联合降压治疗及护理干预对高血压左室肥厚冠状动脉钙化、动脉内皮功能的影响

目的探讨联合降压治疗及护理干预(小剂量氨氯地平+复方阿米洛利或小剂量氨氯地平+替米沙坦)与适当调脂(小剂量辛伐他汀)综合干预,对原发性高血压患者动脉内皮功能、左心室重构、冠状动脉粥样硬化的影响及效果。方法入选50～79岁原发性高血压伴心血管危险因素者200例,随机分为4组:A组、B组、C组及D组,A组使用小剂量氨氯地平(2.5 mg/d)+替米沙坦(40 mg/d);B组使用小剂量氨氯地平+复方阿米洛利(半片/d1);C组在使用小剂量氨氯地平+替米沙坦基础上加小剂量辛伐他汀;D组在使用小剂量氨氯地平+复方阿米洛利基础上加小剂量辛伐他汀。A组及B组患者治疗12个月前后各检查1次超声心动图,对比分析组内治疗前后左室重量指数变化和两组间的差异。C组及D组患者在联合降压治疗(小剂量氨氯地平+复方阿米洛利或小剂量氨氯地平+替米沙坦)基础上适当调脂(小剂量辛伐他汀10 mg),测定治疗12个月前后血浆ACE活性、AngⅡ浓度、肱动脉内皮依赖性舒张功能及经64排螺旋CT冠状动脉钙化检查的冠状动脉斑块的变化。所有患者均给予精细的护理干预。结果小剂量氨氯地平+替米沙坦治疗组(A组)的左室后壁与室间隔厚度在治疗12个月后显著下降(P<0.05),而左室重量及左室重量指数下降更显著(P<0.01);肱动脉内皮依赖性舒张功能明显改善;小剂量氨氯地平+复方阿米洛利治疗组(B组)治疗12个月后的左室重量及左室重量指数下降显著(P<0.05)。小剂量氨氯地平+替米沙坦+小剂量辛伐他汀治疗组(C组)及小剂量氨氯地平+复方阿米洛利治疗组+小剂量辛伐他汀(D组)患者用小剂量辛伐他汀治疗12个月后,血清总胆固醇、LDL胆固醇、ACE活性、AngⅡ浓度、LN显著下降(P值均<0.01)。C组肱动脉内皮依赖性舒张功能明显改善。结论原发性高血压患者在小剂量氨氯地平+替米沙坦或小剂量氨氯地平+复方阿米洛利治疗12个月后,可使原发性高血压患者左室肥厚显著逆转;对左室肥厚、动脉内皮功能的作用,替米沙坦优于复方阿米洛利。小剂量辛伐他汀对防治原发性高血压患者冠状动脉粥样硬化及稳定斑块起着重要的作用。精细的护理干预对患者的治疗及康复起着促进作用,可提高患者的生活质量。

The Influence of Combined Antihypertensive Therapy and Nursing Intervention on Left Ventricular Hypertrophy,Coronary Artery Calcification and Arterial Endothelial Function

Objective To investigate the effect of combined antihypertensive treatment and nursing intervention(low dose amlodipine + compound amiloride or small doses of amlodipine + Telmisartan) with lipid-regulating(small-dose simvastatin) intervention in patients with essential hypertensionartery endothelial function,left ventricular remodeling,coronary atherosclerosis.Methods 200 cases which were essential hypertension with cardiovascular risk factors,from 50 to 79 years,were randomly divided into 4 groups: group A,group B,group C and group D.Group A were used small dose of amlodipine(2.5 mg/d),telmisartan(40 mg/d).The use of small doses of amlodipine combined with compound amiloride(half,d1).Group C on the basis of use of small doses of amlodipine,telmisartan plus small doses of simvastatin,and Group D in the use of small doses of amlodipine compound amiloride and small doses of simvastatin.Echocardiogram were checked in group A and group B before and after 12 months.The comparative analysis of left ventricular mass index before and after treatment were performed between the two groups.Group C and Group D: in the joint step-down therapy(small dose of amlodipine compound amiloride or small doses of amlodipine,telmisartan) on the basis of appropriate lipid-lowering simvastatin 10 mg(low dose),determination of treatment the plasma ACE activity,Ang II concentration,brachial artery endothelium-dependent vasodilation,and 64-slice spiral CT coronary plaque changes before and after 12 months.All patients are therefore correspondingly fine nursing intervention.Group C and Group D patients in the United antihypertensive therapy(small dose of amlodipine compound amiloride or small doses of amlodipine,telmisartan) on the basis of appropriate lipid(simvastatin 10 mg low dose).To Detect plasma ACE activity,Ang II concentration,brachial artery endothelium-dependent vasodilation,and 64-slice spiral CT was used to detect coronary plaque changes before and after 12 months of treatment.All patients are therefore correspondingly fine nursing intervention.Results A group of left ventricular posterior wall and interventricular septum thickness after treatment for 12 months significantly decreased(P<0.05),left ventricular mass and left ventricular mass index decreased more significantly(P<0.01);brachial artery endothelium-dependent vasodilation was significantly improved;group B treatment in December left ventricular mass and left ventricular mass index decreased significantly(P<0.05).Group C and Group D patients in December after the small dose of simvastatin treatment,serum total cholesterol,LDL cholesterol,ACE activity,AngII concentration,LN significantly decreased(P<0.01).Brachial artery endothelium-dependent diastolic function improved significantly in Group C.Conclusion The patients with essential hypertension can make the compound treatment for 12 months after patients with essential hypertension with left ventricular hypertrophy significantly reversed.Small doses of simvastatin on coronary atherosclerosis prevention,essential hypertension and stable plaque plays an important role.Fine intervention care plays a role in promoting the patient′s treatment and rehabilitation,and improve patients′ quality of life.