本文關(guān)鍵詞：培哚普利對(duì)血壓偏低心力衰竭患者心功能及預(yù)后影響的研究　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 培哚普利 心力衰竭 缺血性心臟病 心功能 血壓 預(yù)后

【摘要】：目的:心力衰竭是各種心血管疾病的終末階段,其診療是21世紀(jì)心血管領(lǐng)域的一項(xiàng)重要課題。據(jù)統(tǒng)計(jì),心衰患者中約15%~25%合并低收縮壓,且這部分心衰患者預(yù)后較差。近年來,國內(nèi)外指南均將ACEI推薦為心衰藥物治療的基石。但研究發(fā)現(xiàn),缺血性心臟病作為心衰的主要病因之一,其心血管事件發(fā)生率與血壓之間存在“J型曲線”關(guān)系。因此,對(duì)于血壓偏低的缺血性心臟病心衰患者,應(yīng)用ACEI類藥物對(duì)血壓的進(jìn)一步影響及其和預(yù)后的關(guān)系值得特別關(guān)注,目前國內(nèi)外相關(guān)文獻(xiàn)和報(bào)道不多。本研究旨在觀察培哚普利對(duì)血壓偏低的缺血性心臟病心力衰竭患者心功能及近期預(yù)后的影響。方法:收集2015年12月至2016年12月于河北醫(yī)大二院心血管內(nèi)科住院,經(jīng)治療達(dá)到穩(wěn)定狀態(tài)的缺血性心臟病心力衰竭患者142例,其中男性71例,女性71例,患者血壓(90mmHgSBP≤110mmHg),心功能NYHAⅡ~Ⅳ級(jí),LVEF≤45%。隨機(jī)分為培哚普利組和常規(guī)治療組,兩組患者均給予心衰常規(guī)治療,培哚普利組患者在常規(guī)治療基礎(chǔ)上加用培哚普利2mg,1次/日,無特殊不適在服藥2周后增至4mg,1次/日,若出現(xiàn)低血壓、咳嗽等不良反應(yīng)則改為2mg,1次/日,或酌情停藥。隨訪周期為3個(gè)月,分別觀察兩組患者治療前后NT-Pro BNP、LVEF和NYHA分級(jí),記錄心血管事件,并統(tǒng)計(jì)出院1個(gè)月和3個(gè)月的再住院率。結(jié)果:1兩組患者性別、年齡、病史和服藥情況等基線資料差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2兩組患者治療后NT-Pro BNP水平均顯著下降,兩組間下降程度差異無統(tǒng)計(jì)學(xué)意義(F=0.154,P=0.696)。3兩組患者治療后LVEF均略有升高,提示心功能有所改善,兩組間升高程度差異無統(tǒng)計(jì)學(xué)意義(F=0.835,P=0.362)。4培哚普利組治療后NYHA心功能分級(jí)有所改善,與常規(guī)治療組比心功能改善差異有統(tǒng)計(jì)學(xué)意義(Z=-1.363,P=0.037)。5兩組患者的1個(gè)月再住院率差異無統(tǒng)計(jì)學(xué)意義(X~2=1.225,P=0.268,連續(xù)性校正)。培哚普利組患者3個(gè)月再住院率為3.9%,明顯低于常規(guī)治療組的13.8%,二者差異具有統(tǒng)計(jì)學(xué)意義(X~2=4.510,P=0.034),提示培哚普利有利于降低心衰患者3個(gè)月再住院率,改善近期預(yù)后。6所有142例患者無一失訪,培哚普利組和常規(guī)治療組在隨訪期間發(fā)生急性心肌梗死各有2例,因心衰加重再住院分別有3例(3.9%)和9例(13.8%)。培哚普利組患者發(fā)生咳嗽5例(6.17%),癥狀性低血壓1例(1.23%)。結(jié)論:培哚普利對(duì)于血壓偏低的缺血性心臟病心力衰竭患者,有利于改善心臟功能,降低再住院率,從而改善近期預(yù)后,未增加冠脈事件。
[Abstract]:Objective: heart failure is the terminal stage of various cardiovascular diseases, its diagnosis and treatment is an important subject in the field of cardiovascular in 21th century. According to statistics, about 15% of patients with heart failure associated with low systolic blood pressure. In recent years, ACEI has been recommended as the cornerstone of drug therapy for heart failure in China and abroad. However, it has been found that ischemic heart disease is one of the main causes of heart failure. There is a "J curve" relationship between the incidence of cardiovascular events and blood pressure. Therefore, in patients with ischemic heart failure with low blood pressure. The further effects of ACEI on blood pressure and its relationship with prognosis deserve special attention. The purpose of this study was to observe the effects of perindopril on heart function and short-term prognosis in patients with ischemic heart disease with low blood pressure. From December 2015 to December 2016, we were hospitalized in Department of Cardiovascular Medicine, second Hospital of Hebei Medical University. 142 patients (71 males and 71 females) with stable ischemic heart failure (SBP 鈮，

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