本文選題：左西孟旦 + 難治性心力衰竭��； 參考：《天津醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:分析左西孟旦治療難治性心力衰竭的臨床效果,為臨床規(guī)范化應(yīng)用左西孟旦提供依據(jù)。方法:選取天津市胸科醫(yī)院CICU收治的難治性心力衰竭患者261例,其中缺血性心肌病者154例,非缺血性心肌病者107例,均接受標(biāo)準(zhǔn)心力衰竭治療。根據(jù)是否應(yīng)用左西孟旦,將缺血性心肌病致心力衰竭患者分為:對照組(n=59)與用藥組(n=95);非缺血性心肌病致心力衰竭患者分為:對照組(n=54)與用藥組(n=53)。將261例病人中應(yīng)用左西孟旦治療的患者,根據(jù)原發(fā)疾病不同分為:非缺血性心肌病(NICM)組(n=53)與缺血性心肌病(ICM)組(n=95);根據(jù)年齡分為:非老齡組(n=66)與老齡組(n=82)(中華醫(yī)學(xué)會規(guī)定60歲老齡89歲)。監(jiān)測指標(biāo):(1)患者用藥前及用藥結(jié)束48小時(shí)(對照組在觀察的相同時(shí)間點(diǎn))Na、K、Cl、Hb、Cre、BUN、UA、TnT、NT-pro BNP的變化;(2)患者用藥前及用藥結(jié)束48小時(shí)(對照組在觀察的相同時(shí)間點(diǎn))心臟彩色多普勒超聲的相關(guān)數(shù)值:LV、PAP、LVEF;(3)患者用藥前及用藥開始后(對照組在觀察的相同時(shí)間點(diǎn))1小時(shí)、24小時(shí)、48小時(shí)及72小時(shí)血壓;(4)患者用藥結(jié)束后(對照組在觀察的相同時(shí)間點(diǎn))48小時(shí)及第7天的NYHA分級;(5)患者住院時(shí)間;(7)患者住院死亡率。結(jié)果:1、在缺血性心肌病致心力衰竭患者中,用藥前后LV、LVEF、PAP、NT-proBNP、TnT、BUN、Cre、UA的差值及心功能NYHA分級的改善水平,用藥組優(yōu)于對照組,P0.05;用藥前后K、Na及Hb降低程度,用藥組大于對照組,P0.05;在用藥后患者的住院時(shí)間及住院期間死亡率比較,兩組無統(tǒng)計(jì)學(xué)差異,P0.05。2、在非缺血性心肌病致心力衰竭患者中,用藥前后LVEF、NT-proBNP、TnT、UA的差值及用藥結(jié)束后48小時(shí)心功能NYHA分級的改善水平,用藥組優(yōu)于對照組,P0.05;用藥前后K及Hb的降低程度,用藥組大于對照組,P0.05;用藥前后LV、PAP、BUN、Cre、Na的差值及用藥結(jié)束后第7天心功能NYHA分級改善水平及患者住院時(shí)間、住院死亡率,兩組無統(tǒng)計(jì)學(xué)差異,P0.05。3、在NICM組與ICM組的患者中:在用藥前后LVEF、LV、PAP、NT-proBNP、TnT、BUN、Cre的差值,心功能NYHA分級的改善水平及患者住院時(shí)間及患者住院死亡率,ICM組優(yōu)于NICM組,P0.05;而UA及K的改變NICM組優(yōu)于ICM組,P0.05;用藥前后Na、Hb及血壓變化,兩組無統(tǒng)計(jì)學(xué)差異,P0.05。4、在非老齡組與老齡組的患者中:左西孟旦均可以提高患者的LVEF水平,降低PAP、NT-proBNP、TnT、BUN、UA及血壓,改善LV及心功能NYHA分級水平;在治療前后NT-proBNP、TnT、Cre的差值及用藥結(jié)束后第7天心功能NYHA分級的改善水平,老齡組優(yōu)于非老齡組,P0.05;在治療前后LV、LVEF、PAP、BUN、UA、K、Na、Hb,血壓變化、患者住院時(shí)間及住院死亡率之間,兩組無統(tǒng)計(jì)學(xué)差異,P0.05。結(jié)論:1、左西孟旦可以明顯改善難治性心力衰竭患者的LVEF、NT-pro BNP、TnT、UA與用藥結(jié)束后48小時(shí)心功能NYHA分級水平,降低患者血壓及血清K和Hb水平,能改善缺血性心肌病導(dǎo)致的難治性心力衰竭患者的LV、PAP、BUN、Cre及用藥結(jié)束后第7天心功能NYHA分級水平,但對兩種疾病所導(dǎo)致的心力衰竭患者的住院時(shí)間及住院死亡率無影響。2、與非缺血性心肌病導(dǎo)致的難治性心力衰竭患者相比,左西孟旦可以更好的改善缺血性心肌病導(dǎo)致的難治性心力衰竭患者的LVEF、NT-proBNP、TnT、BUN、Cre及用藥結(jié)束后48小時(shí)心功能NYHA分級水平,降低患者住院時(shí)間及住院死亡率。3、與非老齡難治性心力衰竭患者相比,左西孟旦可以更好的改善老齡難治性心力衰竭患者的NT-proBNP、TnT、Cre及用藥結(jié)束后第7天心功能NYHA分級的水平,但對老齡患者和非老齡患者住院時(shí)間及住院死亡率無影響。
[Abstract]:Objective: to analyze the clinical effect of levosimendan on refractory heart failure, and to provide a basis for clinical standardization of levosimendan. Methods: 261 patients with refractory heart failure treated in Tianjin Thoracic Hospital, CICU, including 154 patients with ischemic cardiomyopathy and 107 cases of non ischemic cardiomyopathy, were treated with standard heart failure. The patients with heart failure caused by ischemic cardiomyopathy were divided into the control group (n=59) and the medication group (n=95), and the patients with heart failure caused by non ischemic cardiomyopathy were divided into two groups: the control group (n=54) and the drug group (n=53). The patients with 261 patients who were treated with Zuo Ximeng were divided into non ischemic myocardium according to the difference of the primary disease. Disease (NICM) group (n=53) and ischemic cardiomyopathy (ICM) group (n=95); according to age: non aging group (n=66) and aging group (n=82) (89 years old aged 60 years old in Chinese Medical Association). Monitoring indexes: (1) patients before and 48 hours of drug use (control group at the same time point of observation) Na, K, Cl, Hb, Cre, BUN, wasting, (2) patients The correlation values of color Doppler echocardiography before and after 48 hours at the same time of the control group (the control group were observed at the same time point): LV, PAP, LVEF; (3) the patient's blood pressure was 1 hours, 24 hours, 48 