本文選題：難治性心力衰竭　切入點：參附注射液　出處：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景據(jù)歐洲心臟病學(xué)會統(tǒng)計,全世界范圍內(nèi)的成人慢性心力衰竭多因冠狀動脈缺血及心肌炎所致,兩者累積高達2600萬,每年新發(fā)入院確診并且伴有心力衰竭的患者約260萬,一年內(nèi)死亡率高達17%-45%。由于心力衰竭患者多因感染等多種因素導(dǎo)致急性發(fā)作需要反復(fù)住院,給社會造成沉重的醫(yī)療負擔(dān),其治療費用約占所有醫(yī)療支出的1%-2%。然而,心力衰竭的治療目前仍是一個難題,許多心衰患者雖然用了多種手段進行治療,效果仍然不理想。連續(xù)性血液濾過是目前臨床上常用的一項治療技術(shù),被廣泛應(yīng)用到各種原因所致的低心排的難治性心力衰竭的治療中。這項治療技術(shù)對水腫嚴重的患者進行持續(xù)穩(wěn)定的脫水排炎癥因子治療,可明顯減輕體內(nèi)液體容量超負荷,從而改善利尿劑抵抗�？墒�,部分患者在經(jīng)過超濾治療后會出現(xiàn)乏力、畏寒、肺水腫及胸腔積液引起呼吸用難、小便次數(shù)多及肢體無力等癥狀,這些屬于中醫(yī)氣陽兩虛的表現(xiàn),倘若能夠給予適當?shù)幕仃柧饶�、益氣攝血治療,就能夠促進血液濾過后心衰患者身體狀況快速恢復(fù),癥狀得到改善與緩解。來源于《重訂嚴氏濟生方》收錄的參附湯的參附注射液就因具有此特殊功效被常用于臨床治療,它能夠增強心臟收縮能力和改善心功能,提高心臟血液輸出量,改善患者血壓,起到調(diào)節(jié)血壓的作用,而且能夠通過降低心臟前后負荷、調(diào)節(jié)血壓和保護心肌細胞的作用,許多研究證實明顯優(yōu)于西醫(yī)單純治療。目的觀察心力衰竭基礎(chǔ)治療上給予參附注射液聯(lián)合連續(xù)性血液濾過(CRRT)治療難治性心力衰竭的療效。方法1.選取2015年12月至2016年12月入住河南省人民醫(yī)院住院病人診斷為難治性心力衰竭的病42例,隨機分成對照組和試驗組,即每組各21例。兩組均給予心力衰竭指南基礎(chǔ)藥物治療(洋地黃、血管緊張素轉(zhuǎn)化酶抑制劑、β受體阻滯劑、醛固酮拮抗劑、利尿劑)及在此基礎(chǔ)上的連續(xù)性血液濾過治療。試驗組另給予參附注射液靜脈輸注,對照組則給予相同劑量的5%葡萄糖注射液作為安慰劑。兩組患者均治療7天。2.監(jiān)測治療前后2組患者體重、收縮壓、心率、24小時尿量;抽血監(jiān)測血漿氨基-末端腦利鈉肽原(NT-proBNP)水平;彩超觀察患者左室射血分數(shù)(LVEF)變化;中醫(yī)證候積分評估癥狀、明尼蘇達心力衰竭生活質(zhì)量問卷表評分情況。結(jié)果1.治療后晨起測血壓、心率、體重均較同組治療前下降,24小時尿量較前增多,差異性有統(tǒng)計學(xué)意義(P0.05);兩組間對比,試驗組血壓、心率下降更明顯(P0.05),差異具有統(tǒng)計學(xué)意義,而兩組間體重及24小時尿量變化不明顯(P0.05)。2.治療后兩組患者NT-proBNP水平均較同組治療前明顯下降(P0.05),且試驗組較對照組下降更明顯(P0.05);而在LVEF方面,兩組治療后較同組治療前有升高,而試驗組較對照組升高更為明顯(P0.05)。3.各組治療后患者明尼蘇達心力衰竭生活質(zhì)量問卷表評分較治療前下降(P0.05);與對照組相比,試驗組下降更明顯(P0.05)。結(jié)論在心力衰竭基礎(chǔ)藥物治療上應(yīng)用參附注射液聯(lián)合血液濾過能夠使難治性心力衰竭患者NT-proBNP水平明顯持續(xù)下降、左室射血分數(shù)得到改善,生活質(zhì)量得到提高,病人治療依從性更好,獲得更大收益,具有重要的臨床意義。
[Abstract]:According to the background of the European Society of Cardiology statistics, worldwide adult coronary artery ischemia and chronic heart failure due to myocarditis caused by the accumulation of up to 26 million, annual new cases diagnosed with heart failure and about 2 million 600 thousand patients, one year mortality rate as high as 17% -45%. due to heart failure patients with bacterial infection and other factors lead to acute attack repeatedly the hospital, causing heavy burden to the society, the treatment costs accounted for all medical expenses 1%-2%.. However, the treatment of heart failure is still a problem, a lot of heart failure patients while using a variety of means of treatment, the effect is still not ideal. Continuous hemofiltration is a common clinical treatment technology, treatment refractory heart failure has been widely applied to various reasons caused by the low cardiac output. The treatment technique for patients with severe edema For sustained dehydration and discharging of inflammatory factors in the treatment, can significantly reduce the fluid volume overload, thereby improving the diuretic resistance. However, some patients appear weak, after ultrafiltration treatment will chills, pulmonary edema and pleural effusion caused by respiratory, urinary frequency and limb weakness and other symptoms, which belongs to the Chinese medicine Qi and yang two virtual performance, if can give appropriate Yang deficiency, tonifying qi and blood treatment, can promote the rapid recovery of the physical condition of patients with heart failure after hemofiltration, symptoms improved with ease. From the Re < Yan Ji Sheng Fang > included