强心利尿基础上联合诺欣妥治疗心肌梗死后心力衰竭的效果和安全性  

The efficacy and safety of combining cardiotonic and diuretic therapy with Entresto in the treatment of heart failure after myocardial infarction

作　　者：戴昭冰 周敏 石鑫 房红梅 陈晓晴 王艳丽[5] DAI Zhaobing;ZHOU Min;SHI Xin;FANG Hongmei;CHEN Xiaoqing;WANG Yanli(Cardiology Department,Ji’nan Innovation East Zone Hospital,Ji’nan Hospital of Shandong Healthcare Group,Shandong,Ji’nan 250104,China;Emergency Department,Ji’nan Innovation East Zone Hospital,Ji’nan Hospital of Shandong Healthcare Group,Shandong,Ji’nan 250104,China;Neurology Department,Ji’nan Innovation East Zone Hospital,Ji’nan Hospital of Shandong Healthcare Group,Shandong,Ji’nan 250104,China;Department of Respiratory Medicine,Ji’nan Innovation East Zone Hospital,Ji’nan Hospital of Shandong Healthcare Group,Shandong,Ji’nan 250104,China;Cardiology DepartmentⅥ,the Second Affiliated Hospital of Qiqihar Medical University,Heilongjiang,Qiqihar 161006,China)

机构地区：[1]济南高新东区医院(山东健康集团济南医院)心内科,山东济南250104 [2]济南高新东区医院(山东健康集团济南医院)急诊科,山东济南250104 [3]济南高新东区医院(山东健康集团济南医院)神经内科,山东济南250104 [4]济南高新东区医院(山东健康集团济南医院)呼吸内科,山东济南250104 [5]齐齐哈尔医学院附属第二医院心内六科,黑龙江齐齐哈尔161006

出　　处：《中国医药科学》2024年第2期91-95,共5页China Medicine And Pharmacy

基　　金：黑龙江省省属高校基本科研业务费基础研究项目(2017-QYKYYWF-0761)。

摘　　要：目的探析强心利尿基础上联合诺欣妥治疗心肌梗死(MI)后心力衰竭(HF)的临床效果。方法纳入济南高新东区医院2022年6—12月经临床确诊的68例MI后HF患者,采用简单随机化方法将纳入患者分为两组,对照组34例给予强心利尿治疗,观察组34例在对照组基础上加施诺欣妥治疗,比较两组临床疗效、心功能指标、心肌损伤指标以及神经内分泌因子和不良反应发生率。结果观察组临床总有效率为94.12%,高于对照组的76.47%,差异有统计学意义(P<0.05)。治疗后,观察组左室射血分数(LVEF)、心搏出量(CO)高于对照组,左室收缩末期内径(LVDs)、左室舒张末期内径(LVDd)低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组心肌肌钙蛋白I(cTn-I)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)均低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组N末端脑钠肽前体(NT-pro BNP)、血清肾素(RA)、血管紧张素Ⅱ(AngⅡ)均低于对照组,差异有统计学意义(P<0.05)。观察组低血压、胃肠道反应、心律失常以及血管性水肿不良反应总发生率为5.88%,与对照组的8.82%比较,差异无统计学意义(P>0.05)。结论在强心利尿基础上采用诺欣妥治疗MI后HF,整体效果较好,改善心功能指标、心肌损伤指标以及神经内分泌因子水平作用显著,不良反应较少,值得临床推广、应用。Objective To explore the clinical effect of combining cardiotonic and diuretic therapy with Entresto in the treatment of heart failure(HF)after myocardial infarction(MI).Methods A total of 68 patients with post-MI HF diagnosed clinically at East District Hospital in Ji’nan Innovation Zone from June to December 2022 were included.The patients were evenly divided into the control group and the observation group using a simple randomization method.The control group(34 cases)received cardiotonic and diuretic treatment,while the observation group(34 cases)received cardiotonic and diuretic treatment combined with Entresto.The clinical efficacy,cardiac function indicators,myocardial injury indicators,neuroendocrine factors,and incidence of adverse reactions were compared between the two groups.Results The total clinical effective rate of the observation group was 94.12%,higher than 76.47% of the control group,with statistically significant difference(P<0.05).After treatment,the left ventricular ejection fraction(LVEF)and cardiac output(CO)in the observation group were higher than those in the control group,while the left ventricular end-systolic diameter(LVDs)and left ventricular end-diastolic diameter(LVDd)were lower than those in the control group,with statistically significant differences(P<0.05).After treatment,the levels of cardiac troponin I(cTn-I),myoglobin(Myo),and creatine kinase isoenzyme(CK-MB)in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).After treatment,the levels of N-terminal pro-brain natriuretic peptide(NT pro-BNP),serum renin(RA),and angiotensin Ⅱ(AngⅡ)in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).Compared to 8.82% in the control group,the total incidence of adverse reactions such as hypotension,gastrointestinal reactions,arrhythmia,and vascular edema in the observation group was 5.88%,without statistically significant difference(P>0.05).Co

关 键 词：心肌梗死 心力衰竭 强心利尿 诺欣妥 临床疗效 心功能 

分 类 号：R542.2[医药卫生—心血管疾病]