本文選題：左西孟旦 + 心肌梗死　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在觀察應(yīng)用左西孟旦注射液治療心肌梗死后心力衰竭患者的臨床療效以及安全性。方法:選取在青島大學(xué)附屬醫(yī)院心內(nèi)科及山東大學(xué)齊魯醫(yī)院(青島)中醫(yī)內(nèi)科住院的心肌梗死后心力衰竭患者一共80例開展研究,將患者隨機(jī)分成40例的對(duì)照組以及40例的治療組,治療組再隨機(jī)分為治療A組20例及治療B組20例。對(duì)照組:給予患者常規(guī)治療,包括利尿,擴(kuò)血管,穩(wěn)定斑塊,抑制腎素-血管緊張素-醛固酮系統(tǒng),從而控制患者的血壓,在限鈉和限水的同時(shí),維持他們的水電解質(zhì)平衡和酸堿平衡等,然后對(duì)心律失常情況進(jìn)行糾正,給予他們抗感染相關(guān)治療。治療組患者在采用常規(guī)治療基礎(chǔ)上給予左西孟旦注射液,劑量為12.5毫克,加5%葡萄糖45毫升配成微量泵,最開始左西孟旦的應(yīng)用負(fù)荷量是12微克/千克,注射的時(shí)間在10分鐘以上,然后按0.1微克/(千克.分)泵入,1小時(shí)后逐漸提升至0.2微克/(千克.分),同時(shí)維持24小時(shí),治療A組應(yīng)用左西孟旦一次,治療B組在首次應(yīng)用左西孟旦一周后再次應(yīng)用左西孟旦,方法、劑量同首次使用。在患者進(jìn)行治療時(shí)給予其血壓監(jiān)測(cè)、心率監(jiān)測(cè)、尿量測(cè)定以及心電圖監(jiān)測(cè)等,在負(fù)荷量及維持給藥開始30-60分鐘內(nèi)密切觀察患者反應(yīng),如出現(xiàn)低血壓、心動(dòng)過速等反應(yīng),則將輸注速度減至0.05微克/(千克.分),甚至停藥。觀察測(cè)量患者治療前后的臨床癥狀、體征、6分鐘步行實(shí)驗(yàn)、NT-pro BNP結(jié)果、左室舒張末內(nèi)徑(LVEDD)、左室射血分?jǐn)?shù)(LVEF)進(jìn)行分析比較。結(jié)果:對(duì)照組、治療A組、治療B組治療前呼吸困難程度評(píng)分以及全身臨床狀況評(píng)分、運(yùn)動(dòng)耐量評(píng)價(jià)(6分鐘步行實(shí)驗(yàn))、血漿NT-pro BNP水平、左室舒張末內(nèi)徑、左室射血分?jǐn)?shù)差別不大;各組患者治療后,呼吸困難程度評(píng)分以及全身臨床狀況評(píng)分、6分鐘步行距離、血漿NT-pro BNP水平、左室舒張末內(nèi)徑、左室射血分?jǐn)?shù)與治療前比較均有所改善,差異有統(tǒng)計(jì)學(xué)意義(均P0.05);治療A組、治療B組治療后呼吸困難程度評(píng)分以及全身臨床狀況評(píng)分、6分鐘步行距離、NT-pro BNP水平、左室舒張末內(nèi)徑、左室射血分?jǐn)?shù)與對(duì)照組治療后比較改善更明顯,差異有統(tǒng)計(jì)學(xué)意義(均P0.05);治療B組治療后呼吸困難程度評(píng)分以及全身臨床狀況評(píng)分、6分鐘步行距離、NT-pro BNP水平、左室舒張末內(nèi)徑、左室射血分?jǐn)?shù)與治療A組治療后相比較均有所改善,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:對(duì)于心肌梗死后心力衰竭患者,在常規(guī)治療基礎(chǔ)上使用左西孟旦能夠更好的改善心功能,有較好的臨床療效。對(duì)于該類患者,首次使用左西孟旦一周后再次使用左西孟旦與使用一次左西孟旦相比更有助于改善心功能。左西孟旦不良反應(yīng)較少,安全性良好。
[Abstract]:Objective: to observe the clinical efficacy and safety of levosimendan injection in the treatment of heart failure after myocardial infarction. Methods: a total of 80 patients with heart failure after myocardial infarction were selected from Department of Cardiology, affiliated Hospital of Qingdao University and Department of traditional Chinese Medicine, Qilu Hospital of Shandong University (Qingdao). The patients were randomly divided into control group (n = 40) and treatment group (n = 40). The treatment group (n = 20) was divided into two groups: group A (n = 20) and group B (n = 20). Control group: patients were given routine treatment, including diuretic, vasodilator, plaque stabilization, inhibition of renin-angiotensin-aldosterone system to control the patient's blood pressure, while limiting sodium and water, Maintain their water-electrolyte balance and acid-base balance, then correct arrhythmias and give them anti-infection related treatment. Patients in the treatment group were given levosimendan injection, 12.5 mg, plus 5% glucose 45 ml to form a micropump on the basis of routine treatment. The initial load of levosimendan was 12 渭 g / kg. The injection took more than 10 minutes, and then 0.1 渭 g / r (kg). The pump gradually rose to 0.2 渭 g / r (kg) after 1 hour of pumping. Group A was treated with levosimendan once, group B was treated with levosimendan again one week after the first application of levosimendan, method, dose was the same as the first time. The patients were given blood pressure monitoring, heart rate monitoring, urine volume monitoring and electrocardiogram monitoring when they were treated. Patients' reactions such as hypotension, tachycardia and so on were closely observed within 30-60 minutes of loading and maintenance administration. The infusion speed was reduced to 0.05 渭 g / r (kg). Even stop taking medicine. The clinical symptoms and signs of the patients before and after treatment were observed and compared with the results of NT-pro BNP, left ventricular end-diastolic diameter (LVEDDN) and left ventricular ejection fraction (LVEF). Results: compared with control group, treatment group A, group B had dyspnea score and systemic clinical status score before treatment, exercise tolerance evaluation and 6-minute walking test, plasma NT-pro BNP level, left ventricular end-diastolic diameter. There was no significant difference in left ventricular ejection fraction (LVEF). After treatment, the scores of dyspnea and systemic clinical status were 6 minutes walking distance, plasma NT-pro BNP level, left ventricular end-diastolic diameter. Left ventricular ejection fraction (LVEF) was significantly improved compared with that before treatment (all P 0.05), and the score of dyspnea after treatment in group A and the score of systemic clinical status were measured at 6 minutes walking distance and NT-pro BNP level in group A and group B, respectively. Left ventricular end-diastolic diameter, left ventricular ejection fraction (LVEF) were significantly improved after treatment compared with control group (all P 0.05), the score of dyspnea after treatment and the score of systemic clinical status in group B were significantly higher than those in control group (P < 0.05), and the 6-minute walking distance and the level of NT-pro BNP in group B were significantly higher than those in the control group (P < 0.05). Left ventricular end-diastolic diameter and left ventricular ejection fraction were improved compared with group A, but the difference was not statistically significant (P 0.05). Conclusion: for patients with heart failure after myocardial infarction, levosimendan on the basis of routine treatment can improve cardiac function better and has better clinical effect. For this group of patients, reusing levosimendan a week after the first use of levosimendan was more helpful in improving cardiac function than using levosimendan once. The adverse reaction of levosimendan is less and the safety is good.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.6

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