Shenfu Decoction of Shenfu injection is due to the special effects is commonly used in clinical treatment, it can enhance the capacity and improve the heart function of heart contraction, increase heart output, improve blood pressure, to adjust the blood pressure, but also can reduce the heart before and after negative The load, regulating blood pressure and protect myocardial cells. Many studies have demonstrated significantly better than simple treatment of Western medicine. Objective To observe the treatment of heart failure based on the given Shenfu injection combined with continuous hemofiltration (CRRT) treatment of refractory heart failure. 42 patients were selected from December 2015 to December 2016 1. in Henan Province People's Hospital inpatients diagnosed with refractory heart failure, were randomly divided into control group and experimental group, 21 cases in each group. The two groups were given the heart failure guideline based drug treatment (digitalis, angiotensin converting enzyme inhibitors, beta blockers, aldosterone antagonists, diuretics) and continuous hemofiltration therapy on the basis of the experimental group was given Shenfu. Intravenous injection of 5% Glucose Injection, the control group were given the same dose as placebo. Two patients were treated for.2. monitoring for 7 days 2 groups of patients before and after weight, systolic blood pressure, heart rate, 24 hour urine volume; monitoring blood plasma amino terminal brain natriuretic peptide (NT-proBNP) level; color Doppler ultrasound observation of patients with left ventricular ejection fraction (LVEF) changes; TCM syndrome integral evaluation of heart failure symptoms, Minnesota quality of life questionnaire score. Results 1. after treatment the early morning blood pressure, heart rate, body weight decreased significantly compared with the group before treatment, 24 hour urine volume increased more than before, has a statistically significant difference (P0.05); the comparison between the two groups, the experimental group blood pressure, heart rate decreased significantly (P0.05), the difference was statistically significant, but the change of weight between the two groups and 24 hour urine volume is not obvious (P0.05) after.2. treatment in patients with NT-proBNP levels of two groups were significantly decreased compared with before treatment (P0.05), and the test group decreased more significantly than the control group (P0.05); but in LVEF, the two groups after treatment compared with the group before treatment increased, while the experimental group than in the control Group increased more significantly (P0.05) in.3. group after treatment of patients with heart failure in Minnesota quality of life questionnaire score decreased (P0.05); compared with the control group, the test group decreased significantly (P0.05). Conclusion the application of Shenfu injection combined with hemofiltration in heart failure therapy based on the level of NT-proBNP in patients with refractory to congestive heart failure was significantly decreased, left ventricular ejection fraction was improved, and improve the quality of life of patients, better treatment compliance, and get more profits, has important clinical significance.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.6

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