左卡尼汀治疗心衰合并糖尿病患者的临床意义

目的观察应用左卡尼汀改善心肌能量代谢治疗心力衰竭(简称心衰)合并2型糖尿病患者的临床疗效.方法选择心衰合并糖尿病患者98例,随机分为对照组和观察组.对照组采取常规治疗2周,治疗组采用左卡尼汀(2g,静脉滴注,1次/d,共2周)治疗.治疗前及经治疗后分别检查两组患者的心脏超声心动图及血清血糖、血脂水平.结果观察组LVEDD、LVESD、LVEF,治疗后较治疗前差异均有统计学意义(P<0.05),LVEDD及LVEF较对照组差异均有统计学意义(P<0.05);观察组GLU、TG、CHO、HDL,治疗后较治疗前均有显著性改善,治疗后观察组GLU及CHO较对照组显著下降,差异均有统计学意义(P<0.05).在常规治疗基础上应用左卡尼汀进行治疗,总有效率明显高于采用常规治疗,差异有统计学意义(P<0.05).结论左卡尼汀对心肌细胞具有保护作用,可延缓心衰进展.     

左卡尼汀对心力衰竭伴2型糖尿病患者的疗效及糖脂代谢的影响

目的 探讨左卡尼汀对慢性心力衰竭合并2型糖尿病患者的疗效及其对患者血糖、血脂的影响.方法 将46例心衰伴2型糖尿病的患者随机分为两组,均给予最优治疗方案,除实验组另给左卡尼汀2 g/d静滴外,两组的其他用药类同,疗程均为15 d,观察治疗前后临床心功能NYHA分级,明尼苏达心衰生活质量评分,超声心动图检查及血糖、血脂变化.结果 实验组与对照组比较,实验组患者心功能改善、生活质量提高、超声心动图指标改善、病情恶化减少、血糖下降等方面均优于对照组,差异均有统计学意义(P《0.05);实验组患者总胆固醇、甘油三酯降低,高密度脂蛋白胆固醇升高,与对照组患者比较差异有统计学意义(P《0.05).结论 短期应用左卡尼汀可使心衰伴2型糖尿病的患者心功能改善,生活质量提高,对降低血糖有帮助,并能调节血脂.     

左西孟旦联合左卡尼汀治疗老年顽固性心力衰竭的临床效果

目的 探讨左西孟旦治疗老年顽固性心力衰竭(H F)的临床疗效及其对患者心功能、炎症因子水平的影响.方法 将125例老年顽固性HF患者按随机数字表法分为对照组62例与观察组63例,对照组在常规治疗基础上给予左卡尼汀治疗,观察组在常规治疗基础上给予左卡尼汀联合左西孟旦治疗.比较2组的临床疗效及治疗前后心功能指标[包括左室射...     

左卡尼汀治疗慢性充血性心力衰竭疗效观察

目的:观察左卡尼汀治疗慢性充血性心力衰竭的疗效。方法:选择慢性充血性心力衰竭患者70例(治疗组和对照组各35例),两组均给予一致的心衰标准治疗,治疗组在此基础上加用左卡尼汀针,对照组加用复方丹参针,均治疗2周。结果:两组治疗后均有效,治疗组心功能改善总有效率明显优于对照组;心功能检查方面,治疗组治疗后较治疗前均有明显改善,与对照组相比有显著差异(P<0.05)。结论:左卡尼汀对慢性充血性心力衰竭患者具有显著改善心功能的作用。     

