目的 探討卡托普利與左西孟旦聯(lián)合治療慢性心力衰竭臨床療效。方法 選取2021年6月-2022年5月中國人民解放軍空軍軍醫(yī)大學(xué)第二附屬醫(yī)院收治的200例慢性心力衰竭患者,隨機(jī)分為對照組(100例)和治療組(100例)。對照組患者靜脈滴注左西孟旦注射液,6~12 µg/kg,1次/d。治療組在對照組基礎(chǔ)上口服復(fù)方卡托普利片,12.5 mg/次,3次/d。兩組患者治療7 d。觀察兩組患者臨床療效,比較治療前后兩組患者癥狀好轉(zhuǎn)時間,心功能指標(biāo)左室射血分?jǐn)?shù)(LVEF)、左心室收縮末容積(LVSED)、左心室舒張末容積(LVEDV)和左心室舒張末期內(nèi)徑(LVEDD),血清因子N-末端B型利鈉肽前體(NT-proBNP)、心肌肌鈣蛋白(cTnT)、白細(xì)胞介素-6(IL-6)和金屬蛋白酶-9(MMP-9)水平及不良反應(yīng)。結(jié)果 治療后,治療組臨床有效率為98.00%,明顯高于對照組(88.00%,P<0.05)。治療后,治療組患者出現(xiàn)的癥狀好轉(zhuǎn)時間均短于對照組(P<0.05)。治療后,兩組心功能LVEF明顯高于治療前,而LVSED、LVDEV和LVEDD指標(biāo)明顯降低(P<0.05);且治療組心功能指標(biāo)明顯好于對照組(P<0.05)。治療后,兩組血清因子IL-6、NT-proBNP、cTnT、MMP-9水平低于治療前(P<0.05),且治療組顯著低于對照組(P<0.05)。治療期間,治療組不良反應(yīng)發(fā)生率為5.00%,明顯低于對照組(14.01%,P<0.05)。結(jié)論 卡托普利聯(lián)合左西孟旦治療慢性心力衰竭療效顯著,明顯改善患者癥狀,有效改善心功能,延緩心肌纖維化的進(jìn)展,并能降低炎癥反應(yīng)。

Objective To investigate the efficacy of captopril combined with levosimendan in treatment of chronic heart failure. Methods Patients (200 cases) with chronic heart failure in the Second Affiliated Hospital of PLA Air Force Military Medical University from June 2021 to May 2022 were randomly divided into control (100 cases) and treatment (100 cases) group. Patients in the control group were iv administered with Levosimendan Injection, 6-12 µg/kg, once daily. Patients in the treatment group po administered with Compound Captopril Tablets on the basis of the control group, 12.5 mg/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical evaluation was evaluated, the relief time of symptom, the cardiac function indexes LVEF, LVSED, LVDEV and LVEDD，the levels of serum factor IL-6, NT-proBNP, cTnT and MMP-9, and and adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 98.00%, which was significantly higher than that of the control group (88.00%, P＜0.05). After treatment, the time of symptom improvement in the treatment group was earlier than that in the control group (P＜0.05). After treatment, the cardiac function LVEF in two groups was significantly higher than that before treatment, while the indexes of LVSED, LVDEV and LVEDD were significantly decreased (P＜0.05), and the cardiac function indexes of the treatment group were significantly better than those of the control group (P＜0.05). After treatment, the serum levels of IL-6, NT-proBNP, cTnT and MMP-9 in two groups were lower than those before treatment (P＜0.05), and which in the treatment group were significantly lower than those in the control group (P＜0.05). During the treatment, the incidence of adverse reactions in the treatment group was 5.00%, which was significantly lower than that in the control group (14.01%, P＜0.05). Conclusion The combination of levosimendan and captopril is more effective, significantly improve patients' symptoms, effectively improve cardiac function, delay the progression of myocardial fibrosis, and reduce inflammatory reaction.

R914

國家自然科學(xué)基金資助項目(81900338)