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[摘要]
目的 评价托伐普坦联合米力农治疗难治性心力衰竭的疗效。方法 选取2018年10月—2020年6月在内蒙古包钢医院治疗的60例难治性心力衰患者作为研究对象,根据治疗方法将患者分为对照组和观察组,每组30例。对照组给予米力农注射液,0.5 μg/(kg·min)持续泵入72 h,继续以每次泵入4 d,共7 d。观察组患者在对照组的基础上口服托伐普坦片,15~30 mg/次,共7 d。观察患者的临床疗效,同时比较两组治疗前后的脑钠肽(BNP)、氨基末端脑钠肽前体(NT-proBNP)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、白细胞介素-6(IL-6)、左室射血分数(LVEF)及左室舒张末径(LVEDD)、平均肺动脉压(mPAP)与肺毛细血管楔压(PCWC)水平。结果 治疗后,对照组总有效率为73.3%,显著低于观察组的90.0%,差异有统计学意义(P<0.05)。治疗后,两组LVEF显著升高,LVEDD值显著降低(P<0.05);治疗后,观察组LVEF显著高于对照组,而LVEDD值显著低于对照组,差异有统计学意义(P<0.05)。治疗后,两组mPAP和PCWC水平均明显下降(P<0.05),且治疗后观察组mPAP和PCWC水平显著低于对照组,差异有统计学意义(P<0.05)。治疗后,两组BNP、NT-proBNP、PRA、AngⅡ、ALD和IL-6水平均显著降低(P<0.05);且观察组血清学指标水平显著低于对照组(P<0.05)。结论 托伐普坦联合米力农治疗难治性心力衰竭疗效显著,且能改善患者心功能、mPAP和PCWC及相关血清学指标水平,提高生活质量。
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[Abstract]
Objective To evaluate the efficacy of tolvaptan combined with milrinone in treatment of refractory heart failure. Methods A total of 60 patients with refractory heart failure who were treated in Baogang Hospital of Inner Mongolia from October 2018 to June 2020 were selected as the research subjects. According to the treatment methods, the patients were divided into control group and observation group, with 30 patients in each group. Patients in the control group were given Milrinone Injection, 0.5 μg/(kg·min), continuously pumped for 72 h, and continued for 4 days. Patients in the observation group were po administered with Tolvaptan Tablets on the basis of control group, 15 — 30 mg/time for 7 days. To observe the clinical efficacy of the patients, at the same time, the levels of BNP, NT-proBNP, PRA, AngⅡ, ALD, IL-6, LVEF, LVEDD, mPAP, and PCWC in two groups before and after treatment were compared. Results After treatment, the total effective rate of the control group was 73.3%, which was significantly lower than 90.0% of the observation group, the difference being statistically significant (P < 0.05). After treatment, LVEF in two groups was significantly increased, but LVEDD was decreased (P < 0.05). After treatment, LVEF of the observation group was significantly higher than that of the control group, while LVEDD of the observation group was significantly lower than that of the control group, with statistical significance (P < 0.05). After treatment, the levels of mPAP and PCWC in two groups were significantly decreased (P < 0.05), and the levels of mPAP and PCWC in the observation group were significantly lower than those in the control group after treatment, the difference was statistically significant (P < 0.05). After treatment, the levels of BNP, NTproBNP, PRA, AngⅡ, ALD, and IL-6 in two groups were significantly decreased (P < 0.05). The serological indexes in observation group were significantly lower than those in control group (P < 0.05). Conclusion Torvaptan combined with milrinone has significant efficacy in treatment of refractory heart failure, and can improve the levels of cardiac function, mPAP, PCWC, and related serological indexes and improve the quality of life of patients.
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