伊伐布雷定联合米力农治疗慢性心力衰竭的临床研究

目的 探讨伊伐布雷定联合米力农治疗慢性心力衰竭的临床疗效。方法 选取2020年1月—2022年1月中国人民解放军联勤保障部队第九八一医院治疗的118例心力衰竭患者,按照随机数字表法将患者分为对照组和治疗组,每组各59例。对照组患者静脉滴注米力农注射液,10 mg加入生理盐水50 mL,微量泵以0.375～0.750μg/(kg·min)维持,1次/d。治疗组患者在对照组的基础上口服盐酸伊伐布雷定片,5 mg/次,2次/d。两组连续用药7 d。观察两组的治疗效果和临床症状改善时间,比较两组患者治疗前后左室收缩期内径（LVESV）、左室射血分数（LVEF）、左室舒张末期内径（LVEDV）、血清可溶性生长刺激表达基因2蛋白（sST2）、白细胞介素-6(IL-6)、氨基末端B型钠尿肽（NT-proBNP）、肿瘤坏死因子-α(TNF-α)水平的变化情况。比较两组不良反应情况。结果 治疗后,治疗组患者总有效率是98.31%,显著高于对照组的83.05%(P<0.05)。治疗后,治疗组心慌、胸闷、气短、下肢水肿等症状缓解时间均短于对照组（P<0.05）。治疗后,两组LVEF均较治疗前显著...     

稳心颗粒联合重组人脑利钠肽治疗终末期心力衰竭的临床研究

目的探讨终末期心力衰竭应用稳心颗粒联合重组人脑利钠肽治疗的临床效果。方法选取2018年2月—2019年2月阿坝州人民医院收治的86例终末期心力衰竭患者,随机分为对照组(n=43)和治疗组(n=43)。对照组给予冻干重组人脑利钠肽,首先以1.5μg/kg的负荷剂量静脉冲击后,继以0.007 5μg/(kg?min)的给药速率连续静脉滴注,连用3 d后继续常规治疗。治疗组在对照组基础上口服稳心颗粒,1袋/次,3次/d,开水冲服。两组均连续治疗4周。比较两组临床疗效和呼吸困难缓解时间,治疗前后呼吸困难评分、超声心动图指标[左心室舒张、收缩末期容积(LVEDV和LVESV)及左心室射血分数(LVEF)]、血流动力学指标和血浆N末端B型利钠肽原(NT-proBNP)、C反应蛋白(CRP)、内皮素-1(ET-1)水平变化情况。结果治疗组总有效率为90.7%,显著高于对照组74.4%,两组比较差异有统计学意义(P0.05)。治疗组呼吸困难缓解时间显著短于对照组(P0.05);两组治疗后呼吸困难评分较治疗前均显著增高(P0.05),且治疗组治疗后呼吸困难评分显著高于对照组同期(P0.05)。与治疗前比较,两组治疗后LVEDV、LVESV值均显著降低(P0.05),LVEF值则均显著升高(P0.05);且治疗后,治疗组超声心动图参数(LVEDV、LVESV、LVEF)的改善效果均显著优于对照组同期(P0.05)。与治疗前相比,两组治疗后心指数(CI)、心输出量(CO)及心脏收缩力指数(HI)值均显著上升(P0.05),而舒张功能指数(O/C)、肺动脉楔压(PAWP)和总外周阻力(TPR)值均显著下降(P0.05);但治疗后,治疗组血流动力学的改善效果更显著(P0.05)。两组治疗后血浆NT-proBNP、CRP、ET-1水平均显著低于治疗前(P0.05),且治疗组下降更显著(P0.05)。结论稳心颗粒联合重组人脑利钠肽治疗终末期心力衰竭的整体疗效确切,能迅速有效地缓解患者的呼吸困难,改善心脏结构和功能,稳定血流动力学状态,正性调节血管内皮功能,减轻病情的严重程度,具有一定的临床推广应用价值。     

奥普力农联合硝普钠治疗老年急性心力衰竭的临床研究

目的探讨盐酸奥普力农联合硝普钠治疗急性心力衰竭的临床疗效。方法选取2014年5月—2017年5月在中国人民解放军第一七五医院(厦门大学附属东南医院)进行治疗的150例急性心力衰竭患者,根据用药的差别分为治疗组(75例)和对照组(75例)。对照组给予注射用硝普钠,50 mg与5%葡萄糖注射液500 mL配伍,开始以0.5μg/(kg·min)静脉滴注,根据反应以0.5μg/(kg·min)递增至3μg/(kg·min),连续应用3 d。治疗组在对照组治疗基础上给予盐酸奥普力农注射液,初始剂量为10μg/kg,缓慢静脉注射5 min,随后以0.1～0.3μg/kg·min的剂量静脉滴注,必要时以0.4μg/(kg·min)的剂量增加。两组均治疗3 d。观察两组的临床疗效,比较两组治疗前后心功能指标、血清学指标、QRS积分、心肌梗死面积的变化情况。结果治疗后,对照组和治疗组的总有效率分别是85.33%、97.33%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗后两组左心室射血分数(LVEE)显著升高,左室舒张末期内径(LVEDD)、左心室收缩末内径(LVESD)、左心室收缩末期容积(LVESV)显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组LVEE高于对照组,LVEDD、LVESD、LVESV低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组经治疗C反应蛋白(hs-CRP)、氨基末端脑钠肽前体(NT-proBNP)、肌钙蛋白(cTnT)、胱抑素C(Cys-C)、内皮素-1(ET-1)、QRS积分、心肌梗死面积均显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组hs-CRP、NT-proBNP、cTnT、Cys-C、ET-1水平、QRS积分、心肌梗死面积显著低于对照组,两组比较差异有统计学意义(P0.05)。结论盐酸奥普力农联合硝普钠治疗急性心力衰竭具有较好的临床疗效,可有效改善患者心功能,降低机体炎症反应,保护心肌细胞受损,有一定的临床推广应用价值。     

