氯沙坦治疗慢性充血性心力衰竭45例临床分析

慢性充血性心力衰竭(CHF)是各种心血管疾病发展的严重阶段，有很高的病死率和致残率。血管紧张素转换酶抑制剂(ACEI)用于CHF的治疗已有多年的历史，临床观察证实能显著减少CHF患者的病死率、致残率和住院率，成为目前CHF治疗的常规药物，但对于因应用ACEI出现药疹、血管性水肿、顽固性咳嗽、味觉改变而不能继续治疗的患者，理     

48例充血性心力衰竭患者住院治疗状况分析

目的 :了解近 2年安徽中医学院第一附属医院心内科充血性心力衰竭 (CHF)的住院治疗状况。方法 :调查2 0 0 1年 4月— 2 0 0 3年 2月在该院住院的全部CHF患者 ,选择其中资料较为完整的冠心病、扩张型心肌病、高血压性心脏病患者 48例 ,对其进行分析。结果 :强心、利尿、扩血管仍然是本次所观察CHF患者的主要治疗方法 :ACEI的实际使用率为 5 6.2 % ,略高于 2 0 0 0年全国 40 .4%的水平 ,实际 /适宜使用率为 61 .4% ,实际应用 β受体阻滞剂者仅占 3 1 .2 % ,实际 /适宜使用率也仅为 40 .5 % ,而且绝大多数适宜使用而没有使用 β受体阻滞剂的患者未能提供未使用的原因。比较而言 ,ACEI使用情况较好 ;β受体阻滞剂应用较少的原因 ,可能与临床医生对治疗益处认识不足有关 ;中医辨证为心血瘀阻占 68.8% ,心脾肾气虚占 3 5 .4% ,气阴两虚占 2 7.1 % ,静脉中药使用率较高 ,达到 85 .4% ,使用较多的是丹参注射液、参麦注射液和黄芪注射液。结论 :该院治疗CHF与我国新近“慢性收缩性心力衰竭治疗建议”的要求还存在一定的差距 ,静脉中药的使用率较高 ,但尚缺少确切的疗效评价体系。     

血管紧张素转化酶抑制剂与血管紧张素受体阻滞剂治疗充血性心力衰竭的系统评价

目的通过对左室结构参数、血液动力学参数、心功能级别改善及副作用发生率等指标进行比较,探讨血管紧张素转化酶抑制剂(angiotensin-converting enzyme inhibitor,ACEI)与血管紧张素受体阻滞剂(angiotensin receptor blocker,ARB)治疗充血性心力衰竭是否具有相似的疗效和安全性.方法计算机检索MEDLINE(1966～2004)、EMBASE(1989～2000)、Cochrane图书馆临床对照试验资料库(2004年第1期)、国际药学文摘(IPA)(1970～2004)、中国生物医学文献光盘数据库(1980～2003),纳入比较ACEI和ARB治疗充血性心力衰竭患者的随机对照试验,对纳入研究的方法学质量进行评价,并应用RevMan 4.2软件进行统计分析.结果共纳入17个随机对照试验.Meta分析结果表明,ACEI与ARB对于左室舒张末期内径、心输出量、心率、心功能级别改善等方面的作用差异无统计学意义(P＞0.05),ACEI与ARB治疗中产生副作用例数的合并效应量差异有统计学意义[RR 2.17,95%CI (1.53,3.07),P＜0.000 01].结论 ACEI与ARB两类药物对心功能和左室重构方面的作用差异无统计学意义;在药物安全性方面,ACEI较ARB副作用发生率更高,安全性更低,其差异有统计学意义.在充血性心力衰竭的治疗中,ARB可适用于对ACEI不能耐受的病例,上述结论对于临床用药具有很好的指导意义.     

厄贝沙坦治疗充血性心力衰竭的临床观察

厄贝沙坦是一长效的血管紧张素Ⅱ受体AT1Ⅱ型受体阴断剂。可通过扩张血管，降低心脏前后负荷等治疗心衰，便患者左室射血分数增加。运动耐力改善。本院内科应用该药治疗患者35例取得较好疗效，现总结如下。     

厄贝沙坦治疗充血性心力衰竭的临床观察

目的：观察厄贝沙坦治疗充血性心力衰竭（CHF）的临床疗效。方法：36例经常规洋地黄、利尿剂、血管扩张剂等治疗效：果欠佳的CHF患者，给予口服厄贝沙坦75～150mg／d，治疗4～6周。观察治疗前后心率、心胸比、血压、左室射血分数变化。结果：治疗后心率、血压、心胸比与治疗前比较明显下降（P〈0．01）。左室射血分数增加（P〈0．01），心功能改善1-2级。药物副作用少，患者耐受性好。结论：厄贝沙坦治疗CHF疗效好，副作用较少，将是慢性心力衰竭的治疗药物。     

