螺内酯联合血府逐瘀胶囊治疗难治性高血压心力衰竭ACEI/ARB治疗后醛固酮逃逸的疗效及对心率变异性、主要心血管事件的影响  

Efficacy of spironolactone combined with Xuefu Zhuyu Capsule on aldosterone escape after ACEI/ARB treatment in patients with refractory hypertension with heart failure and its influence on heart rate variability and major cardiovascular events

作　　者：左晓莉 袁梅[2] ZUO Xiaoli;YUAN Mei(The 961st Hospital of Joint Service Support Force of PLA, Qiqihar 161000, Heilongjiang, China;The 962nd Hospital of Joint Service Support Force of PLA, Harbin 150080, Heilongjiang, China)

机构地区：[1]中国人民解放军联勤保障部队第961医院,黑龙江齐齐哈尔161000 [2]中国人民解放军联勤保障部队第962医院,黑龙江哈尔滨150080

出　　处：《现代中西医结合杂志》2019年第17期1851-1855,1869,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察螺内酯联合血府逐瘀胶囊治疗难治性高血压心力衰竭患者经ACEI/ARB治疗后醛固酮逃逸的疗效及对心率变异性、主要心血管事件(MACE)的影响。方法将100例难治性高血压心力衰竭经ACEI/ARB治疗后发生醛固酮逃逸的患者按照随机数字表法分为观察组51例和对照组49例,对照组给予螺内酯治疗(20 mg/次,2次/d),观察组在对照组治疗基础上给予血府逐瘀胶囊治疗(6粒/次,2次/d),2组疗程均为3个月。记录2组治疗前后临床症状积分、血清醛固酮(Ald)水平、心功能指标[左室射血分数(LVEF)、缩短分数(FS)、E/A、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)]、心功能分级、心率变异性指标(SDNN、SDANN、RMMSD、PNN50、HF、LF、LF/HF)、明尼苏达心力衰竭生活质量量表(MLHFQ)评分,随访2组治疗后6个月时MACE发生率。结果治疗后2组胸闷憋气、端坐呼吸、咳嗽咳痰、心悸、倦怠乏力、发绀积分和总积分均较治疗前显著降低(P均<0.05),观察组治疗后以上积分均显著低于对照组(P均<0.05);2组治疗后血清Ald水平均显著降低(P均<0.05),观察组治疗后血清Ald水平显著低于对照组(P<0.05),且醛固酮逃逸治疗的有效率显著高于对照组(P<0.05);2组治疗后LVEF、FS、E/A、LVEDD、LVESD及NYHA心功能分级、心率变异性指标均较治疗前显著改善(P均<0.05),观察组LVEF、FS、E/A改善情况均优于对照组(P均<0.05);观察组MACE发生率显著低于对照组(P<0.05)。2组治疗后MLHFQ量表中体力限制领域、症状领域、情绪领域、社会功能领域评分和总评分均显著降低(P均<0.05),观察组治疗后以上评分均显著低于对照组(P均<0.05)。结论螺内酯联合血府逐瘀胶囊可显著改善难治性高血压心力衰竭患者经ACEI/ARB治疗后醛固酮逃逸现象,不仅可缓解临床症状,改善心功能,还能改善自主神经功能,提高生存质量,降低MACE发生率。Objective It is to observe the efficacy of spironolactone combined with Xuefu Zhuyu Capsule in the treatment of refractory hypertensive heart failure patients with aldosterone escape after ACEI/ARB treatment and its influence on heart rate variability and major cardiovascular events (MACE). Methods 100 patients with refractory hypertensive heart failure who suffered from aldosterone escape after ACEI/ARB treatment were randomly divided into observation group (51 cases) and control group (49 cases). The control group was given spironolactone (20 mg/time, 2 times/d), the observation group was given Xuefu Zhuyu Capsule on the basis of the control group (6 capsules/time, 2 times/d), and the course of treatment was 3 months. The clinical symptom scores, serum aldosterone (Ald) level, cardiac function index [left ventricular ejection fraction (LVEF), fractional shortening (FS), E/A, left ventricular end-diastolic diameter (LVEDD), left ventricle end-systolic inner diameter (LVESD)], cardiac function classification, heart rate variability (SDNN, SDANN, RMMSD, PNN50, HF, LF, LF/HF), Minnesota Heart Failure Quality of Life Scale (MLHFQ) score were observed before and after treatment. The incidence of MACE in the last 6 months of treatment was followed-up in the two groups. Results After treatment, the scores of chest tightness, suffocation, cough, expectoration, fatigue, cyanosis and total scores were significantly lower than those before treatment ( P <0.05), the above scores in the observation group were significantly lower than those in the control group ( P <0.05). The serum Ald levels were significantly lower after treatment ( P <0.05), and level in the observation group was significantly lower and the effective rate of treatment for aldosterone escape was significantly higher than that in the control group ( P <0.05). The LVEF, FS, E/A, LVEDD, LVESD and NYHA cardiac function grading and heart rate variability indexes were significantly improved after treatment in the two groups( P <0.05), the improvements of LVEF, F

关 键 词：螺内酯 血府逐瘀胶囊 高血压 心力衰竭 醛固酮逃逸 心率变异性 主要心血管事件 生存质量 

分 类 号：R541.6[医药卫生—心血管疾病]