心舒宁联合曲美他嗪治疗尿毒症性心肌病临床评价
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摘要
目的探讨心舒宁联合曲美他嗪治疗尿毒症性心肌病的疗效及对心功能和N末端脑钠肽前体(NT-pro BNP)的影响。方法选择2014年1月至2017年1月医院收治的95例尿毒症性心肌病患者,随机分为对照组(47例)和治疗组(48例)。对照组患者给予曲美他嗪治疗,治疗组患者给予心舒宁联合曲美他嗪治疗,两组均连续治疗3个月。结果治疗组总有效率为91.67%,明显高于对照组的68.09%(χ~2=8.254,P=0.004<0.01);治疗后,两组患者血清NT-pro BNP水平均明显低于治疗前,且治疗组明显低于对照组(t=34.085,P<0.01);治疗后,两组患者左心房内径(LAD)、左心室收缩末期内径(LVESd)、左心室舒张末期内径(LVEDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPET)均明显小于治疗前,舒张早期最大血流速率/舒张晚期最大血流速率(E/A)及左心室射血分数(LVEF)均明显大于治疗前,且治疗组变化更明显(P<0.05);两组治疗过程中不良反应发生率相当(8.33%比6.38%,χ~2=0.132,P=0.716)。结论心舒宁联合曲美他嗪治疗尿毒症性心肌病的临床疗效显著,能明显改善患者的心功能,且安全性较好,值得临床推广。
Objective To investigate the clincial effect of Xinshuning combined with trimetazidine in the treatment of uremic cardiomyopathy and its effect on cardiac function and NT-pro BNP.Methods Totally 95 patients with uremia cardiomyopathy admitted to our hospital from January 2014 to January 2017 were selected and randomly divided into the control group(n = 47) and the treatment group(n = 48).The control group was treated with trimetazidine,while the treatment group was treated with Xinshuning combined with trimetazidine.The two groups were treated for 3 months.Results The total effective rate of the treatment group was 91.67%,which was significantly higher than 68.09% of the control group(χ~2 = 8.254,P = 0.004 < 0.01).After treatment,the levels of serum NT-pro BNP in the two groups were significantly lower than those before treatment,and that of the treatment group were significantly lower than that of the control group(t = 34.085,P < 0.01).After treatment,the LAD,LVESd,LVEDd,IVST,LVPWT of the two groups were significantly lower than those before treatment,the E/A and LVEF of the two groups were significantly higher than those before treatment,and the improvement of the treatment group was more significant(P < 0.05).There was no significantly difference in the incidence rate of the adverse reactions in the two groups during the treatment(8.33 % vs.6.38 %,χ~2 = 0.132,P = 0.716).Conclusion Xinshuning combined with trimetazidine in the treatment of patients with uremia cardiomyopathy has a good effect and safety,it can improve the cardiac function of patients,which is worthy of clinical promotion.
Objective To investigate the clincial effect of Xinshuning combined with trimetazidine in the treatment of uremic cardiomyopathy and its effect on cardiac function and NT-pro BNP.Methods Totally 95 patients with uremia cardiomyopathy admitted to our hospital from January 2014 to January 2017 were selected and randomly divided into the control group(n = 47) and the treatment group(n = 48).The control group was treated with trimetazidine,while the treatment group was treated with Xinshuning combined with trimetazidine.The two groups were treated for 3 months.Results The total effective rate of the treatment group was 91.67%,which was significantly higher than 68.09% of the control group(χ~2 = 8.254,P = 0.004 < 0.01).After treatment,the levels of serum NT-pro BNP in the two groups were significantly lower than those before treatment,and that of the treatment group were significantly lower than that of the control group(t = 34.085,P < 0.01).After treatment,the LAD,LVESd,LVEDd,IVST,LVPWT of the two groups were significantly lower than those before treatment,the E/A and LVEF of the two groups were significantly higher than those before treatment,and the improvement of the treatment group was more significant(P < 0.05).There was no significantly difference in the incidence rate of the adverse reactions in the two groups during the treatment(8.33 % vs.6.38 %,χ~2 = 0.132,P = 0.716).Conclusion Xinshuning combined with trimetazidine in the treatment of patients with uremia cardiomyopathy has a good effect and safety,it can improve the cardiac function of patients,which is worthy of clinical promotion.
引文
[1]Taylor D,Bhandari S,Seymour AM.Mitochondrial dysfunction in uremic cardiomyopathy[J].Am J Physiol Renal Physiol,2015,308(6):579-587.
[2]李睿.中西医结合治疗尿毒症心肌病疗效分析[J].中医临床研究,2014,6(15):72-73.