伊伐布雷定联合左西孟旦治疗慢性心力衰竭的临床研究

目的探讨伊伐布雷定联合左西孟旦治疗慢性心力衰竭的临床疗效。方法选取2017年1月—2018年1月在焦作市第二人民医院进行治疗的80例慢性心力衰竭患者,根据用药差别分为对照组和治疗组,每组各40例。对照组患者给予左西孟旦注射液,先以12μg/kg初始剂量静脉推注,推注10 min,然后以微量泵持续泵入,泵入速度0.1μg/(kg·min),持续泵入24 h。治疗组在对照组基础上口服盐酸伊伐布雷定片,5 mg/次,2次/d。两组均治疗2周后进行效果比较。观察两组的临床疗效,比较两组治疗前后心功能指标、6 min步行距离(6WMT)、GQOLI-74评分、血清学指标和心肌纤维化标志物的变化情况。结果治疗后,对照组和治疗组的总有效率分别是75.0%、95.0%,两组比较差异具有统计学意义(P0.05)。治疗后,两组左心室射血分数(LVEE)、6WMT、GQOLI-74评分均较治疗前显著升高,而左心室收缩末内径(LVEDD)、左心室收缩末容量(LVESV)、左心室舒张末内径(LVESD)均显著下降,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组LVEE、6WMT、GQOLI-74评分高于对照组,而LVEDD、LVESV、LVESD低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清N-末端B型利钠肽前体(NT-proBNP)、可溶性晚期糖基化终产物受体(sRAGE)、心肌肌钙蛋白T(cTnT)、高迁移率族蛋白B1(HMGB1)、金属蛋白酶9(MMP-9)、β-内啡肽(β-EP)、Ⅰ型胶原交联羧基末端肽(ICTP)、Ⅲ型前胶原氨基末端肽(PIIINP)、结缔组织生长因子(CTGF)、透明质酸(HA)、层连蛋白(LA)水平均显著下降,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组这些血清学指标和心肌纤维化标志物指标均显著低于对照组,两组比较差异具有统计学意义(P0.05)。结论伊伐布雷定联合左西孟旦治疗慢性心力衰竭具有较好的临床疗效,可有效改善患者心功能,降低血清细胞因子水平,延缓心肌纤维化进展,促进患者运动耐量提高,有利于改善患者生活质量,具有一定的临床推广应用价值。     

Characteristics and Outcomes of Patients Who Achieve High Workload (≥10 Metabolic Equivalents) During Treadmill Exercise Echocardiography

ObjectiveTo determine the frequency and prognostic significance of abnormal exercise echocardiographic results for patients achieving a workload of 10 or more metabolic equivalents during treadmill exercise echocardiography.Patients and MethodsPatients who underwent treadmill exercise echocardiography from November 1, 2003, through December 31, 2008, and exercised for 9 or more minutes using the Bruce protocol (N=7236) were included. Clinical and exercise echocardiographic characteristics and outcomes were evaluated. Variables associated with abnormal exercise echocardiographic results and mortality were identified.ResultsExercise echocardiographic results were positive for ischemia in 862 patients (12%). Extensive ischemia developed in 265 patients (4%). For patients with normal exercise echocardiographic results, all-cause and cardiovascular mortality rates were 0.30% and 0.05% per person-year of follow-up, respectively. For patients who had extensive ischemia, all-cause and cardiovascular mortality rates were 0.84% and 0.25% per person-year of follow-up, respectively. Patients at highest risk were those who had extensive and severe regional wall motion abnormalities at rest (n=58), and their all-cause and cardiovascular mortality rates were 2.65% and 0.76% per person-year of follow-up. Exercise echocardiographic variables did not identify sizable patient subgroups at risk for death and did not provide incremental prognostic information (C statistic was 0.74 compared with 0.73 for the clinical plus exercise electrocardiography model).ConclusionPatients achieving a workload of 10 or more metabolic equivalents during treadmill exercise testing do not often have extensive ischemic abnormalities on exercise echocardiography. Although exercise echocardiographic results provide some prognostic information, it is not of incremental value for these patients, whose short-term and medium-term prognosis is excellent.     

Cardiovascular Magnetic Resonance in the Oncology Patient

Patients with or receiving potentially cardiotoxic treatment for cancer are susceptible to developing decrements in left ventricular mass, diastolic function, or systolic function. They may also experience valvular heart disease, pericardial disease, or intracardiac masses. Cardiovascular magnetic resonance may be used to assess cardiac anatomy, structure, and function and to characterize myocardial tissue. This combination of features facilitates the diagnosis and management of disease processes in patients with or those who have survived cancer. This report outlines and describes prior research involving cardiovascular magnetic resonance for assessing cardiovascular disease in patients with or previously having received treatment for cancer.