托拉塞米治疗慢性心力衰竭急性期的临床疗效
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摘要
目的:观察托拉塞米用于慢性心力衰竭(心衰)急性期的临床疗效及对患者心室肥厚度、生活质量、肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法:选取2016年6月—2018年6月我院收治的106例慢性心衰急性期患者作为研究对象,按随机数字表法分为对照组与观察组,各53例。对照组给予呋塞米(20 mg/次,必要时2 h追加一次)治疗,观察组在对照组基础上给予托拉塞米(20 mg加至100 mL 0.9%氯化钠注射液或5%葡萄糖注射液中,静脉滴注,qd)治疗,两组均以7 d为一疗程;治疗1疗程后,评估两组临床疗效,观察治疗前、后两组血浆N末端脑钠肽前体(NT-pro BNP)、RAAS指标、心室肥厚度指标及生活质量的变化情况。结果:观察组总有效率为92.45%,高于对照组的71.70%,差异有统计学意义(P <0.05);治疗后两组心室肥厚度指标、生活质量评估结果、RAAS指标与NT-proBNP均较治疗前改善,且观察组优于对照组,差异有统计学意义(P <0.05);两组不良反应发生率比较差异无统计学意义(P> 0.05)。结论:托拉塞米应用于慢性心衰急性期的治疗中,能够有效提高临床疗效,减轻心室肥厚度与RAAS过度激活,从而降低心脏负荷,改善心室重构与生活质量。
Objective: To observe the clinical efficacy of torasemide in treatment of chronic heart failure(CHF) in acute phases and its effects on ventricular hypertrophy, quality of life and renin-angiotensin-aldosterone system(RAAS). Methods: 106 patients with chronic heart failure in acute phases admitted to our hospital from June 2016 to June 2018 were selected as subjects investigated and randomly divided into a control group and an observation group, 53 cases each. The patients in the control group were treated with furosemide(20 mg/time,added one time every two hours if necessary), and the patients in the observation group were treated with torasemide(20 mg drug was added to 100 mL 0.9% sodium chloride injection or 5% glucose injection, intravenous drip, qd) on the basis of the control group, 7 days as a course of treatment. After 1 course of treatment, the clinical efficacy in the two groups was evaluated, and the changes in plasma N-terminal pro-brain natriuretic peptide(NT-proBNP), RAAS indexes, ventricular hypertrophy indexes and quality of life before and after treatment were observed. Results: The total effective rate in the observation group was 92.45%, which was higher than 71.70% in the control group, and the difference was statistically significant(P<0.05). The ventricular hypertrophy indexes, assessment results of quality of life and RAAS indexes after treatment were improved compared with those before treatment, and the indexes and assessment results in the observation group were better than those in the control group, with statistically significant differences(P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Torasemide can effectively improve clinical efficacy and alleviate ventricular hypertrophy and excessive activation of RAAS in the treatment of chronic heart failure in acute phases, thereby reducing cardiac load and improving ventricular remodeling and quality of life.
Objective: To observe the clinical efficacy of torasemide in treatment of chronic heart failure(CHF) in acute phases and its effects on ventricular hypertrophy, quality of life and renin-angiotensin-aldosterone system(RAAS). Methods: 106 patients with chronic heart failure in acute phases admitted to our hospital from June 2016 to June 2018 were selected as subjects investigated and randomly divided into a control group and an observation group, 53 cases each. The patients in the control group were treated with furosemide(20 mg/time,added one time every two hours if necessary), and the patients in the observation group were treated with torasemide(20 mg drug was added to 100 mL 0.9% sodium chloride injection or 5% glucose injection, intravenous drip, qd) on the basis of the control group, 7 days as a course of treatment. After 1 course of treatment, the clinical efficacy in the two groups was evaluated, and the changes in plasma N-terminal pro-brain natriuretic peptide(NT-proBNP), RAAS indexes, ventricular hypertrophy indexes and quality of life before and after treatment were observed. Results: The total effective rate in the observation group was 92.45%, which was higher than 71.70% in the control group, and the difference was statistically significant(P<0.05). The ventricular hypertrophy indexes, assessment results of quality of life and RAAS indexes after treatment were improved compared with those before treatment, and the indexes and assessment results in the observation group were better than those in the control group, with statistically significant differences(P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Torasemide can effectively improve clinical efficacy and alleviate ventricular hypertrophy and excessive activation of RAAS in the treatment of chronic heart failure in acute phases, thereby reducing cardiac load and improving ventricular remodeling and quality of life.
引文
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[11]王昆,朱天刚,于超,等.老年慢性心力衰竭的临床特点及药物治疗回顾性分析[J].中国药学杂志,2015,50(10):901-904.
[12]张骞,刘小慧,董建增.慢性心力衰竭药物治疗进展[J].中国实用内科杂志,2016,36(4):272-276.
[13]Wong AP,Niedzwiecki A,Rath M.Myocardial energetics and the role of micronutrients in heart failure:a critical review[J].Am J Cardiovasc Dis,2016,6(3):81-92.
[14]黄勇.新型袢利尿剂托拉塞米治疗心衰进展[J].中西医结合心血管病电子杂志,2016,4(1):9-10.
[15]Buggey J,Mentz RJ,Pitt B,et al.A reappraisal of loop diuretic choice in heart failure patients[J].Am Heart J,2015,169(3):323-333.
[2]袁逾喆,王志甫,冯柯.曲美他嗪联合芪苈强心胶囊对慢性心力衰竭患者血清Gal-3、Copeptin水平变化及生活质量的影响[J].中国合理用药探索,2018,15(4):45-51,59.
[3]肖艳,崔颖,邵蔚.托拉塞米联合小剂量多巴胺治疗心衰合并肾功能不全患者的临床观察[J].中华肿瘤防治杂志,2016,23(S2):140-141.
[4]王翔,易省阳.慢性心力衰竭诊断及治疗新进展[J].中华实用诊断与治疗杂志,2015,29(1):10-12.
[5]刘辉,王学惠,张永春,等.托拉塞米治疗慢性心力衰竭的临床观察[J].中国药房,2016,27(29):4093-4095.
[6]朱宏文,沈洁,黄小群,等.托拉塞米治疗终末期肥厚型非梗阻性心肌病心力衰竭患者的疗效与安全性[J].临床心血管病杂志,2016,32(2):127-130.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[8]孙明,王蔚文.临床疾病诊断与疗效判断标准[M].北京:科学技术文献出版社,2010:241-242.
[9]龚开政,张振刚,张昕,等.明尼苏达州心力衰竭生活质量问卷与36条简明健康状况调查表对慢性心力衰竭患者生活质量的评估作用[J].中国临床康复,2005,9(28):29-31.
[10]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2014》概要[J].中国循环杂志,2015,30(7):617-622.
[11]王昆,朱天刚,于超,等.老年慢性心力衰竭的临床特点及药物治疗回顾性分析[J].中国药学杂志,2015,50(10):901-904.
[12]张骞,刘小慧,董建增.慢性心力衰竭药物治疗进展[J].中国实用内科杂志,2016,36(4):272-276.
[13]Wong AP,Niedzwiecki A,Rath M.Myocardial energetics and the role of micronutrients in heart failure:a critical review[J].Am J Cardiovasc Dis,2016,6(3):81-92.
[14]黄勇.新型袢利尿剂托拉塞米治疗心衰进展[J].中西医结合心血管病电子杂志,2016,4(1):9-10.
[15]Buggey J,Mentz RJ,Pitt B,et al.A reappraisal of loop diuretic choice in heart failure patients[J].Am Heart J,2015,169(3):323-333.