本文選題：左西孟旦 + 老年患者�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:研究分析老年重度心力衰竭患者應(yīng)用左西孟旦治療的臨床效果。方法:參與本次實(shí)驗(yàn)的老年重度心力衰竭患者共138例,所有患者均為我院2014年1月-2015年12月期間收治的,按照隨機(jī)數(shù)字表法將其分成兩組,分別為研究組(n=68)和參照組(n=70)。研究組中,有冠狀動(dòng)脈粥樣硬化性心臟病的患者49例,老年性退行性心臟瓣膜病患者15例,擴(kuò)張性心肌病患者4例;參照組中,有冠狀動(dòng)脈粥樣硬化性心臟病的患者51例,老年性退行性心臟瓣膜病患者16例,擴(kuò)張性心肌病患者3例。對(duì)兩組患者均行常規(guī)心衰治療方法,與此同時(shí)研究組患者給予一次左西孟旦(悅文,規(guī)格:5ml,12.5mg/支,齊魯制藥)注射治療,初始10min給予負(fù)荷量為12μg/kg靜脈推注,繼而以0.1μg/(kg·min)微量泵入,1h后將輸注速率增至0.2μg/(kg·min)持續(xù)24h;參照組加用米力農(nóng)注射液治療7d。治療前、用藥第8d及出院1個(gè)月分別進(jìn)行臨床癥狀評(píng)估,并抽血化驗(yàn)NT-proBNP,超聲檢查L(zhǎng)VEF和FS及安全性評(píng)價(jià)。結(jié)果:(1)兩組呼吸困難改善及心衰定量標(biāo)志物NT-proBNP水平比較結(jié)果:①治療前研究組與參照組呼吸困難Borg評(píng)分分別為(8.2±1.3)、(8.3±1.4),經(jīng)治療第8天呼吸困難癥狀均有所改善,Borg評(píng)分分別為(1.2±0.5)、(2.6±0.7),均明顯低于治療前,差異存在統(tǒng)計(jì)學(xué)意義(P0.05);治療后兩組間比較,研究組更低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),提示研究組對(duì)呼吸困難的改善效果更好;②治療前研究組的NT-proBNP水平為(26842.6±411.4),參照組的為(26783.3±488.4),兩組對(duì)比并無(wú)明顯差異(P0.05)。治療第8天,研究組的 NT-proBNP 水平(10274.6±445.7),參照組為(12956.2士403.5)。均較治療前明顯降低,差異存在統(tǒng)計(jì)學(xué)意義(P0.05);兩組間比較,研究組NT-proBNP水平更低于參照組,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。出院1個(gè)月復(fù)查研究組(n=55)的 NT-proBNP 水平(7012.6±415.3),參照組(n=56)為(9526.2±423.5),均較入院時(shí)明顯降低,差異存在統(tǒng)計(jì)學(xué)意義(P0.05);組間比較研究組NT-proBNP水平更低于參照組,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。(2)兩組超聲檢查指標(biāo)的比較結(jié)果:①在治療前,研究組的LVEF為(35.06±4.9),參照組的為(34.07±4.8),兩組比較無(wú)明顯差異(P0.05)。用藥治療第8天,研究組LVEF為(36.67±4.8),參照組為(35.53±4.6)。兩組左室射血分?jǐn)?shù)較治療前改善不明顯(P0.05);兩組間比較,亦無(wú)明顯差異(P0.05)。出院1個(gè)月復(fù)查研究組(n=55)的LVEF為(41.06±4.2),參照組(n=56)的LVEF為(38.07±4.3),均較治療前改善,差異存在統(tǒng)計(jì)學(xué)意義(P0.05),兩組間比較研究組LVEF高于參照組,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。②研究組與參照組治療前左心室短軸縮短率(FS)分別為(17.63±2.8)、(17.42±2.7),用藥治療第8天研究組FS為(22.66±2.7),參照組FS為(20.02±2.5),兩組與治療前相比,差異均存在統(tǒng)計(jì)學(xué)意義(P0.05)。兩組間相比,研究組改善效果更明顯,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);出院1個(gè)月復(fù)查研究組(n=55)與參照組(n=56)FS分別為(26.63±2.8)、(22.42±2.7),均較治療前改善,差異存在統(tǒng)計(jì)學(xué)意義(P0.05),兩組間比較研究組FS高于參照組,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。(3)安全性對(duì)比情況:在用藥7天內(nèi)參照組中出現(xiàn)2例低血鉀、1例頭痛頭暈、2例低血壓、3例室性心律失常,不良反應(yīng)發(fā)生率為11.42%(8/70),除了1例低血鉀患者給予補(bǔ)鉀、1例低血壓患者減慢輸液速度、1例室速和1例室早二聯(lián)律患者,經(jīng)抗心律失常治療后恢復(fù),其余不良反應(yīng)都較輕,無(wú)需處理;研究組中出現(xiàn)1例頭痛、1例低血壓,不良反應(yīng)發(fā)生率為2.94%(2/68),且不良反應(yīng)均較輕,未特殊治療自行恢復(fù)。出院1個(gè)月復(fù)查肝功、腎功兩組均未見明顯異常,研究組(n=55)無(wú)不良反應(yīng)發(fā)生,參照組(n=56)有1例低血鉀,考慮服用利尿劑所致。結(jié)論:左西孟旦可有效改善老年重度心力衰竭患者的呼吸困難等癥狀,安全性高。
[Abstract]:Objective: To study and analyze the clinical effect of levosimendan on elderly patients with severe heart failure. Methods: 138 cases of elderly patients with severe heart failure were enrolled in this experiment. All the patients were treated in our hospital during December -2015 December. They were divided into two groups according to the random digital table method, which were the study group (n=68) and reference, respectively. Group (n=70). In the study group, there were 49 patients with coronary atherosclerotic heart disease, 15 cases of senile degenerative heart valvular disease, 4 cases of dilated cardiomyopathy, 51 cases with coronary atherosclerotic heart disease, 16 cases of senile degenerative heart valvular disease, 3 cases of dilated cardiomyopathy in the reference group, and 3 cases of dilated cardiomyopathy. Two The patients in the group were treated with conventional heart failure treatment. At the same time, the patients in the study group were given an injection of levosimendan (Yue Wen, specification: 5ml, 12.5mg/ branch, Qilu pharmaceutical). Initial 10min was injected with a load of 12 mu g/kg, then 0.1 micron g/ (kg. Min) was injected, and the infusion rate was increased to 0.2 u g/ (kg. Min) after 1h, and the reference group added Before treatment with Milrinone Injection for 7d. treatment, the clinical symptoms were evaluated by 8D and 1 months discharged from hospital, and NT-proBNP, LVEF and FS and safety evaluation were examined by ultrasonography. Results: (1) the results of two groups of dyspnea and the comparison of the level of NT-proBNP in the heart failure: (1) the pre treatment group and the reference group of the dyspnea