血管紧张素转换酶抑制剂对慢性心力衰竭患者认知功能障碍的改善作用

目的探讨血管紧张素转换酶抑制剂(ACEI)对慢性心力衰竭(CHF)伴认知功能障碍患者认知功能的改善作用。方法选取2017年9月年至2019年2月江苏省荣军医院住院治疗及无锡市山北街道合并认知功能障碍的CHF患者60例,采用随机数表法将患者分为治疗组和对照组,各30例。对照组患者的治疗包括病因治疗、去除诱因、改善心力衰竭等传统疗法,治疗组在对照组基础上给予ACEI治疗。分别采用蒙特利尔认知评估量表(MoCA)、汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)分别评估患者的认知功能、焦虑和抑郁状况。采用SPSS 21.0统计软件分析数据。结果干预前,2组患者MoCA各项评分及总分比较,差异均无统计学意义(P0.05)。干预后,与对照组相比,治疗组患者MoCA各项评分均有所增加,其中视空间及执行能力(4.27±0.52)vs(2.70±0.54)分]和总分值(24.70±1.09)vs(22.23±1.43)分]差异有统计学意义(P0.01)。与干预前比较,治疗组干预后各项MoCA评分均增加,其中总分(24.70±1.09)vs(22.60±1.54)分]和视空间及执行能力(4.27±0.52)vs(2.77±0.68)分]差异有统计学意义(P0.05)。干预前及干预后,2组患者间心功能、左室射血分数、焦虑、抑郁评分比较差异均无统计学意义(P0.05);各组干预前后上述指标比较差异亦无统计学意义(P0.05)。治疗期间2组患者心功能始终处于稳定状态,均未诱发急性心功能衰竭,药物治疗种类及方案也未调整。2组患者均未出现严重不良反应,亦未出现新的合并症。结论 ACEI类药物能够改善CHF患者的认知功能,提高患者的执行能力。

Alleviation of cognitive impairment by angiotensin-converting enzyme inhibitors in patients with chronic heart failure

Objective To investigate the effect of angiotensin-converting enzyme inhibitor (ACEI) on the cognitive function in patients with chronic heart failure (CHF) and cognitive dysfunction. Methods From September 2017 to February 2019, a total of 60 CHF patients with cognitive dysfunction from Rongjun Hospital of Jiangsu Province and Shanbei Street of Wuxi City was selected and randomized into the treatment group and the control group. The treatment for the control group included etiological treatment, eliminating inducements and improving the symptoms of heart failure. The treatment group were treated with ACEI plus the treatment for the control group. Montreal Cognitive assessment scale (MoCA) was used for the evaluation of cognition, Hamilton anxiety scale (HAMA)for anxiety, and Hamilton depression scale (HAMD)for depression. SPSS statistics 21.0 was used for data analysis. Results Before the intervention, there was no significant difference in MoCA scores and total scores between the two groups (P>0.05). After the intervention, MoCA scores for the treatment group were higher than those for the control group, among which visual space and executive ability (4.27±0.52) vs(2.70±0.54)] and total score (24.70±1.09) vs(22.23±1.43)] had significant difference (P<0.01). The scores of MoCA in the treatment group were higher after the intervention than before the intervention, and the total score (24.70±1.09) vs(22.60±1.54)] and visual space and executive ability (4.27±0.52) vs(2.77±0.68)] had significant difference (P<0.05). No significant difference was observed between the two groups in the scores for cardiac function, left ventricular ejection fraction, anxiety and depression both before and after the intervention (P>0.05), and no significant difference was observed in the above indices before and after the intervention in two groups (P>0.05). During the treatment period, the cardiac function in the two groups remained stable without induced acute heart failure and adjustment of drug treatment in either the type or the scheme. No serious adverse reactions or new complications occurred in both groups. Conclusion ACEI can improve cognitive function and the ability to perform tasks in CHF patients.