CAJ | 학술논문

目的观察前列地尔联合托拉塞米治疗顽固性心力衰竭的近期疗效.方法对经常规抗心力衰竭治疗效果不佳的30例顽固性心力衰竭患者予以前列地尔及托拉塞米治疗,前列地尔20 mg加入5％葡萄糖或0.9％氯化钠100 ml静脉滴注1次/d;托拉塞米20～40 mg静脉注射2次/d;托拉塞米用3d后根据病情调整用量,其余常规抗心力衰竭治疗不变.疗程1周.观察治疗前后患者的血压、体质量、尿量、血肌酐、电解质、N-末端脑钠肽前体(NT-proBNP)及左心室射血分数(LVEF)的变化.结果治疗后,所有患者呼吸困难、水肿、肺部干湿性哕音等临床症状均明显好转,治疗中3例患者出现轻度低钾血症,经及时补钾得以纠正.治疗后体质量与治疗前比较降低[(63.8±7.6) ks比(82.6±10.7) kg],尿量与治疗前比较升高[(2 328.3±367.8) ml/d比(568.7±104.6) ml/d],差异均有统计学意义(P＜0.O1);而治疗前后收缩压、舒张压比较差异无统计学意义(P＞0.05).治疗后LVEF与治疗前比较升高[(44.5±8.3)％比(31.9±10.2)％],血肌肝水平与治疗前比较降低[(97.8±18.6) μmol/L比(143.8±21.7)μmol/L],差异有统计学意义(P＜0.05);治疗后NT-proBNP水平与治疗前比较降低[(567.4±212.3) ng/L比(2 726.5±525.3) ng/L],差异有统计学意义(P＜0.01).结论前列地尔联合托拉塞米治疗顽固性心力衰竭,能快速有效改善症状,有助于心肾功能的改善,且无明显不良反应发生.
목적 관찰전렬지이연합탁랍새미치료완고성심력쇠갈적근기료효.방법 대경상규항심력쇠갈치료효과불가적30례완고성심력쇠갈환자여이전렬지이급탁랍새미치료,전렬지이20 mg가입5％포도당혹0.9％록화납100 ml정맥적주1차/d;탁랍새미20～40 mg정맥주사2차/d;탁랍새미용3d후근거병정조정용량,기여상규항심력쇠갈치료불변.료정1주.관찰치료전후환자적혈압、체질량、뇨량、혈기항、전해질、N-말단뇌납태전체(NT-proBNP)급좌심실사혈분수(LVEF)적변화.결과 치료후,소유환자호흡곤난、수종、폐부간습성홰음등림상증상균명현호전,치료중3례환자출현경도저갑혈증,경급시보갑득이규정.치료후체질량여치료전비교강저[(63.8±7.6) ks비(82.6±10.7) kg],뇨량여치료전비교승고[(2 328.3±367.8) ml/d비(568.7±104.6) ml/d],차이균유통계학의의(P＜0.O1);이치료전후수축압、서장압비교차이무통계학의의(P＞0.05).치료후LVEF여치료전비교승고[(44.5±8.3)％비(31.9±10.2)％],혈기간수평여치료전비교강저[(97.8±18.6) μmol/L비(143.8±21.7)μmol/L],차이유통계학의의(P＜0.05);치료후NT-proBNP수평여치료전비교강저[(567.4±212.3) ng/L비(2 726.5±525.3) ng/L],차이유통계학의의(P＜0.01).결론 전렬지이연합탁랍새미치료완고성심력쇠갈,능쾌속유효개선증상,유조우심신공능적개선,차무명현불량반응발생.
Objective To observe the short-term effect of alprostadil combined with torasemide in the treatment of intractable heart failure.Methods Thirty cases of patients with intractable heart failure and ineffective in routine therapy were given alprostadil and torasemide treatment,with alprostadil 20 mg in 5％ glucose or 0.9％ sodium chloride solution 100 ml intravenous infusion once a day and torasemide 20-40 mg intravenous twice a day 3 days later torasemide dosage was adjusted according to the disease,and the remaining conventional anti-heart failure therapy unchanged.Course was one week.The blood pressure,body weight,urine output,creatinine,electrolytes,N-terminal pro-brain natriuretic peptide (NT-proBNP)and left ventricular ejection fraction (LVEF) before and after treatment was observed.Results After treatment,clinical symptoms of dyspnea,edema,pulmonary rales,such as wet and dry significantly improved in all patients.During the course of the treatment,3 patients appeared mild hypokalemia,and potassium was promptly corrected.Body weight after treatment reduced compared with that before treatment [(63.8 ± 7.6) kg vs.(82.6 ± 10.7) kg],urine output increased after treatment compared with that before treatment [(2 328.3 ±367.8) ml/d vs.(568.7 ± 104.6) ml/d],and the differences were statistically significant (P ＜ 0.01).Systolic blood pressure,diastohc blood pressure difference was not statistically significant after treatment,compared with that before treatment (P ＞ 0.05).LVEF after treatment increased compared with that before treatment [(44.5 ± 8.3)％ vs.(31.9 ± 10.2)％],serum creatinine levels reduced [(97.8 ± 18.6) μmol/L vs.(143.8 ±21.7) μmol/L],and the difference was statistically significant (P＜ 0.05) ; NT-proBNP after treatment reduced compared with that before treatment [(567.4 ± 212.3) ng/L vs.(2 726.5 ± 525.3) ng/L],and the difference was statistically significant(P ＜ 0.01).Conclusion Alprostadil combined with torasemide treatment can quickly and effectively improve symptoms and help improve heart and kidney function in intractable heart failure,and has no significant adverse reactions.