本文選題：老年人 + 頑固性心力衰竭��； 參考：《延安大學(xué)》2014年碩士論文

【摘要】：目的心力衰竭是一種嚴(yán)重威脅人類(lèi)健康的疾病，與其他疾病相比具有很高的致殘率、致死率，明顯影響患者的生活質(zhì)量，流行病學(xué)調(diào)查顯示，65歲以上人群中內(nèi)科住院治療的最主要原因?yàn)樾牧λソ�。左西孟旦作為一種新型鈣離子增敏劑問(wèn)世已有十余年。左西孟旦作用機(jī)制不同于傳統(tǒng)抗心衰藥物，左西孟旦增加心肌收縮力的主要機(jī)制是鈣離子選擇性的與肌鈣蛋白C結(jié)合，在不改變心肌細(xì)胞內(nèi)鈣離子濃度的情況下增加心肌收縮力。近年來(lái)，左西孟旦治療頑固性心力衰竭成為心衰藥物治療的研究熱點(diǎn)，左西孟旦已被心衰指南推薦為心力衰竭藥物治療的重要組成部分但其有效性及安全性研究尚少，故本研究正是為了觀(guān)察該藥在老年頑固性心力衰竭臨床治療中的療效及安全性。 方法本研究納入樣本量總共72例，選自2012年11月-2013年4月陜西省人民醫(yī)院心內(nèi)科72例住院患者(高血壓、擴(kuò)張型心肌病、冠狀動(dòng)脈粥樣硬化性心臟病)，心功能分級(jí)為III-IV級(jí)（NYHA分級(jí)），均符合納入標(biāo)準(zhǔn)，分實(shí)驗(yàn)組（左西孟旦組）與對(duì)照組（傳統(tǒng)抗心衰藥物組），各36例，接受左西孟旦及傳統(tǒng)抗心衰治療。兩組患者入院后分別給予心電監(jiān)護(hù)、臥位休息、氧療、同時(shí)洋地黃類(lèi)、利尿劑、AECI/ARB、血管擴(kuò)張劑治療，在上述藥物治療基礎(chǔ)上，一組加用左西孟旦治療，另一組繼續(xù)抗心衰藥物治療。用藥期間，持續(xù)24小時(shí)心電監(jiān)測(cè)兩組患者的血壓與心率變化。用藥后1天及3天評(píng)估呼吸困難癥狀及心衰分級(jí)有無(wú)好轉(zhuǎn)。觀(guān)察兩組治療前后氨基末端腦鈉肽前體（NT-proBNP）水平、同時(shí)檢測(cè)血液生化（肝功能、腎功能、電解質(zhì)）等實(shí)驗(yàn)室觀(guān)察指標(biāo)。行心臟B超分別觀(guān)察兩組用藥前及治療后1天及3天左室射血分?jǐn)?shù)（LVEF）、左室短軸縮短率（FS）、左室舒張末期容積（LVEDD）等指標(biāo)。 結(jié)果1.基本資料特征：所選入組患者年齡73-88歲之間，平均值80.4±7.1歲，，兩組間的年齡差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)，兩組間性別差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。2.治療3天后，左西孟旦組和對(duì)照組的呼吸困難好轉(zhuǎn)率分別為94.4%與75%，左西孟旦組的呼吸困難改善情況好于對(duì)照組（P0.05）。左西孟旦組的呼吸困難好轉(zhuǎn)最少達(dá)到有效的可能性是對(duì)照組的5.7倍。治療3天后，心功能有效達(dá)33例，總有效率89%，優(yōu)于對(duì)照組的72%（P0.05）,左西孟旦組心功能分級(jí)提高至少達(dá)到有效的可能性是對(duì)照組的4.2倍。3.與治療前相比，左西孟旦組LVEF（49.8±7.9%），F(xiàn)S（30.6±4.8%）和對(duì)照組的LVEF（45.0±9.0%）,FS(28.1±3.6%）均明顯增高（P0.05）。左西孟旦組LVEF和FS值與對(duì)照組比較有統(tǒng)計(jì)學(xué)意義（P0.05）,左西孟旦組的LVEF和FS值增高較明顯。4.與治療前相比，左西孟旦組的NT-proBNP數(shù)值（1675.5±446.8pg/ml）與對(duì)照組（1955.1±404.4pg/ml）均顯著回落（P0.05）；左西孟旦組NT-proBNP降低較對(duì)照組具有統(tǒng)計(jì)學(xué)意義（P0.05）。5.安全性評(píng)價(jià)：治療期間，左西孟旦組頻發(fā)室性早搏出現(xiàn)2例，對(duì)照組3例（P0.05）。治療后，兩組患者心率數(shù)值輕度降低，兩組之間的降低幅度無(wú)統(tǒng)計(jì)學(xué)差異，兩組患者均未出現(xiàn)嚴(yán)重肝腎功能不全等情況。左西孟旦組患者均無(wú)收縮壓90mmHg。 結(jié)論1.左西孟旦藥物老年頑固性心力衰竭患者療效顯著，能快速緩解心功能衰竭臨床癥狀。2.左西孟旦能明顯改善老年頑固性心力衰竭患者的血流動(dòng)力學(xué)參數(shù)，提高左室射血分值，改善患者心功能。3.左西孟旦短期應(yīng)用于治療老年頑固性心衰患者臨床觀(guān)察安全可行。
[Abstract]:Objective heart failure is a serious threat to human health. Compared with other diseases, it has a high rate of disability and mortality, which obviously affects the quality of life of the patients. Epidemiological investigation shows that the most important reason for the hospitalization of internal medicine in the population over 65 years old is the exhaustion of Internal Medicine. The mechanism of left Simendan action is different from that of traditional anti heart failure drugs. The main mechanism of left Simendan's increase of myocardial contractility is the combination of calcium ion selectively and troponin C, which increases myocardial contractility without changing the intracellular calcium concentration. In recent years, levosimendan has been used to treat refractory heart failure. For the research hotspot of drug therapy for heart failure, left Simendan has been recommended as an important component of heart failure drug treatment, but the study of its effectiveness and safety is few. Therefore, this study is to observe the efficacy and safety of the drug in the clinical treatment of senile refractory heart failure.