左卡尼汀注射液治疗慢性心力衰竭92例疗效观察

目的：观察左卡尼汀治疗慢性心力衰竭的近期疗效。方法将2011年1月至2013年1月南充市第五人民医院收治的184例慢性心力衰竭患者随机分成治疗组和对照组。对照组给予强心、利尿及扩血管药物等心力衰竭常规治疗;治疗组在上述治疗基础上加用左卡尼汀注射液3 g加入5％葡萄糖注射液或生理盐水100 m L中静脉滴注10～15 d。同时还测定了脑钠肽（BNP）的平均浓度作为衡量心力衰竭程度的指标。结果治疗组总有效率为96．7％,对照组总有效率为81．5％,两组比较差异有统计学意义（P＜0．05）。治疗组BNP含量也要显著低于低于对照组。结论应用左卡尼汀注射液治疗慢性心力衰竭,可以显著改善患者心功能。     

左卡尼汀治疗缺血性心肌病心力衰竭的临床价值

目的探讨左卡尼汀治疗缺血性心肌病心力衰竭的临床价值。方法选取本院诊治的缺血性心肌病心力衰竭患者127例,随机被分为两组,常规治疗患者63例为对照组,常规治疗加用左卡尼汀患者64例为观察组,疗程3个月,比较两组临床病症改善情况、临床指标改变情况、临床疗效及不良反应。结果治疗后,两组左心室射血分数、左心室短轴缩短率、心输出量、每搏输出量、6分钟步行距离均明显增加,两组左心室舒张末期内径、左心室收缩末期内径、血浆B型钠尿肽均明显减小。观察组左心室射血分数、左心室短轴缩短率、心输出量、每搏输出量、6分钟步行距离均明显大于对照组,观察组左心室舒张末期内径、左心室收缩末期内径、血浆B型钠尿肽均明显小于对照组,观察组胸闷病症消失率、气短病症消失率、乏力病症消失率、水肿病症消失率、治疗总有效率均明显高于对照组(均P0.05)。结论左卡尼汀可明显改善缺血性心肌病心力衰竭患者的临床病症,显著改善患者的临床指标,临床疗效显著,引发的不良反应较少,具有较高的安全性。     

糖尿病并心衰采用左卡尼汀治疗的临床效果分析

选取我院2011年03月01日~2013年10月01日收治的85例患糖尿病并心衰患者为研究对象,并进行随机分组,分为治疗组与对照组,对照组40例,治疗方法为:口服地高辛0.125mg,po dp.螺内酯20mg,po bid2,氢氯噻嗪25mg po bid;治疗组45例,治疗方法法为:在上述治疗基础上使用生理盐水100ml加左卡尼汀2g静脉滴注,每天一次,比较两组的治疗效果。结果治疗组的总有效率为96.56%,对照组的总有效率为85.00%,两组具有显著性差异(P0.05);两组治疗后心功能分级、超声心动图检测指标、血糖及血脂均明显改善,但以治疗组改善明显(P0.05)。左卡尼汀可改善糖尿病并心衰患者的心功能,具有效果显著、安全等特点,值得临床上的广泛推广使用。     

左卡尼汀治疗扩张型心肌病心力衰竭临床观察

扩张型心肌病（DCM）是一种以心脏扩大、心律失常和充血性心力衰竭为主要表现的严重心肌病，至今缺乏特异性的治疗方法。作用左卡尼汀（L-CN）治疗DCM心力衰竭患，评价其对心功能的影响。     

左卡尼汀对80岁以上老年冠心病心力衰竭患者脑钠肽及心功能的影响

传统治疗心力衰竭（heart failure,HF）的药物,如血管紧张素转换酶抑制剂、β-受体阻滞剂和利尿剂,能减轻HF症状,增加运动耐量,提高生存率,但HF治疗前景仍不容乐观,因此探索缓解症状及改善预后的其他治疗途径刻不容缓。研究发现,短期缺乏卡尼汀即可引起心肌功能异常,包括收缩功能紊乱和收缩储备力下降,长期缺乏左卡尼汀,尤其是心脏处于高负荷状态时,心室收缩舒张功能和顺应性均受到影响。文献报道,脑钠肽（brain natriuretic peptide,BNP）可以客观定量反映HF严重程度,     