充血性心力衰竭患者血浆一氧化氮和内皮素含量及其临床意义

目的：探讨血浆一氧化氮（ＮＯ）和内皮素（ＥＴ）的改变在充血性心力衰竭（ＣＨＦ）病程中的临床意义。方法：检测３５例ＣＨＦ患者外周静脉血和肺动脉血中ＮＯ、ＥＴ、血管紧张素转换酶（ＡＣＥ）的含量。以２０例健康体检者作为对照组。结果：ＣＨＦ患者外周静脉和肺动脉血浆中ＮＯ、ＥＴ含量显著高于健康对照组（Ｐ均＜０．０５）;血浆ＡＣＥ水平呈现相同的变化;血浆ＥＴ增加的幅度大于ＮＯ,因此,ＣＨＦ患者ＮＯ／ＥＴ比值降低（Ｐ＜０．０５）。这些变化在患者的肺动脉中比外周静脉中更明显（Ｐ均＜０．０５）,与心力衰竭的严重程度有关。结论：血浆ＮＯ水平增高,ＮＯ／ＥＴ比值降低是ＣＨＦ的病理生理特征之一,反映了心力衰竭时血管内皮细胞的功能紊乱     

充血性心力衰竭的低钠血症对治疗的影响探讨

目的：探讨充血性心力衰竭（ＣＨＦ）并发低钠血症分组治疗前后血钠值对治疗影响。方法：对６０例ＣＨＦ患者随机分三组给予不同的治疗,治疗前后分别值钠值进行各组对比分析。瞳托普利组治疗后血钠值较治疗前明显上升,血管扩张组治疗后血钠值上升,利尿组治疗后血钠值下降。结论：ＣＨＦ并发低欠血症与肾素－血管紧张素－醛固酮系统有关,血钠值因心功能级的增加而下降,应选择血管紧张素转换酶抑制剂治疗。     

氯沙坦治疗慢性充血性心力衰竭的临床观察

目的观察氯沙坦治疗慢性充血性心力衰竭的治疗效果。方法对86例不能耐受血管紧张素转换酶抑制剂的心衰患者，在常规治疗基础上加用氯沙坦治疗，观察治疗效果。结果应用氯沙坦后心功能明显改善，总有效率为88．4％。结论对不能耐受血管紧张素转换酶抑制剂的心衰患者，可用氯沙坦替代治疗。     

LCZ696治疗心力衰竭有效性与安全性meta分析

目的 通过检索国内外有关LCZ696（沙库巴曲缬沙坦钠）治疗心力衰竭的RCTs,评价LCZ696治疗心力衰竭的有效性与安全性。方法 通过Cochrane library、Pubmed、Web of science、CNKI、VIP、万方数据库检索有关LCZ696治疗心力衰竭的文献,根据纳入排除标准进行文献筛选,采用Cochrane干预措施系统评价手册5.1.0版中的偏倚风险评估工具对纳入研究进行质量评价,所有结局指标均使用RevMan 5.3软件进行meta分析。结果 共选入6篇RCTs研究,共计14 967例患者被纳入,合并结局指标结果显示,与依那普利和缬沙坦比较,LCZ696治疗后左心室容积指数（LAVI）［WMD=-2.18,95%CI（-3.63,-0.74）,P=0.003］、舒张早期二尖瓣最大充盈速度与舒张早期二尖瓣环最大速度比值（E/e'）［WMD=-1.01,95%CI（-1.89,-0.12）,P=0.03］、病死率［RR=0.89,95%CI（0.83,0.96）,P=0.003］、因心力衰竭再住院率［RR=0.83,95%CI（0.78,0.88）,P<0.01］下降更明显,而生活质量评分［WMD=1.32,95%CI（0.69,1.95）,P<0.01］、症状性低血压发生率［RR=1.46,95%CI（1.34,1.60）,P<0.01］升高更为明显。结论 LCZ696可以明显降低心力衰竭患者的病死率和再住院率,且不增加肾功能损伤、血管性水肿、高血钾不良事件风险。     

Sacubitril/valsartan (LCZ696) for the treatment of heart failure

The PARADIGM-HF study, a large outcome trial in heart failure and reduced ejection fraction (HFrEF), has recently shown improved cardiovascular outcomes with sacubitril/valsartan (Entresto®, Novartis), still commonly referred to as LCZ696, compared to ACE-inhibitor therapy, possibly leading us to a new era for heart failure (HF) treatment. LCZ696 represents a first-in-class drug acting through inhibition of angiotensin receptor and neprilysin, thus modulating the renin angiotensin aldosterone system and vasoactive substances such as natriuretic peptides. Based on the PARADIGM-HF results, the FDA recently approved LCZ696 as an effective means to reduce the burden of HF with reduced ejection fraction. Furthermore, these data also provided rationale to test LCZ696 in an ongoing trial with HF and preserved ejection fraction. Despite the enthusiasm regarding this novel compound, real world data on its efficacy and safety are eagerly expected. This article summarizes all evidences regarding LCZ696 and how to implement this new drug in the current HF armamentarium.     

