目的 探讨丹参多酚酸盐联合曲美他嗪对慢性心力衰竭患者心功能的影响.方法 慢性心力衰竭患者74例,应用随机数字表随机分为对照组37例和治疗组37例.对照组给予洋地黄制剂、利尿剂、扩张血管药物、血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体阻断剂(ARB)或β受体阻滞剂治疗,疗程24周；治疗组在常规治疗基础上加用丹参多酚酸盐0.2g加入5％葡萄糖注射液250 ml或0.9％氯化钠注射液250 ml中静脉滴注,每日1次；曲美他嗪20 mg口服,每日3次,疗程24周.观察两组患者治疗前后心功能及脑钠肽的变化.结果 对照组与治疗组治疗24周后心功能均明显好转,总有效率分别为70.3％(26/37)和91.9％(34/37),两组比较差异有统计学意义(x2 =5.638,P＜0.05).治疗组治疗前左心室射血分数(LVEF)、每搏输出量(SV)、心输出量(CO)分别为(39±5)％、(46.53±12.14) ml、(4.79±1.02) L/min,治疗后分别为(52±7)％、(65.10±12.87) ml、(5.65±1.18) L/min,治疗前后比较差异均有统计学意义(t值分别为9.192、6.384、3.352,P均＜0.01)；治疗组治疗前收缩压、舒张压、心率、舒张末期左心室内径(Dd)、舒张期左心室后壁厚度(PWT)、舒张期室间隔厚度(IVST)、左心室质量(LVMW)、血浆脑钠肽分别为(134±12) mmHg、(84±8)mmHg、(118±11)次/min、(55.2±7.8) mm、(11.7±2.3) mm、(10.5±2.4) mm、(228±111)g、(568.7±179.5)ng/L,治疗后分别为(105±8) mmHg、(75±9) mmHg、(76±8)次/min、(48.7±3.7)mm、(9.1±1.4) mm、(8.7±1.2)mm、(170±59)g、(104.1±19.5) ng/L,治疗前后比较差异均有统计学意义(t值分别为-12.231、-4.546、-18.782、-4.579、-5.874、-4.080、-2.806、15.652,P均＜0.01).对照组治疗前LVEF、SV分别为(38±6)％、(46.76±11.80) ml,治疗后分别为(43±8)％、(58.69±11.58) ml,治疗前后比较差异均有统计学意义(t值分别为3.041、4.389,P均＜0.05)；对照组治疗前收缩压、心率、PWT、血浆脑钠肽分别为(132±10) mmHg、(116±10)次/min、(11.5±2.6) mm、(570.2±177.3)ng/L,治疗后分别为(116±11) mmHg、(77±9)次/min、(10.4±2.0) mm、(211.6±21.2) ng/L,治疗前后比较差异均有统计学意义(t值分别为-6.546、-17.632、-2.039、12.215,P均＜0.01).治疗组治疗后收缩压、舒张压、LVEF、SV、CO、Dd、PWT、IVST、LVMW、血浆脑钠肽均明显优于对照组(t值分别为-4.919、-2.867、5.150、2.252、2.851、-2.319、-3.238、-3.628、-2.231、-22.701,P＜0.01或＜0.05).结论 丹参多酚酸盐联合曲美他嗪治疗慢性心力衰竭效果显著,对左心室有逆转作用.
