糖皮质激素辅助治疗对重症心力衰竭患者心功能及血浆皮质醇、脑钠肽的影响  

Effects of Glucocorticoid Adjuvant Therapy on Cardiac Function,Plasma Cortisol and B-type Natriuretic Peptide of Patients with Severe Heart Failure

作　　者：魏新考 李亚昭 崔利锋[3] 

机构地区：[1]衡水市第二人民医院心内科,河北衡水053000 [2]衡水市第二人民医院急诊科,河北衡水053000 [3]衡水市第二人民医院呼吸内科,河北衡水053000

出　　处：《医学综述》2017年第3期581-584,共4页Medical Recapitulate

摘　　要：目的探讨糖皮质激素辅助治疗重症心力衰竭患者对心功能及血浆皮质醇(COR)、脑钠肽(BNP)的影响。方法选择2014年2月至2015年10月衡水市第二人民医院救治的86例重症心力衰竭患者为研究对象,按照随机数字法分为观察组和对照组,各43例。对照组给予常规治疗(包括强心剂、利尿剂、扩血管药物、β受体阻滞剂等药物),观察组在常规治疗的基础上辅以醋酸泼尼松片口服治疗(每日清晨顿服40~60 mg),用药2周后逐渐减量直至停止。观察两组患者治疗前及治疗2周后心功能、COR及BNP的变化,并结合临床症状评估临床疗效。结果两组治疗后左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)均较治疗前显著减少(P<0.01),左心室射血分数(LVEF)较治疗前显著增加(P<0.01),观察组治疗后LVEDD、LVESD水平显著低于对照组[(53.28±6.23)mm比(57.36±6.05)mm;(41.27±4.26)mm比(44.32±4.13)mm,P<0.01],LVEF水平显著高于对照组[(47.17±4.85)mm比(44.58±4.76)mm,P<0.05]。两组治疗后COR水平均较治疗前显著提高,BNP水平均较治疗前显著降低(P<0.01),观察组治疗后COR水平显著高于对照组[(179.83±55.73)μg/L比(146.69±57.46)μg/L,P<0.05],BNP水平显著低于对照组[(593.18±68.94)ng/L比(782.65±73.57)ng/L,P<0.01]。观察组临床疗效明显优于对照组(P<0.05)。结论应用糖皮质激素辅助治疗重症心力衰竭患者可有效改善心功能及COR、BNP水平,提高临床疗效,改善患者预后。Objective To explore the effects of glueoeortieoid adjuvant therapy on cardiac function, plasma cortisol （COR） and B-type natriurefic peptide（BNP） of patients with severe heart failure. Methods A total of 86 patients with severe heart failure in Hengshui Second People＇s Hospital from Feb. 2014 to Oct. 2015 were included in the study, and divided into an observation group and a control group according to the random number method,43 cases in each group. The control group was given conventional treatment （including cardiac, diuretic, vasodilator drugs, beta-blockers and other drugs ）. The observation group, on the basis of the conventional treatment, was supplemented with oral medication Of predni- sone acetate tablets（40 to 60 mg administrated every morning） , and the medicine after two weeks was gradually reduced to end. The changes of cardiac function, COR and BNP of patients in both groups were observed before the treatment and after two weeks＇ treatment, and the clinical effect was assessed with the combination of clinical symptoms. Results The left ventricular end diastolic dimension （ LVEDD ） and left ventricular end systolic dimension （ LVESD ） of both groups were decreased significantly after the treatment （P 〈 0.01 ）, and left ventricular ejection fraction（LVEF） was significantly decreased after the treatment（ P 〈 0. 01 ）. The LVEDD and LVESD of the observation group were significantly lower than the control group[ （53.28±6. 23） mm vs （57. 36±6.05） ram; （41.27±4.26） mm vs （44. 32±4. 13） mm,P 〈0. 01 ] ,and the LVEF level was significantly higher than the control group [ （47. 17± 4. 85 ） mm vs （44. 58 ±4. 76 ） mm, P 〈 0. 05 ]. The COR of both groups was significantly increased than before the treatment, and BNP level was both significantly decreased than before the treatment（ P 〈 0. 01 ）. The COR level of the observation group after treatment was significantly higher than the control group[ （ 179.83±55.73 ） μg,/L vs （

关 键 词：重症心力衰竭 糖皮质激素 心功能 血浆皮质醇 血浆脑钠肽 

分 类 号：R541.4[医药卫生—心血管疾病]