“金三角”药物在治疗老年慢性射血分数降低性心力衰竭患者中的价值  

The evaluation of the “Golden Triangle” drugs in the treatment of elderly chronic heart failure patients with reduced ejection fraction

作　　者：林岳武 方勇强 洪鹭蓉[1] UN Yue-wu;FANG Yong-qiang;HONG Lu-rong(Zhangzhou Hospital of Fujian Province,Zhangzhou 333300,China)

机构地区：[1]福建省漳州市医院,福建漳州363000

出　　处：《吉林医学》2019年第4期716-719,共4页Jilin Medical Journal

基　　金：福建省卫生计生青年科研课题[项目编号:2017-2-64]

摘　　要：目的:研究老年慢性射血分数降低性心力衰竭(HF-REF)患者规范使用"金三角"药物(β受体阻滞剂、ACEI/ARB、醛固酮受体拮抗剂)的总体剂量情况,分析规范治疗前后心衰指标的改善情况。方法:选择入组病情稳定、未规范治疗的老年HF-REF患者,在治疗前评估心功能分级、BNP、LVEDD、LVEF等指标,低剂量开始使用ACEI与β受体阻滞剂,与此同时,加用常规剂量螺内酯20 mg,1次/d,结合临床情况,每1～2周增加一次药物剂量,使ACEI与β受体阻滞剂渐达到目标剂量或可耐受的最大剂量,在治疗过程,如患者无法耐受ACEI,改用ARB。上述药物达指定剂量后3个月再次评估心功能分级、BNP、LVEF、LVEDD等心力衰竭指标,对指标进行分析。结果:入组患者的心功能较治疗前改善,治疗前心功能分级为2.99±0.61,治疗后为2.70±0.57,差异有统计学意义(P<0.01);BNP指标由治疗前的(1 049.3±886.4)ng/ml下降至治疗后的(809.3±735.0)ng/ml,前后指标差异有统计学意义(P<0.01);而彩超评估方面,LVEDD在治疗前为(59.40±7.70)mm,规范化治疗后下降为(56.12±7.62)mm,LVEF由(38.36±5.79)%上升至(43.89±6.90)%,前后指标差异有统计学意义(P<0.01)。结论:老年HF-REF患者对"金三角"药物的耐受性较好,规范的联合药物治疗可改善HF-REF患者的临床心力衰竭指标。Objective To investigate the overall doses of the "Golden Triangle" drugs(β-blockers,ACE inhibitors/ARBs and aldosterone receptor antagonists) in elderly chronic heart failure patients with reduced ejection fraction(HF-REF),and to analyze the improvement of heart failure indicators after treatment.Method Elderly HF-REF patients with stable condition and without standard treatment were enrolled in this study.Before treatment,heart function grade,BNP,LVEDD,LVEF and other indicators were evaluated.In the beginning,ACEI and β-blockers were used at low doses.In addition,conventional dose of spironolactone(20 mg once a day) was used,and the drug dose was increased once every 1~2 week(s) according to the clinical conditions to make ACEI and beta-blockers gradually reach the target dose or the maximum tolerant dose.During the course of treatment,if patients were unable to tolerate ACEI,then ARB would take the place.After the above-mentioned drugs reached the assigned dose for 3 months,indicators including heart function grading,BNP,LVEF,LVEDD and other heart failure indexes were evaluated and analyzed again.Results The cardiac function of the enrolled patients was improved compared with that before treatment.The cardiac function classification before treatment was 2.99±0.61,while after treatment the classification was increased to 2.70±0.57,with significant difference(P<0.01).The BNP index was decreased from(1 049.3±886.4) ng/ml(before treatment) to(809.3±735.0) ng/ml(after treatment),with significant difference(P<0.01).For the color Doppler assessment,the LVEDD index was decreased from(59.40±7.70) mm(before treatment) to(56.12±7.62) mm(after treatment),while the LVEF index was increased from(38.36±5.79)%(before treatment) to(43.89±6.90)%(after treatment),with significant difference(P <0.01).Conclusion The elderly HF-REF patients show better tolerance to the "Golden Triangle" drugs.And a standard therapy with drug combination can improve the clinical heart failure indexes of HF-REF patients.

关 键 词：慢性心力衰竭 射血分数降低 金三角 

分 类 号：R541.6[医药卫生—心血管疾病]