盐酸奥普力农注射液治疗充血性心力衰竭的临床效果

摘要

Objective To explore the effect and safety of olprinone in treating congestive heart failure (CHF).Methods Totally 52 patients of CHF from April 2009 to May 2010 were randomly divided into observation group (26 cases) receiving olprinone and control group (26 cases) receiving milrinone.Before and after treatment,the echocardiogram parameters [including left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVESD),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),left ventricular ejection fraction (LVEF),left ventricular fractional shortening (LVFS) and left atrial diameter] were measured; the cardiothoracic ratio on chest X-ray,liver and renal functions,blood and urine routine examinations,general states,heart function scores [New York heart association (NYHA) class and Boston score] and adverse reactions were recorded; the cadiovascular events (deterioration,readmission,death) 6 months after discharge were followed up.Results The effective rates showed no significantly differences between observation group and control group regarding NYHA class [88.5％ (23/26) vs 84.6％ (22/26)] and Boston score [61.5％ (16/26) vs 57.7％ (15/26)] (P ＞ 0.05).The heart rate,systolic blood pressure,Boston score,LVEF,LVEDV,LVESV and LVFS were all significantly improved after treatment in observation group [(73 ±10) times/min vs (94 ±26) times/min,(120±11) mmHg vs (128 ±19) mmHg,(5.4 ± 1.7) scorevs (9.9±1.3) score,(47±11)％ vs (41 ±11)％,(222±74) ml vs (236±75) ml,(118 ± 57) ml vs (138 ±67) ml,(27 ±8) mm vs (23 ±8) mm] and control group [(76 ± 11) times/min vs (100 ± 30) times/min,(119 ±10) mmHg vs (127 ±21) mmHg,(5.7 ± 1.6) score vs (9.8 ±1.0) score,(47 ± 19)％ vs (43±7)％,(218±67) ml vs (231 ±69) ml,(116±50) ml vs (133 ±55) ml,(25 ±5) mm vs (22 ± 4) mm] (P ＜ 0.05),but diastolic blood pressure,cardiothoracic ratio,LVEDD,LVSDD and left atrial diameter were not significantly improved (P ＞ 0.05).After treatment,the hemoglobin and blood platelet in observation group,the hemoglobin in control group were significantly increased[(141 ± 22) g/L vs (139 ± 19) g/L,(184±67) × 109/L vs (160 ±61) × 109/L,(138 ± 13) g/L vs (133 ± 13) g/L] (P＜0.05).No statistical changes of liver and kidney function were found after treatment in both groups (P ＞ 0.05).No significant differences of these parameters were found between the two groups (P ＞ 0.05).The incidence of adverse reactions was not significantly different between the two groups (P ＞ 0.05).During 6 months of follow-up period,deteriorations were observed in 7 patients in control group and 6 patients in observation group without statistical differences (P ＞ 0.05).Conclusion Short time-use of olprinone can effectively and safely relieve the clinical symptoms in patients of CHF,without influence on liver and kidney function.%目的 评价盐酸奥普力农注射液治疗充血性心力衰竭(CHF)的有效性和安全性.方法 选择2009年4月至2010年5月在扬州市第一人民医院心内科确诊为CHF的患者52例,采用随机数字表法分成观察组(26例)和对照组(26例).观察组给予盐酸奥普力农注射液治疗,对照组给予米力农注射液治疗.采用超声心动图检测治疗前后左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心房内径,记录心胸比、肝肾功能、血尿常规、心电图,记录患者用药期间的一般状况及心功能评分,并记录不良反应.随访出院后6个月心血管事件发生情况(恶化、再住院、死亡).结果 根据纽约心脏病学会心功能疗效评分,观察组总有效率为88.5％(23/26),对照组总有效率为84.6％(22/26);按Boston心功能疗效评分,观察组总有效率为61.5％ (16/26),对照组总有效率为57.7％ (15/26);2组疗效比较差异均无统计学意义(均P＞0.05).2组治疗后心率、收缩压、Boston评分、LVEF、LVEDV、LVESV、LVFS与治疗前比较均明显改善[观察组:(73±10)次/min比(94±26)次/min,(120±11)mmHg(1 mmHg=0.133 kPa)比(128±19) mmHg,(5.4±1.7)分比(9.9±1.3)分,(47±11)％比(41±11)％,(222±74) ml比(236±75) ml,(118±57) ml比(138±67) ml,(27±8) mm比(23±8)mm;对照组:(76±11)次/min比(100 ±30)次/min,(119±10) mmHg比(127 ± 21) mmHg,(5.7±1.6)分比(9.8±1.0)分,(47±19)％比(43±7)％,(218±67) ml比(231 ±69) ml,(116±50) ml比(133±55) ml,(25±5) mm比(22±4)mm](均P＜0.05),舒张压、心胸比、LVEDD、LVSDD、左心房内径与治疗前比较差异无统计学意义(P＞0.05).观察组治疗后血红蛋白水平和血小板计数明显高于治疗前[(141±22) g/L比(139±19) g/L,(184±67)×109/L比(160±61)×109/L],对照组治疗后血红蛋白水平均明显高于治疗前[(138±13) g/L比(133±13) g/L] (P ＜0.05).观察组和对照组治疗后肝肾功能指标无明显改变(P＞0.05).2组间治疗前后心功能、生化指标和肝肾功能指标比较差异均无统计学意义(均P＞0.05).对照组和观察组不良反应发生率比较,差异无统计学意义(P＞0.05).随访6个月,对照组7例、观察组6例心力衰竭恶化,差异无统计学意义(P＞0.05).结论 盐酸奥普力农短期应用能有效缓解心力衰竭的临床症状,对肝肾功能无明显不良影响.