Methods a total of 72 samples were selected from 72 hospitalized patients (hypertension, dilated cardiomyopathy, coronary atherosclerotic heart disease) in the Department of Cardiology, Shaanxi People's Hospital, November 2012 -2013, and the cardiac function classification was III-IV grade (NYHA grade), which were all conformed to the inclusion criteria and divided into the experimental group (Zuo Simendan group) and the control group. The anti heart failure drug group), 36 cases were treated with levosimendan and traditional anti heart failure. The two groups were given ECG monitoring, recumbent rest, oxygen therapy, and rehmannia, diuretic, AECI/ARB, vasodilator treatment. On the basis of the treatment, one group was treated with levosimendan, and the other continued anti heart failure medication. During the medication, the blood pressure and heart rate of the two groups were monitored for 24 hours. The symptoms of dyspnea and the grade of heart failure were evaluated at 1 and 3 days after the medication. The level of the amino terminal brain natriuretic peptide (NT-proBNP) before and after treatment in the two groups was observed, and the blood biochemistry (liver function, renal function and electrolyte) were measured at the same time. The left ventricular ejection fraction (LVEF), left ventricular short axis shortening (FS) and left ventricular end diastolic volume (LVEDD) were observed before and after 1 and 3 days after treatment in two groups.
Results 1. basic data characteristics: the age of the selected group was 73-88 years old, the average value was 80.4 + 7.1 years old. The age difference between the two groups was not statistically significant (P0.05). The gender differences between the two groups did not have statistical significance (P0.05).2. treatment for 3 days, and the improvement rate of dyspnea in left Simendan and control groups was 94.4% and 75%, respectively, left Simendan. The improvement of respiratory difficulty in the group was better than that of the control group (P0.05). The respiratory difficulty of the left Simendan group was 5.7 times more effective than the control group. 3 days after the treatment, the heart function was effective in 33 cases, the total effective rate was 89%, superior to the control group (72% (P0.05)), and the improvement of the cardiac function classification at least in the left Simendan group was at least the effective possibility. The 4.2 times.3. of the group was LVEF (49.8 + 7.9%), FS (30.6 + 4.8%) and LVEF (45 + 9%) in the control group and FS (28.1 + 3.6%) in the left Simendan group (P0.05). The value of LVEF and FS in Zuo Simendan group was statistically significant compared with the control group (P0.05), and the LVEF and FS value of the left Simendan group was higher than that before and before the treatment, left Simendan. The NT-proBNP values of the group (1675.5 + 446.8pg/ml) and the control group (1955.1 + 404.4pg/ml) were all significantly decreased (P0.05), and the NT-proBNP reduction in the left Simendan group was statistically significant (P0.05).5. security evaluation: during the treatment, 2 cases of frequent ventricular premature beat appeared in the left Simendan group and 3 cases in the control group (P0.05). After treatment, the heart rate of the two groups was in the two group. There was no statistical difference between the two groups. There was no severe liver and renal dysfunction in the two groups. There was no systolic pressure of 90mmHg. in the left Simendan group.
Conclusion 1. levosimendan drugs in elderly patients with intractable heart failure are effective, and can quickly relieve the clinical symptoms of heart failure.2. left Simendan can significantly improve the hemodynamic parameters of elderly patients with refractory heart failure, improve the value of left ventricular ejection, and improve the short-term application of.3. left Simendan in the treatment of senile obstinacy. The clinical observation of patients with heart failure is safe and feasible.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R541.6

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