Borg The scores were (8.2 + 1.3) and (8.3 + 1.4). The symptoms of dyspnea after eighth days were improved. The Borg score was (1.2 + 0.5) and (2.6 + 0.7), respectively. The difference was statistically significant (P0.05). The study group was lower and the difference was statistically significant (P0.05) after the treatment of the treatment group (P0.05), suggesting that the study group had difficulty in breathing. The NT-proBNP level of the study group was (26842.6 + 411.4) and the reference group was (26783.3 + 488.4), and there was no significant difference between the two groups (P0.05). The level of NT-proBNP in the study group (10274.6 + 445.7) and the reference group were (12956.2 403.5). The difference was significantly lower than that before the treatment (P0.05 Compared with the two groups, the NT-proBNP level of the study group was lower than the reference group, the difference was statistically significant (P0.05). The level of NT-proBNP in the study group (n=55) was 1 months after discharge (7012.6 + 415.3), and the reference group (n=56) was (9526.2 + 423.5), and the difference was significantly lower than that of the admission group (P0.05); the NT-proBNP level of the study group was compared with the group (P0.05). More than the reference group, the difference was statistically significant (P0.05). (2) the comparison of the two groups of ultrasound examination indexes: (35.06 + 4.9) before the treatment, the reference group was (34.07 + 4.8), the two groups had no significant difference (P0.05). The treatment group was treated for eighth days, the study group was (36.67 + 4.8), and the reference group was (35.53 + 4.6). The two group left ventricular ejection. The blood fraction was not significantly improved before the treatment (P0.05), and there was no significant difference between the two groups (P0.05). The LVEF of the 1 month reexamination study group (n=55) was (41.06 + 4.2), and the LVEF in the reference group (n=56) was (38.07 + 4.3), and the difference existed statistically significant (P0.05), and the LVEF in the two groups was higher than the reference group, and the difference existed in the group. Study significance (P0.05). (2) the short axis shortening rate of left ventricle (FS) in the study group and the reference group was (17.63 + 2.8), (17.42 + 2.7), and FS in the study group was (22.66 + 2.7) for eighth days, and FS in the reference group was (20.02 + 2.5). The difference was statistically significant (P0.05) compared with the treatment group (P0.05). Compared with group two, the improvement effect of the study group was more obvious, The difference was statistically significant (P0.05); the 1 month reexamination study group (n=55) and the reference group (n=56) FS were respectively (26.63 + 2.8) and (22.42 + 2.7), respectively, compared with before treatment, the difference was statistically significant (P0.05). The difference between the two groups was higher than the reference group, the difference was statistically significant (P0.05). (3) the safety contrast: within 7 days of drug use In the reference group, there were 2 cases of hypokalemia, 1 cases of headache and dizziness, 2 cases of hypotension, 3 cases of ventricular arrhythmia, the incidence of adverse reaction was 11.42% (8/70). Except 1 cases of hypokalemia patients were given potassium supplementation, 1 cases of hypotension were slowed down, 1 cases of ventricular tachycardia and 1 cases of ventricular early two were recovered, and the other adverse reactions were mild. In the study group, there were 1 cases of headache, 1 cases of hypotension, the incidence of adverse reaction was 2.94% (2/68), and the adverse reactions were all mild and no special treatment was recovered. There were no obvious abnormalities in the two groups of the two groups in the 1 months of discharge. The study group (n=55) had no adverse reactions, and the reference group (n=56) had 1 cases of hypokalemia and considered taking diuretics. Conclusion: Levosimendan can effectively improve dyspnea and other symptoms in elderly patients with severe heart failure, and has high safety.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 于景峰;郭景源;賈艷君;;重度心力衰竭中鎂的治療價(jià)值[J];中國(guó)傷殘醫(yī)學(xué);2006年01期

