速尿、ACEI联合螺内酯治疗顽固性心衰的疗效及对凝血功能、心功能及血管内皮功能的影响

目的 探究速尿、血管紧张素转换酶抑制剂(ACEI)联合螺内酯治疗顽固性心衰的临床观察及对患者凝血功能、心功能及cTnI、Myo、ET-1、NO的影响.方法 选取2014年1月至2017年1月来南京市高淳人民医院就诊的顽固性心衰患者64例,按照随机数表法将患者分为对照组及观察组各32例,对照组以速尿及ACEI进行治疗,观察组患者采用速尿、ACEI联合螺内酯进行治疗.治疗2周后,观察各组患者的临床症状,并评估各组患者凝血功能、心功能及血管内皮功能指标水平的变化.结果 观察组患者的治疗总有效率为90.63%,显著高于对照组的71.87%,差异有统计学意义(P<0.05).治疗前,两组患者左心室射血分数(LVEF)、每搏量(SV)、心脏指数(CI)、心率(HR)、心肌肌钙蛋白(cTnI)、肌红蛋白(Myo)、内皮素(ET-1)、一氧化氮(NO)、P-选择素、血管性血友病因子(vWF)、D-二聚体的平均水平比较差异均无统计学意义(P>0.05).治疗后,观察组患者的LVEF、SV、CI、NO的水平分别为(55.4±4.9)%、(57.8±5.2)mL、(4.7±0.5)L/(min·m2)、(61.29±5.84)μmol/L,均明显高于对照组,HR、cTnI、Myo、ET-1、P-选择素、vWF、D-二聚体的水平分别为(69.5±7.9)次/min、(0.23±0.03)ng/mL、(54.37±6.31)ng/mL、(42.23±4.45)ng/mL、(16.87±1.53)g/L、(137.42±14.23)%、(0.53±0.05)mg/L,明显低于对照组,差异均有统计学意义(P<0.05).结论 速尿、ACEI联合螺内酯能有效治疗顽固性心衰,改善患者的凝血功能及心功能,并调节患者血清中cTnI、Myo、ETP1、NO的水平,值得临床推广使用.

Clinical observation of furosemide,ACEI combined with spironolactone in the treatment of refractory heart failure and its effect on coagulation function,cardiac function and vascular endothelial function

Objective To investigate the clinical observation of furosemide, ACEI combined with spironolac-tone in the treatment of refractory heart failure and its effect on coagulation function, cardiac function and cTnI, Myo, ET-1 and NO. Methods A total of sixty-four patients with refractory heart failure, who admitted to Gaochun People's Hospital from January 2014 to January 2017, were selected and divided into the control group and the observation group according to the random number method. The control group (n=32) was treated with furosemide and ACEI. The observation group (n=32) was treated with furosemide, ACEI combined with spironolactone. After 2 weeks of treatment, the clinical symptoms of each group were observed and the coagulation function, cardiac function and the levels of cardiac troponin (cTnI), myoglobin (ET) and NO were evaluated. Results The total effective rate of the observation group was 90.63%, which was significantly higher than 71.87%of the con-trol group (P<0.05). Before the treatment, left ventricular ejection fraction (LVEF), stroke volume (SV), heart index (CI), heart rate (HR), cardiac troponin (cTnI), myoglobin (Myo), endothelin (ET-1), nitric oxide (NO), P-selectin, von Willebrand factor (vWF) and D-dimer showed no statistically significant difference between two groups (P>0.05). After the treatment, the levels of LVEF, SV, CI and NO in the observation group were (55.4±4.9)%, (57.8±5.2) mL, (4.7±0.5) L/(min·m2), (61.29±5.84)μmol/L, which were significantly higher than those of the control group (P<0.05). The levels of HR, cTnI, Myo, ET-1, P-selectin, vWF and D-dimer were (69.5±7.9) times/min, (0.32± 0.03) ng/mL, (54.37±6.31) ng/mL, (42.23±4.45) ng/mL, (16.87±1.53) g/L, (137.42±14.23)%, (0.53±0.05) mg/L, which were significant-ly lower than those in the control group (P<0.05).Conclusion Furosemide, ACEI combined with spironolactone can effectively treat re-fractory heart failure, improve the coagulation function and cardiac function of patients, and regulate the serum levels of cTnI, Myo, ET-1, NO, which was worthy of clinical use.