目的 探討丹參多酚痠鹽聯閤麯美他嗪對慢性心力衰竭患者心功能的影響.方法 慢性心力衰竭患者74例,應用隨機數字錶隨機分為對照組37例和治療組37例.對照組給予洋地黃製劑、利尿劑、擴張血管藥物、血管緊張素轉換酶抑製劑(ACEI)、血管緊張素受體阻斷劑(ARB)或β受體阻滯劑治療,療程24週；治療組在常規治療基礎上加用丹參多酚痠鹽0.2g加入5％葡萄糖註射液250 ml或0.9％氯化鈉註射液250 ml中靜脈滴註,每日1次；麯美他嗪20 mg口服,每日3次,療程24週.觀察兩組患者治療前後心功能及腦鈉肽的變化.結果 對照組與治療組治療24週後心功能均明顯好轉,總有效率分彆為70.3％(26/37)和91.9％(34/37),兩組比較差異有統計學意義(x2 =5.638,P＜0.05).治療組治療前左心室射血分數(LVEF)、每搏輸齣量(SV)、心輸齣量(CO)分彆為(39±5)％、(46.53±12.14) ml、(4.79±1.02) L/min,治療後分彆為(52±7)％、(65.10±12.87) ml、(5.65±1.18) L/min,治療前後比較差異均有統計學意義(t值分彆為9.192、6.384、3.352,P均＜0.01)；治療組治療前收縮壓、舒張壓、心率、舒張末期左心室內徑(Dd)、舒張期左心室後壁厚度(PWT)、舒張期室間隔厚度(IVST)、左心室質量(LVMW)、血漿腦鈉肽分彆為(134±12) mmHg、(84±8)mmHg、(118±11)次/min、(55.2±7.8) mm、(11.7±2.3) mm、(10.5±2.4) mm、(228±111)g、(568.7±179.5)ng/L,治療後分彆為(105±8) mmHg、(75±9) mmHg、(76±8)次/min、(48.7±3.7)mm、(9.1±1.4) mm、(8.7±1.2)mm、(170±59)g、(104.1±19.5) ng/L,治療前後比較差異均有統計學意義(t值分彆為-12.231、-4.546、-18.782、-4.579、-5.874、-4.080、-2.806、15.652,P均＜0.01).對照組治療前LVEF、SV分彆為(38±6)％、(46.76±11.80) ml,治療後分彆為(43±8)％、(58.69±11.58) ml,治療前後比較差異均有統計學意義(t值分彆為3.041、4.389,P均＜0.05)；對照組治療前收縮壓、心率、PWT、血漿腦鈉肽分彆為(132±10) mmHg、(116±10)次/min、(11.5±2.6) mm、(570.2±177.3)ng/L,治療後分彆為(116±11) mmHg、(77±9)次/min、(10.4±2.0) mm、(211.6±21.2) ng/L,治療前後比較差異均有統計學意義(t值分彆為-6.546、-17.632、-2.039、12.215,P均＜0.01).治療組治療後收縮壓、舒張壓、LVEF、SV、CO、Dd、PWT、IVST、LVMW、血漿腦鈉肽均明顯優于對照組(t值分彆為-4.919、-2.867、5.150、2.252、2.851、-2.319、-3.238、-3.628、-2.231、-22.701,P＜0.01或＜0.05).結論 丹參多酚痠鹽聯閤麯美他嗪治療慢性心力衰竭效果顯著,對左心室有逆轉作用.
목적 탐토단삼다분산염연합곡미타진대만성심력쇠갈환자심공능적영향.방법 만성심력쇠갈환자74례,응용수궤수자표수궤분위대조조37례화치료조37례.대조조급여양지황제제、이뇨제、확장혈관약물、혈관긴장소전환매억제제(ACEI)、혈관긴장소수체조단제(ARB)혹β수체조체제치료,료정24주；치료조재상규치료기출상가용단삼다분산염0.2g가입5％포도당주사액250 ml혹0.9％록화납주사액250 ml중정맥적주,매일1차；곡미타진20 mg구복,매일3차,료정24주.관찰량조환자치료전후심공능급뇌납태적변화.결과 대조조여치료조치료24주후심공능균명현호전,총유효솔분별위70.3％(26/37)화91.9％(34/37),량조비교차이유통계학의의(x2 =5.638,P＜0.05).치료조치료전좌심실사혈분수(LVEF)、매박수출량(SV)、심수출량(CO)분별위(39±5)％、(46.53±12.14) ml、(4.79±1.02) L/min,치료후분별위(52±7)％、(65.10±12.87) ml、(5.65±1.18) L/min,치료전후비교차이균유통계학의의(t치분별위9.192、6.384、3.352,P균＜0.01)；치료조치료전수축압、서장압、심솔、서장말기좌심실내경(Dd)、서장기좌심실후벽후도(PWT)、서장기실간격후도(IVST)、좌심실질량(LVMW)、혈장뇌납태분별위(134±12) mmHg、(84±8)mmHg、(118±11)차/min、(55.2±7.8) mm、(11.7±2.3) mm、(10.5±2.4) mm、(228±111)g、(568.7±179.5)ng/L,치료후분별위(105±8) mmHg、(75±9) mmHg、(76±8)차/min、(48.7±3.7)mm、(9.1±1.4) mm、(8.7±1.2)mm、(170±59)g、(104.1±19.5) ng/L,치료전후비교차이균유통계학의의(t치분별위-12.231、-4.546、-18.782、-4.579、-5.874、-4.080、-2.806、15.652,P균＜0.01).대조조치료전LVEF、SV분별위(38±6)％、(46.76±11.80) ml,치료후분별위(43±8)％、(58.69±11.58) ml,치료전후비교차이균유통계학의의(t치분별위3.041、4.389,P균＜0.05)；대조조치료전수축압、심솔、PWT、혈장뇌납태분별위(132±10) mmHg、(116±10)차/min、(11.5±2.6) mm、(570.2±177.3)ng/L,치료후분별위(116±11) mmHg、(77±9)차/min、(10.4±2.0) mm、(211.6±21.2) ng/L,치료전후비교차이균유통계학의의(t치분별위-6.546、-17.632、-2.039、12.215,P균＜0.01).치료조치료후수축압、서장압、LVEF、SV、CO、Dd、PWT、IVST、LVMW、혈장뇌납태균명현우우대조조(t치분별위-4.919、-2.867、5.150、2.252、2.851、-2.319、-3.238、-3.628、-2.231、-22.701,P＜0.01혹＜0.05).결론 단삼다분산염연합곡미타진치료만성심력쇠갈효과현저,대좌심실유역전작용.