2 張艷婷;任守峰;;無(wú)創(chuàng)雙水平氣道正壓通氣治療慢性重度心力衰竭臨床療效觀察[J];臨床醫(yī)藥實(shí)踐;2014年01期

3 趙雪松;重度心力衰竭的運(yùn)動(dòng)療法[J];中國(guó)臨床康復(fù);2002年07期

4 商淑琴,韓輝;老年重度心力衰竭150例臨床分析與健康教育[J];齊魯護(hù)理雜志;2005年09期

5 王中潔;嚴(yán)華;黃春燕;;重度心力衰竭患者早期活動(dòng)的探討[J];中國(guó)實(shí)用護(hù)理雜志;2006年07期

6 賈海蓮;李彥萍;;高齡中重度心力衰竭62例臨床分析[J];廣西醫(yī)學(xué);2006年05期

7 王印林;張明生;張俊慧;蘇運(yùn)星;楊素芹;;無(wú)創(chuàng)雙水平正壓通氣治療重度心力衰竭[J];北京醫(yī)學(xué);2007年02期

8 樊君娜;;運(yùn)動(dòng)干預(yù)對(duì)重度心力衰竭患者康復(fù)的影響[J];護(hù)理學(xué)雜志;2009年03期

9 陳幻;王中潔;陳麗媛;嚴(yán)華;黃春燕;;早期運(yùn)動(dòng)干預(yù)對(duì)減少重度心力衰竭患者并發(fā)癥的研究[J];心血管病防治知識(shí)(學(xué)術(shù)版);2011年03期

