were lower than those of control group.CK(287.47±28.66)U/L,NT-proBNP(859.24±63.47)ng/L,ET-1(21.69±3.47)ng/L,MDA(7.49±1.57)nmol/L,TNF-α(42.26±2.47)ng/L,and IL-6(275.36±32.18)ng/L(P<0.05),and SOD(261.78±14.44)nU/L was higher than that in control group(210.54±12.83)nU/L(P<0.05).There was insignificant difference in incidence rates of nausea and vomiting(2.44%vs.2.44%),dizziness and headache(2.44%vs.7.32%),cardiogenic shock(0.00%vs.2.44%),fatigue(4.88%vs.2.44%)and other adverse reactions between these two groups(P>0.05).Conclusion The combination of isosorbide mononitrate injection and Shuxuening injection in treatment of AMI with acute left heart failure has significant effect in improvement of imaging,symptoms,signs and markers of heart failure.And it can effectively improve the state of oxidative stress without any influence on blood pressure.Besides,it has high safety.

作者秦林燕陈淼 QIN Lin-yan;CHEN Miao(Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)

机构地区首都医科大学附属北京友谊医院急诊科

出处《临床和实验医学杂志》 2019年第1期31-36,共6页 Journal of Clinical and Experimental Medicine

基金国家自然科学基金资助项目(编号:81374004)

关键词急性心肌梗死急性左心衰单硝酸异山梨酯注射液舒血宁心功能心衰标志物呼吸衰竭 Acute myocardial infarction Acute left heart failure Isosorbide Mononitrate Injection Shuxuening Heart function Markers of heart failure Respiratory failure