托拉塞米联合不同剂量螺内酯对慢性射血分数降低的心力衰竭患者的影响  

Effect of Torasemide Combined with Different Doses of Spironolactone in Patients with Chronic Heart Failure with Reduced Ejection Fraction

作　　者：荆珍 JING Zhen(Department of Cardiology,the First People’s Hospital of Lingbao,Lingbao 472500,China)

机构地区：[1]灵宝市第一人民医院心内科,河南灵宝472500

出　　处：《河南医学研究》2025年第1期139-143,共5页Henan Medical Research

摘　　要：目的分析托拉塞米联合不同剂量螺内酯对慢性射血分数降低性心力衰竭(HFrEF)患者的影响。方法选取灵宝市第一人民医院2018年3月至2020年7月接收的150例HFrEF患者作为研究对象,均接受托拉塞米治疗,应用随机数表法分为3组,小剂量组(50例)患者使用10 mg螺内酯治疗,中剂量组(50例)使用20 mg螺内酯治疗,大剂量组(50例)使用40 mg螺内酯治疗。观察3组治疗前、治疗3个月后心功能指标、氨基末端脑钠肽前体(NT-proBNP)、炎症因子水平及治疗有效率、不良反应发生情况。结果治疗前3组左心室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)水平及6分钟步行距离差异无统计学意义(P>0.05),治疗后3组LVEF、LVEDD、LVESD水平及6分钟步行距离比较,差异有统计学意义(P<0.05),且治疗后LVEF水平及6分钟步行距离均高于治疗前,中剂量组高于小剂量组、大剂量组,治疗后LVEDD、LVESD水平低于治疗前,中剂量组低于小剂量组、大剂量组。治疗前3组NT-proBNP、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)水平差异无统计学意义(P>0.05),治疗后3组NT-proBNP、TNF-α、hs-CRP水平比较,差异有统计学意义(P<0.05),且治疗后低于治疗前,中剂量组低于小剂量组、大剂量组。小剂量组不良反应发生率(6.00%)低于大剂量组(20.00%)(P<0.05),但小剂量组与中剂量组(10.00%)差异无统计学意义(P>0.05)。中剂量组总有效率(94.00%)高于小剂量组(78.00%)、大剂量组(76.00%)(P<0.05)。结论与10、40 mg剂量的螺内酯相比,20 mg螺内酯联合托拉塞米改善HFrEF患者心功能的效果最好,减轻炎症反应,10 mg螺内酯不良反应发生风险最低,但20 mg不良反应发生风险在可控范围内,使用20 mg螺内酯治疗总体疗效最高。Objective To analyze the effects of torasemide combined with different doses of spironolactone in patients with chronic heart failure with reduced ejection fraction(HFrEF).Methods A total of 150 HFrEF patients received in the First People’s Hospital of Lingbao from March 2018 to July 2020 were selected as the research object,and all received torasemide treatment.They were divided into 3 groups by random number table method.Patients in the low-dose group(50 cases)were treated with 10 mg spironolactone,the middle-dose group(50 cases)were treated with 20 mg spironolactone,and the high-dose group(50 cases)were treated with 40 mg spironolactone.The heart function indexes,N-terminal B-type natriuretic peptide(NT-proBNP),inflammatory factor levels and the effective rate of treatment and the occurrence of adverse reactions were observed before and after 3 months of treatment in the 3 groups.Results There were no significant differences in left ventricular ejection fraction(LVEF),left ventricle end-diastolic diameter(LVEDD),left ventricle end-systolic diameter(LVESD)levels and 6-minute walking distance in the three groups before treatment(P>0.05).There were significant differences in LVEF,LVEDD,LVESD levels and 6-minute walking distance among the 3 groups after treatment(P<0.05).The LVEF level and 6-minute walking distance after treatment were higher than those before treatment,and the middle-dose group was higher than the low-dose and high-dose groups.The levels of LVEDD and LVESD were lower than before treatment,and the middle-dose group was lower than the low-dose and high-dose groups.There were no significant difference in the levels of NT-proBNP,tumor necrosis factorα(TNF-α),and high-sensitivity C-reactive protein(hs-CRP)in the three groups before treatment(P>0.05).There were significant differences in NT-proBNP,TNF-α,hs-CRP levels and 6-minute walking distance among the 3 groups after treatment(P<0.05),and after treatment was lower than before treatment,the middle-dose group was lower than the low-dose group an

关 键 词：慢性心力衰竭 射血分数降低 螺内酯剂量 N末端B型钠尿肽 

分 类 号：R541.6[医药卫生—心血管疾病]