心力衰竭患者血液细胞因子与心功能的关系

背景充血性心力衰竭血清中一些细胞因子如白细胞介素6和肿瘤坏死因子α以及神经激素如去甲肾上腺素对于心力衰竭发生发展过程中是否起到重要作用.目的探讨心力衰竭患者血清肿瘤坏死因子α、白细胞介素6,去甲肾上腺素的变化及意义,为判定心力衰竭严重程度及预后提供依据.设计病例对照研究.单位上海市市东医院心内科.方法选择2000-01/2001-10上海市市东医院心内科住院心力衰竭患者58例(患者组),男33例,女25例.按纽约心脏病学会心功能分级,其中Ⅱ级12例,Ⅲ级32例,Ⅳ级14例.选择同期本院自愿健康体检者30例为对照组,男18例,女12例.采用酶联免疫双抗体夹心法测定血清肿瘤坏死因子α,白细胞介素6,去甲肾上腺素水平,用二维心脏超声测定左室射血分数,以此来观察血清细胞因子与心功能之间的关系.结果①心功能Ⅲ级,Ⅳ级患者血清白细胞介素6[(367.6±78.6),(569.7±117.3)ng/L],肿瘤坏死因子醄(395.3,(583.1±124.8)ng/L],NE[(396.5±85.3),(675.9±136.2)ng/L]水平明显高于心功能Ⅱ级和对照组[(221.5±58.4),(170.2±42.7)ng/L;(205.4±59.2),(180.3±43.8)ng/L;(227.4±65.6),(163.8±41.5)ng/L,P均＜0.05].心功能Ⅱ级患者与对照组比较,差异无显著性意义(P＞0.05).②白细胞介素6,肿瘤坏死因子?去甲肾上腺素与左室射血分数呈高度负相关(r=-0.63,P＜0.01;r=-0.54,P＜0.05;r=-0.58,P＜0.01).心力竭衰程度越重,血清肿瘤坏死因子?白细胞介素6和去甲肾上腺素水平越高.肿瘤坏死因子嵊肴ゼ咨錾舷偎?白细胞介素6与去甲肾上腺素呈明显正相关(r=0.57,P＜0.01;r=0.51,P＜0.05).心力衰竭患者心力衰竭越重,血清白细胞介素6与肿瘤坏死因子崴皆礁?且两者呈正相关(r=0.39,P＜0.05).结论心力衰竭患者血清肿瘤坏死因子岷桶紫赴樗?水平均升高,尤其在中重度心力衰竭患者中更加明显,并与左室射血分数呈负相关,提示血清白细胞介素6、肿瘤坏死因子崴娇勺魑牧λソ哐现爻烫度判断与预后的指标,并为康复干预措施介入提供量化评估依据.     

Respiratory sleep disorders in patients with congestive heart failure

AIM: To examine respiration in sleeping patients with congestive heart failure (CHF). MATERIAL AND METHODS: Night cardiorespiratory monitoring was made in 30 CHF patients with coronary heart disease (CHD), arterial hypertension and dilated cardiomyopathy. The control group consisted of 16 patients with obstructive sleep apnea and hypopnea (OSAH) free of CHF. RESULTS: Respiratory sleep disorders were registered in all the examinees. Moderate and severe OSAH occurred more often. CHF patients vs controls had shorter inhalation, expiration, overall duration of the respiratory cycle, higher rate of the respiratory movements. With aggravation of the respiratory disorders in sleeping CHF patients, minute ventilation, respiratory volume and mean inspiratory flow arose. In severe OSAH there was low functional residual lung capacity and high intraalveolar volume in end expiration positive pressure. The above changes may cause fatigue and weakness of the respiratory muscles and alter intracardiac hemodynamics. CONCLUSION: For CHF patients it is recommended to perform CPAP-therapy in sleep.     

Ischemic heart disease and congestive heart failure in diabetic patients

Ischemic heart disease and heart failure are major contributors to the morbidity and mortality associated with diabetes mellitus.With growing knowledge of how the metabolic derangements of diabetes contribute to the pathogenesis of cardiovascular disease, we must continuously refine our understanding of optimal screening and strategies for prevention and treatment for these interlinked disorders.This article summarizes our current understanding of ischemic heart disease and heart failure in patients with diabetes mellitus, highlighting gaps in our knowledge about the relationship between diabetes and cardiovascular disease. Special consideration is given to new strategies for treating the adverse effects of abnormal glucose metabolism on the cardiovascular system.     