10 鄢圣遠(yuǎn);肖小煒;;多西他賽致重度心力衰竭1例報(bào)告[J];中國(guó)實(shí)用醫(yī)藥;2011年27期

相關(guān)會(huì)議論文 前10條

1 王印林;張明生;張俊慧;蘇運(yùn)興;楊素芹;;無(wú)創(chuàng)雙水平氣道正壓通氣治療重度心力衰竭[A];中華醫(yī)學(xué)會(huì)第七次全國(guó)呼吸病學(xué)術(shù)會(huì)議暨學(xué)習(xí)班論文匯編[C];2006年

2 徐如堂;;老年重度心力衰竭44例救治體會(huì)[A];第四屆全國(guó)心功能學(xué)術(shù)研討會(huì)論文摘要集[C];1994年

3 孫桂芳;劉鳳岐;;心區(qū)交感神經(jīng)阻滯術(shù)治療重度心力衰竭患者[A];中華醫(yī)學(xué)會(huì)心血管病分會(huì)第八次全國(guó)心血管病學(xué)術(shù)會(huì)議匯編[C];2004年

4 欒波濤;劉斌;陳麗娟;;心臟再同步治療中重度心力衰竭的療效[A];中華醫(yī)學(xué)會(huì)心電生理和起搏分會(huì)第十次全國(guó)學(xué)術(shù)年會(huì)會(huì)議匯編[C];2012年

5 周卓;;機(jī)械通氣治療急性重度心力衰竭患者BNP動(dòng)態(tài)變化及意義[A];2009年浙江省檢驗(yàn)醫(yī)學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2009年

6 梅瑞杰;張令春;;靜脈應(yīng)用胺碘酮在老年重度心力衰竭合并快速心律失常患者中的療效及安全性的觀察和護(hù)理[A];全國(guó)內(nèi)科護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議、全國(guó)心臟內(nèi)、外科�？谱o(hù)理學(xué)術(shù)會(huì)議論文匯編[C];2006年

7 周靜;;重度心力衰竭患者心臟再同步治療的圍術(shù)期護(hù)理[A];2012年安徽省科協(xié)年會(huì)省護(hù)理學(xué)會(huì)分會(huì)場(chǎng)安徽省護(hù)理學(xué)會(huì)護(hù)理專業(yè)化發(fā)展暨學(xué)術(shù)年會(huì)論文匯編[C];2012年

8 張明;侯平;姜鈞文;周鑫;杜丹;姜曉楓;王懷林;;應(yīng)用臍帶血干細(xì)胞移植治療老年急性廣泛前壁心肌梗死后心原性休克合并重度心力衰竭一例[A];中華醫(yī)學(xué)會(huì)第11次心血管病學(xué)術(shù)會(huì)議論文摘要集[C];2009年

9 郭曉萍;;100例重度心力衰竭患者應(yīng)用重組人腦利鈉肽(rhBNP)的療效及干預(yù)[A];中華醫(yī)學(xué)會(huì)第十五次全國(guó)心血管病學(xué)大會(huì)論文匯編[C];2013年

10 朱玲;魏長(zhǎng)良;韓衛(wèi);宋彬;;硝普鈉對(duì)急性心肌梗塞并發(fā)重度心力衰竭的療效觀察[A];中華醫(yī)學(xué)會(huì)急診醫(yī)學(xué)學(xué)會(huì)第六次全國(guó)急診醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];1996年

相關(guān)碩士學(xué)位論文 前2條

1 馮瑩;左西孟旦治療老年重度心力衰竭的療效評(píng)價(jià)[D];山東大學(xué);2017年

2 楊玉春;連續(xù)性腎臟替代治療對(duì)慢性重度心力衰竭的臨床療效研究[D];新疆醫(yī)科大學(xué);2010年

，

本文編號(hào)：1941558