左卡尼汀治疗缺血性心脏病心力衰竭的疗效及其对血脂的影响

目的:探讨左卡尼汀治疗缺血性心脏病并发心力衰竭患者的疗效及其对血脂水平的影响。方法:将2005年3月至2007年3月收住的60例缺血性心脏病并发心衰患者分为左卡尼汀组和对照组各30例,对照组给予常规抗心衰治疗,左卡尼汀组在常规抗心衰治疗基础上加用左卡尼汀静滴,3g/d,2周为1个疗程,间断应用5个疗程。记录用药前后患者心功能改善情况、超声心动图、血脂的变化情况。结果:左卡尼汀组患者心功能及超声心动图各项指标改善优于对照组,差异有显著性(P<0.05);左卡尼汀组患者总胆固醇、甘油三酯降低,高密度脂蛋白胆固醇升高,与对照组患者比较差异有显著性(P<0.01)。结论:左卡尼汀治疗缺血性心脏病并发心力衰竭有较好疗效,对血脂调节有效。     

老年糖尿病患者急性心力衰竭血浆脂联素浓度变化及临床意义

目的 研究老年糖尿病患者急性心力衰竭（AHF）时血浆脂联素（APN）浓度变化及临床意义.方法 135例观察对象,根据有无急性心力衰竭及糖尿病分为4组：非糖尿病心力衰竭组（A组）31例;糖尿病心力衰竭组（B组）43例,非糖尿病对照组（C组）30例,糖尿病对照组（D组）31例.入院即刻检测APN、NTproBNP,并行超声心动图检查,记录缓解时间及随访30 d心血管事件发生情况,分析各组之间的差异及各指标间的相关性.结果 （1） AHF时,B组肺部哕音≥50％的患者发生率,下肢水肿发生比例、LgNTproBNP、治疗时间＞24h比例、30 d内心血管事件发生率明显高于A组（P＜0.05）;心脏射血分数（EF）值明显降低（P＜0.01）.（2）A组、B组、C组、D组APN浓度分别为：（21.27±4.36） μg/L,（18.31 ±4.17） μg/L,（14.27±2.54） μg/L,（11.49±1.09） μg/L,各组间差异有统计学意义.（3）B组APN＞ 18.31 μg/L的患者中有66.7％治疗时间＞24h,30 d心血管事件发生率为61.5％.（4）AHF患者APN浓度与LgNTproBNP呈正相关（A组r =0.693,B组r=0.575,P均＜0.01）.结论 （1）合并糖尿病的老年AHF患者心力衰竭程度重、治疗反应差,死亡率高,30 d内心血管事件多发.（2）AHF患者血浆APN浓度明显升高,糖尿病患者APN代偿性升高能力受到抑制.     

磷酸肌酸对老年心力衰竭患者的疗效观察

目的观察常规治疗加用磷酸肌酸对老年心力衰竭患者的疗效及安全性。方法选择老年心力衰竭患者136例,对照组予常规抗心力衰竭治疗,感染患者给予静脉或口服抗感染药物治疗。治疗组:在对照组基础上每日加用磷酸肌酸2.0 g/d,静脉滴注,疗程14～21 d。全部病例药物干预前后检测心电图、超声心动图、NT-proBNP,评估心功能改善情况。结果与对照组比较,磷酸肌酸治疗组∑ST和心率降低更明显,心功能指标提高,Pro-BNP明显下降(P<0.05),总有效率达95.45%。结论磷酸肌酸可以更有效缓解老年心力衰竭患者的临床症状,减轻心肌缺血,改善心功能,不良反应少。     