Efficacy and pharmacokinetics of piretanide in patients with congestive heart failure

The efficacy and pharmacokinetics of the diuretic piretanide were studied in two groups of six patients hospitalized for congestive heart failure. A dosage of 2 x 6 mg day-1 to 2 x 12 mg day-1 of intravenous piretanide for 7 days was sufficient to abrogate most symptoms of cardiac insufficiency. When compared with another group of healthy volunteers, patients with congestive heart failure had reduced total body clearance of piretanide of about 50% which was attributable to a diminished renal but not non-renal clearance. The analysis of the interrelationship between urinary piretanide excretion and diuresis by means of a linearized Emax-model revealed a maximal diuresis of 231 ml h-1 and a urinary piretanide excretion to induce half-maximal diuresis of 245 micrograms h-1. Thus patients with congestive heart failure exhibit a decreased renal clearance of piretanide and a good response to this high ceiling diuretic after intravenous dosing.     

充血性心力衰竭患者血小板功能状态的研究

目的：观察充血性心力衰竭患者血小板功能状态的变化。方法：采用放射免疫法及流式细胞技术测定56例老年缺血性心衰患者血浆血栓素A2（TXA2）的代谢产物血栓素B2（TXB2）及前列腺素（PGI2）的代谢产物6－酮－前列腺素1α（6-keto-PGF1α）、血小板膜糖蛋白CD62P、CD61（Ⅲa）及血小板聚集率,并与43例非心衰老年冠心病患者进行对照。结果：充血性心力衰竭患者TXB2的水平显著高于对照组（P＜0．01）,6-keto-PGF1α明显低于对照组（P＜0．05）,CD62P、CD61及血小板聚集率均显著增加（P＜0．01,P＜0．01,P＜0．01）。结论充血性心力衰竭患者血小板呈相对激活状态,有利于血小板的粘附,聚集及血栓前状态的形态。     

充血性心力衰竭患者的甲状腺激素检测结果分析

目的 探讨充血性心力衰竭与总三碘甲状腺原氨酸(TT3)水平的关系.方法 观察测定56例充血性心力衰竭患者的总三碘甲状腺原氨酸(TT3)、总四碘甲状腺原氨酸(TT4)和促甲状腺激素(TSH)水平,按照纽约心脏病学会(NYHA)分类方法,心功能I级为对照组.结果 心功能Ⅱ级巩水平低于对照组,但2组问差异无统计学意义(1.1±0.4)ng/ml vs(1.5±0.5)nS/ml,(P＞0.05),而心功能Ⅲ级n为(0.8±0.3)nS/m、Ⅳ级为(0.5-t-0.2)ng/m,与对照组比较差异有统计学意义(P＜0.05);n和TSH结果各级间差异无统计学意义(P＞0.05).结论 TT,水平与心力衰竭的发作严重程度相关.     

NT-proBNP in monitoring treatment of patients with congestive heart failure

OBJECTIVE: The aim of this study was to assess the utility of plasma N-terminal proBrain Natriuretic Peptide (NT-proBNP) assay in monitoring the therapy of congestive heart failure patients. BACKGROUND: Treatment of congestive heart failure aims to improve left ventricular function by reducing the pressure and volume overload. The human heart secretes brain natriuretic peptide in response to increased intracardiac volume or pressure. Therefore the therapy of congestive heart failure could have an effect on the plasma natriuretic peptide level. METHODS: The study included 149 patients with heart failure admitted to the Al-Assad and Al-Mowasah Hospitals, Damascus, Syria, during a 19-month period from February 2004 to September 2005. The age of the patients was between 35-85 years (mean+/-SD: 57+/-13.5). The patients were clinically divided into 4 groups according to the New York Heart Association Classification. Plasma NT-proBNP levels were measured and echocardiography was performed in all patients. We repeated physical examination, echocardiography, the patient's history, and the NT-proBNP assay in 46 patients from different stages after 3 months of drug treatment. The monitored patients were divided into three subgroups according to the clinical state: (A) 21 patients who clinically improved; (B) 18 patients with no clinical improvement; (C) 7 patients who were clinically stable. Plasma NT-proBNP levels were measured by electrochemiluminescence immunoassay (Roche). Statistical analysis was carried out by T-distribution, and the difference was considered to be significant at P < 0.05. RESULTS: The plasma NT-proBNP levels significantly decreased (P < 0.001) in clinically improved patients after 3 months of treatment, and this was accompanied by improvement of the echocardiographic data and symptoms. In contrast, the plasma NT-proBNP levels increased in patients with no clinical improvement and a decrease in the ejection fraction after 3 months of therapy, but the difference was not statistically significant (P > 0.05). There was also no statistically significant difference (P>0.05) between the plasma NT-proBNP level at diagnosis and after 3 months of treatment in clinically stable patients. CONCLUSION: The plasma NT-proBNP levels alter in response to drug therapy and can be used in monitoring treated patients with congestive heart failure.