Objective To explore the effect of salvianolate combined with Qumei trimetazidine on cardiac function in patients with chronic heart failure.Methods Seventy-four patients with chronic heart failure were randomly divided into treatment group and control group (37 cases per group).Patients in control group were treated with the regular treatment scheme including digitalis,diuretics,vasodilators,angiotensin converting enzyme inhibitor(ACEI),angiotensin receptor blockers (ARB) or β blocker therapy for 24 weeks treatment.Patients in treatment group were given the regular treatment scheme plus salvianolic acid and Qumei trimetazidine treatment,of which,the dose of salvianolic was 0.2 g into 5％ glucose injection 250 ml or 0.9％ sodium chloride injection 250 ml by intravenous injection,1 times/day,and Qumei trimetazidine for 20 mg,3 times/day,for 24 weeks.Cardiac function was observed in patients of two groups before and after treatment.The level of brain natriuretic peptide (BNP) was measured.Results Heart function were improved,the total effective rate in treatment group was 91.9％ (34/37),higher than that of control group (70.3％ (26/37),x2 =5.638,P ＜ 0.05).In treatment group,left ventricular ejection fraction (LVEF),stroke volume (SV),cardiac output (CO) of patients after treatment were (52 ± 7) ％,(65.10 ± 12.87) ml,(5.65 ± 1.18) L/min respectively,significant different from that before treatment ((39 ±5)％,(46.53 ± 12.14) ml,(4.79 ± 1.02) L/min,and the differences were statistic significant (t =9.192,6.384,3.352,P ＜ 0.05).Meanwhile,in treatment group,systolic pressure,diastolic pressure,heart rate,left ventricular end diastolic diameter (Dd),left ventricular diastolic posterior wall thickness(PWT),interventricular septal thickness (IVST),left ventricular mass (LVMW),plasma brain natriuretic peptide of patients after treatment were (105 ± 8) mmHg,(75 ± 9) mmHg,(76±8) time/min,(48.7 ±3.7) mm,(9.1 ±1.4) mm,(8.7 ±1.2) mm,(170±59) g,(104.1 ±19.5) ng/L respectively,significant different from that of before treatment((134 ± 12) mmHg,(84 ±8) mmHg,(118 ±11) time/min,(55.2 ±7.8) mm,(11.7 ±2.3) mm,(10.5 ±2.4) mm,(228 ± 111) g,(568.7±179.5) ng/L t=-12.231,-4.546,-18.782,-4.579,-5.874,-4.080,-2.806,15.652,P ＜ 0.01).The same trend was seen in control group in terms of LVEF,SV,systolic blood pressure,heart rate,PWT,plasma BNP before and after treatment(LVEF:(38 ±6)％ vs.(43 ± 8)％ ;:(46.76 ± 11.80) ml vs.(58.69 ± 11.58) ml; systolic blood pressure:(132 ± 10) mmHg vs.(116 ± 11) mmHg; heart rate:(116 ± 10) time/min vs.(77 ±9) time/min;PWT:(11.5 ±2.6) mm vs.(10.4 ±2.0) mm;plasma BNP:(570.2 ± 177.3) ng/L vs.(211.6 ± 21.2) ng/L;t =3.041,4.389;-6.546,-17.632,-2.039,12.21 ;P ＜ 0.05 or P ＜ 0.01).Moreover,after treatment,systolic pressure,diastolic pressure,LVEF,SV,CO,Dd,PWT,IVST,LVMW,plasma brain natriureticpeptide in treatment group were significantly better than that of control grouo (t =-4.919,-2.867,5.510,2.252,2.581,-2.319,-3.238,-3.628,-2.231,-22.701,P ＜0.01 or P ＜ 0.05).Conclusion The effect of salvianolate combined Qumei trimetazidine on treating chronic heart failure is significant,and there is a reverse effect on the left ventricle.