左卡尼汀序贯治疗老年人充血性心力衰竭

目的观察左卡尼汀(LC)序贯治疗老年人充血性心力衰竭(CHF)的近期疗效。方法对照组35例,常规按心衰治疗;LC组37例,在对照组基础上加用静滴LC 3 g/d×2周,后改服LC 2 g/d×2周。4周后比较两组患者治疗前后及组间NYHA心功能分级、明尼苏达心衰生活质量评分、ECG及UCG改善程度。结果(1)治疗后两组NYHA分级总有效率无显著差异,但LC组显效率高于对照组。(2)治疗后LC组CO、SV、EF、FS、VE/VA较治疗前明显升高。(3)治疗后LC组常规12导联中ST段压低>0.25 mm的导联数、常规12导联中ST段压低的总和较治疗前及对照组明显改善。(4)治疗后LC组明尼苏达心衰生活质量评分(MLWHF)高于对照组,血浆白蛋白、前白蛋白水平均较治疗前及对照组高。结论常规疗法联合应用LC序贯疗法治疗老年人CHF近期疗效显著、安全。     

行动体验式心理健康教育对老年糖尿病合并心力衰竭患者心理应激的影响

目的：探讨行动体验式心理健康教育对老年糖尿病合并心力衰竭患者的效果及对心理应激的影响。方法：选取152例老年糖尿病合并心力衰竭患者,按随机数字表分为观察组与对照组,各76例。对照组采取常规健康教育,观察组采取行动体验式心理健康教育,干预时间2个月。比较2组干预前后的血清空腹血糖（FPG）、餐后2 h血糖（PG2h）、糖化血红蛋白（HbA1c）、去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（Cr）及自我管理效能。结果：两组干预2个月后,2组的FPG、PG2h与HbA1c均较干预前降低（P<0.05）。观察组干预后的FPG、PG2h与HbA1c低于对照组（P<0.05）。2组干预2个月后的KAB疾病知识与行为评分均较干预前升高、KAB态度评分较干预前降低（P<0.05）。观察组干预后的KAB疾病知识与行为评分高于对照组,态度评分低于对照组（P<0.05）。干预2个月后,2组的血清NE、E、Cr均较干预前降低,且观察组低于对照组（P< 0.05）。结论：与常规健康教育相比,行动体验式心理健康教育可有效强化老年糖尿病合并心力衰竭患者的血糖控制效果,提高患者自我管理能力,减轻心理应激。     

Association of frailty with in-hospital outcomes in elderly patients with heart failure

BACKGROUNDFrailty is prevalent in elderly patients with cardiovascular diseases. However, the association between frailty and in-hospital outcomes for elderly patients with heart failure and reduced ejection (HFrEF) remains unknown.AIMTo evaluate the predictive efficacy of frailty, compared with pre-frailty, for adverse events in these patients. METHODSElderly patients (≥ 60 years) with HFrEF were assessed. Frailty was evaluated with the Fried phenotype criteria, and physical performance was evaluated based on handgrip strength and the short physical performance battery (SPPB). The composite incidence of adverse events, including all-cause death, multiple organ failure, cardiac shock, and malignant arrhythmia, during hospitalization was recorded. RESULTSOverall, 252 elderly individuals with HFrEF [mean age: 69.4 ± 6.7 years, male: 169 (67.0%)] were included. One hundred and thirty-five (53.6%) patients were frail and 93 (36.9%) were pre-frail. Frail patients were older, more likely to be female, to have a lower blood pressure, and to present with left ventricular thrombosis (P all < 0.05). Frail patients with HFrEF had a higher incidence of in-hospital mortality (11.9% vs 4.3%, P = 0.048). Multivariate analyses showed that female gender (OR = 0.422), aging (OR = 1.090), poor cardiac functional class (OR = 2.167), frailty (OR = 2.379), and lower handgrip strength (OR = 1.106) were independent predictors of in-hospital adverse events (P all < 0.05). CONCLUSIONFrailty may be associated with poor in-hospital outcomes for elderly patients with HFrEF. The influence of frailty on long-term prognosis in these patients deserves further investigation.     