[3]任婷.心舒宁治疗冠心病心绞痛32例疗效观察[J].湖南中医杂志,2010,26(5):17-35.
[4]薛立光,孙慧琼,宗学莉.尿毒症性心肌病行曲美他嗪治疗的疗效探讨[J].中外医疗,2015,34(30):110-111.
[5]陈灏珠.实用内科学[M].北京:人民卫生出版社,2013:2098-2107.
[6]陈新,孙剑萍,周丽娜,等.碳酸镧联合环磷腺苷葡胺治疗尿毒症性心肌病的疗效分析[J].临床肾脏病杂志,2015,15(11):674-677.
[7]Semple DJ,Bhandari S,Seymour AM.Uremic cardiomyopathy is characterized by loss of the cardioprotective effects of insulin[J].Am J Physiol Renal Physiol,2012,303(9):1275-1286.
[8]Srivastava VK,Agrawal S,Das PK,et al.Low dose spinal with epidural volume extension for renal transplantation in a patient with uremic cardiomyopathy[J].Indian J Anaesth,2014,58(1):93-94.
[9]熊燕,赵毅,顾少华,等.曲美他嗪治疗尿毒症性心肌病30例[J].实用医学杂志,2014,30(4):620-622.
[10]刘淑娟.尿毒症心肌病中医证候学回顾性调查[J].山西中医,2009,25(6):49-55.
[11]李佑生,黄江波,朱棱,等.益气养阴活血解毒法对尿毒症心肌病患者左室功能与结构的影响[J].湖南中医学院学报,2003,23(2):31-64.
[12]么丽颖.中药辅治尿毒症心肌病的临床观察[J].疑难病杂志,2011,10(5):369-370.
[13]吴风富,覃善都,覃梓健.强化心肌病治疗对尿毒症性心肌病患者N末端脑钠肽前体及心脏腔室的影响[J].疑难病杂志,2012,11(2):86-88.
[14]周琦,孙刚.心舒宁合剂对舒张性心力衰竭患者BNP、CA125和CRP的影响分析[J].中国现代医学杂志,2017,27(19):116-119.
[15]安东.曲美他嗪治疗尿毒症性心肌病患者的临床疗效[J].中国药物经济学,2016,11(1):75-76.
[2]李睿.中西医结合治疗尿毒症心肌病疗效分析[J].中医临床研究,2014,6(15):72-73.
[3]任婷.心舒宁治疗冠心病心绞痛32例疗效观察[J].湖南中医杂志,2010,26(5):17-35.
[4]薛立光,孙慧琼,宗学莉.尿毒症性心肌病行曲美他嗪治疗的疗效探讨[J].中外医疗,2015,34(30):110-111.
[5]陈灏珠.实用内科学[M].北京:人民卫生出版社,2013:2098-2107.
[6]陈新,孙剑萍,周丽娜,等.碳酸镧联合环磷腺苷葡胺治疗尿毒症性心肌病的疗效分析[J].临床肾脏病杂志,2015,15(11):674-677.
[7]Semple DJ,Bhandari S,Seymour AM.Uremic cardiomyopathy is characterized by loss of the cardioprotective effects of insulin[J].Am J Physiol Renal Physiol,2012,303(9):1275-1286.
[8]Srivastava VK,Agrawal S,Das PK,et al.Low dose spinal with epidural volume extension for renal transplantation in a patient with uremic cardiomyopathy[J].Indian J Anaesth,2014,58(1):93-94.
[9]熊燕,赵毅,顾少华,等.曲美他嗪治疗尿毒症性心肌病30例[J].实用医学杂志,2014,30(4):620-622.
[10]刘淑娟.尿毒症心肌病中医证候学回顾性调查[J].山西中医,2009,25(6):49-55.
[11]李佑生,黄江波,朱棱,等.益气养阴活血解毒法对尿毒症心肌病患者左室功能与结构的影响[J].湖南中医学院学报,2003,23(2):31-64.
[12]么丽颖.中药辅治尿毒症心肌病的临床观察[J].疑难病杂志,2011,10(5):369-370.
[13]吴风富,覃善都,覃梓健.强化心肌病治疗对尿毒症性心肌病患者N末端脑钠肽前体及心脏腔室的影响[J].疑难病杂志,2012,11(2):86-88.
[14]周琦,孙刚.心舒宁合剂对舒张性心力衰竭患者BNP、CA125和CRP的影响分析[J].中国现代医学杂志,2017,27(19):116-119.
[15]安东.曲美他嗪治疗尿毒症性心肌病患者的临床疗效[J].中国药物经济学,2016,11(1):75-76.
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