本文選題：培哚普利 + 慢性缺血性心力衰竭��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:心力衰竭的高發(fā)病率及高死亡率已經(jīng)嚴重威脅到了人類的生命與健康,心力衰竭的治療依然是全世界疾病治療中的難題,近些年來心力衰竭的循證醫(yī)學(xué)證明ACEIs是心衰治療的基石,但同時ACEIs又影響心衰患者的血壓,而血壓作為反應(yīng)全身血流動力學(xué)的指標,跟心血管疾病預(yù)后又有著密切的聯(lián)系,據(jù)流行病學(xué)統(tǒng)計有15%-25%的心衰患者合并低收縮壓,且血壓偏低的心衰患者死亡率明顯升高,特別是冠心病患者可能存在血壓J點,本臨床實驗旨在觀察慢性缺血性心力衰竭合并血壓偏低患者在應(yīng)用小劑量培哚普利期間的血壓變化情況及安全性。方法:收集2015年12月至2016年12月就診于河北醫(yī)科大學(xué)第二醫(yī)院心內(nèi)三科的缺血性心臟病心力衰竭患者81例,其中男性42例(51.9%),女性39例(48.1%),平均年齡60.52±7.62歲,NYHA分級Ⅱ-Ⅳ級,LVEF≤45%,其中Ⅱ級37例(45.7%),Ⅲ級28例(34.6%),Ⅳ16例(19.7%)。經(jīng)過休息、限制鈉鹽與水量攝入以及應(yīng)用抗血小板聚集、降脂、擴冠、利尿劑等基礎(chǔ)治療后收縮壓≤110mmHg,除外應(yīng)用ACEIs類藥物的禁忌癥。給予培哚普利2mg,1次/天,14天后若無不良反應(yīng)發(fā)生,且SBP≥90mmHg,則增至4mg,1次/天,若不能耐受,退至上次劑量。隨訪時間30天。觀察指標:診室血壓、家庭血壓、24小時動態(tài)血壓、血肌酐、血鉀水平等指標的變化情況。結(jié)果:1 69名受試者能耐受培哚普利4mg,1次/天,無低血壓發(fā)生,用藥前后血壓下降不明顯,出院時收縮壓(102mmHg)較入院時收縮壓(106mmHg)下降了4mmHg,家庭平均收縮壓(100mmHg)較出院時收縮壓(102mmHg)下降了2mmHg,統(tǒng)計學(xué)上有差異(106(6)vs 102(4)vs 100(4),F=91.838,P0.001),入院時、出院時、家庭平均舒張壓比較(67(6)vs 64(7.5)vs 62(6),F=25.223,P0.001),用藥前后只下降了2mmHg,且無心絞痛等冠脈事件或血管神經(jīng)性水腫等不良反應(yīng)。用藥前及用藥30天后24小時動態(tài)血壓監(jiān)測結(jié)果比較:24hSBP(102.0(6.0)vs 100.0(4.5),F=7.562,P=0.008),統(tǒng)計學(xué)上有差異,治療后較治療前下降2mmHg;24hDBP比較(65.0(7.5)vs 63(4.5),F=3.922,P=0.052),統(tǒng)計學(xué)上無差異。血肌酐及血鉀水平(Cr 67.4ummol/l vs 70.1ummol/l,P=0.058;K+4.2mmol/l vs 4.2mmol/l,P=0.192)用藥前后統(tǒng)計學(xué)上無差異。2 8名受試者能耐受2mg,1次/天;1名受試者應(yīng)用2mg培哚普利期間出現(xiàn)癥狀性低血壓而終止服用培哚普利。3 5名受試者出現(xiàn)干咳反應(yīng)(6.2%),其中3名出現(xiàn)嚴重干咳不能耐受培哚普利的治療,且多為老年女性,平均年齡≥74歲。結(jié)論:1大多數(shù)血壓偏低的慢性心衰患者能耐受小劑量培哚普利,未發(fā)生明顯低血壓相關(guān)癥狀。2長時間應(yīng)用小劑量培哚普利對于血壓偏低的慢性心衰患者的遠期預(yù)后尚待進一步研究。
[Abstract]:Objective: the high incidence and high mortality rate of heart failure have seriously threatened human life and health. The treatment of heart failure is still a difficult problem in the treatment of diseases all over the world. In recent years, evidence-based medicine for heart failure has proved that ACEIs are the cornerstone of heart failure treatment, but at the same time, ACEIs also affect the blood pressure of patients with heart failure, and blood pressure, as an indicator of systemic hemodynamics, is closely related to the prognosis of cardiovascular disease. According to epidemiological statistics, 15% to 25% of patients with heart failure complicated with low systolic blood pressure, and the mortality rate of patients with heart failure with low blood pressure was significantly increased, especially in patients with coronary heart disease, who may have blood pressure J points. The purpose of this clinical trial was to observe the changes and safety of blood pressure in patients with chronic ischemic heart failure complicated with hypotension during the use of low dose perindopril. Methods: from December 2015 to December 2016, 81 patients with heart failure with ischemic heart disease were collected from the second Hospital of Hebei Medical University. The mean age was 60.52 鹵7.62 years old. The LVEF of NYHA grade 鈪，

本文編號：1995446