达格列净治疗糖尿病合并慢性心力衰竭的临床研究

目的探讨达格列净治疗糖尿病合并慢性心力衰竭(CHF)临床疗效及对患者血清炎症因子的影响。方法 122例糖尿病合并CHF患者依简单随机数表法分为达格列净组与对照组各61例。在常规治疗CHF(ACEI或ARB、β受体阻滞剂、醛固酮拮抗剂联合应用治疗方案)基础上,对照组服用非钠-葡萄糖协同转运蛋白-2抑制剂降糖药,达格列净组为达格列净10 mg/d,均治疗4个月。统计2组总有效率、治疗前后血糖指标[空腹血糖(FPG)、餐后2 h血糖(2 hPG)、GHbA1c]水平、心功能指标参数(LVEF、CO、SV、CI)、血清炎性因子(TNF-α、IL-1β、IL-6)水平、生活质量(MLHFQ)、6 min步行距离(6MWT)及评估不良反应发生率。结果达格列净组治疗总有效率(95.08%)高于对照组(83.61%)(P <0.05);治疗后2组FPG、2 hPG、GHbA1c水平较治疗前降低,且达格列净组的改善程度优于对照组(P均<0.05);治疗后2组LVEF、CO、CI、SV较治疗前增高,且达格列净组改善更显著(P均<0.05);治疗后2组血清TNF-α、IL-1β、IL-6水...     

糖化血红蛋白与糖尿病合并慢性心力衰竭严重程度的相关性

目的研究糖化血红蛋白(HbA1c)与糖尿病患者合并慢性心力衰竭严重程度之间的相关性。方法 86例糖尿病合并慢性心力衰竭患者均检测其血HbA1c及N末端B型利钠肽前体(NT-proBNP)水平,依据HbA1c水平分为3组:A组29例(HbA1c<6.5%)、B组29例(6.5%≤HbA1c<8.0%)、C组28例(HbA1c≥8.0%),对所观察指标进行统计学分析。结果和A组相比,B、C两组NT-proBNP水平均明显升高(P<0.05),且C组NT-proBNP水平较B组更高(P<0.01),三组患者的NT-proBNP与HbA1c水平间呈正相关(P<0.01)。结论糖尿病合并慢性心力衰竭患者的HbA1c水平与NT-proBNP呈正相关,临床上可根据HbA1c水平对糖尿病合并慢性心力衰竭患者进行危险分层。     

Clinical and socio-demographic determinants of self-care behaviours in patients with heart failure and diabetes mellitus: A multicentre cross-sectional study

BackgroundSelf-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care.Objectives(1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes.DesignSecondary analysis of data from a multicentre cross-sectional study.SettingOutpatient clinics from 29 Italian provinces.Participants1192 adults with confirmed diagnosis of heart failure.MethodsSocio-demographic and clinical data were abstracted from patients’ medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score <70 indicates inadequate self-care. Multiple linear regression analyses were performed.ResultsOf 1192 heart failure patients, 379 (31.8%) had diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance (p = 0.12), self-care management (p = 0.21) or self-care confidence (p = 0.51). Age (p = 0.04), number of medications (p = 0.01), presence of a caregiver (p = 0.04), family income (p = 0.009) and self-care confidence (p < 0.001) were determinants of self-care maintenance. Gender (p = 0.01), number of medications (p = 0.004) and self-care confidence (p < 0.001) were significant determinants of self-care management. Number of medications (p = 0.002) and cognitive function (p < 0.001) were determinants of self-care confidence.ConclusionsSelf-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care.     

老年糖尿病患者心率变异性分析

目的探讨老年糖尿病患者心率变异性（HRV）的特征。方法应用24h动态心电图心率变异性频谱，检测45例单纯糖尿病（DMA）组和42例合并心血管疾病的糖尿病（DMB）组，与正常组对照并进行分析。结果糖尿病HRV值均低于正常组，合并心血管疾病的糖尿病患者降低明显（P〈0.01）。结论心率变异性测定是一种敏感的诊断糖尿病自主神经病变的方法。