hours and 72 at the same time point of the control group (the control group was observed at the same time); (4) after the use of the control group (the control group was observed at the same time. Points) NYHA grade of 48 hours and 7 days; (5) patients' hospitalization time; (7) patient mortality. Results: 1, in patients with heart failure induced by ischemic cardiomyopathy, the difference of LV, LVEF, PAP, NT-proBNP, TnT, BUN, Cre, UA, and the improvement of cardiac function NYHA grades were better than those of the control group, P0.05; K, K, and decreased degrees before and after medication, The medication group was larger than the control group, P0.05. The two groups had no statistically significant difference in hospitalization time and hospitalized mortality rate after medication, P0.05.2. In patients with heart failure caused by non ischemic cardiomyopathy, the difference between LVEF, NT-proBNP, TnT, UA before and after medication and the level of NYHA grade of cardiac function 48 hours after the end of drug use were better than those in the treatment group. The reduction of K and Hb before and after the use of P0.05 was greater than that of the control group, P0.05, the difference between LV, PAP, BUN, Cre, Na, and the level of cardiac function NYHA grading seventh days after the drug use and the hospitalization time, the mortality of the patients, the two groups were not statistically different, P0.05.3, in the NICM group and the patients before and after the drug use. The difference between AP, NT-proBNP, TnT, BUN, Cre, the improvement of the cardiac function NYHA grade and the patient's time of hospitalization and patients' hospitalization mortality, ICM group was better than the NICM group, P0.05, while UA and K were better than those in the group, and the two groups were not different in the old group and the aged group: Zuo Ximeng Dan can improve the LVEF level of patients, reduce PAP, NT-proBNP, TnT, BUN, UA and blood pressure, improve the level of LV and cardiac function NYHA grading, and the improvement level of NT-proBNP, TnT, Cre, and seventh days after the treatment, and the aging group is better than the non aging group. There was no statistical difference between the two groups in the two groups. 1, levosimendan could significantly improve the LVEF, NT-pro BNP, TnT, UA and the NYHA grade of cardiac function at 48 hours after the end of drug use, reducing the blood pressure and serum K and Hb levels in the patients, and improving the cause of ischemic cardiomyopathy. LV, PAP, BUN, Cre, and seventh days of cardiac function NYHA grading after the end of drug use in patients with refractory heart failure, but the time of hospitalization and mortality in patients with heart failure caused by two diseases have no effect on.2, and left Simendan can better improve ischemia compared to those with refractory heart failure caused by non ischemic cardiomyopathy. LVEF, NT-proBNP, TnT, BUN, Cre, and 48 hours cardiac NYHA grading levels after the end of drug use in patients with sexual cardiomyopathy, lower hospitalization time and hospitalized mortality.3, and compared with non aged patients with refractory heart failure, levosimendan can better improve NT-proBNP in elderly patients with refractory heart failure. TnT, Cre and the NYHA grading of cardiac function at seventh days after the end of treatment, but had no effect on the hospitalization time and mortality of elderly and non elderly patients.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 杜賀;史承勇;陳少萍;;左西孟旦的研究新進(jìn)展[J];中國循環(huán)雜志;2014年07期

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本文編號：1946934