小剂量螺内酯用于冠心病慢性心力衰竭的疗效及护理研究

摘要

Objective To investigate the clinical effect of small dose of spironolactone for treating coronary heart disease(CHD)compli-cating chronic heart failure(CHF). Methods Totally 72 patients with CHD complicating heart failure admitted to the hospital in 2013 were selected and divided into the study group and control group according to the random number table method,36 cases in each group. The control group was given oral captopril and metoprolol on the basis of the conventional therapy,while on the basis of the control group treatment,the study group was combined with the application of small dose of spironolactone. The clinical effects and oc-currence situation of adverse reactions were compared between the two groups. Results The 6 min walking distance after 3,6 months treatment in the study group was significantly prolonged compared with before treatment( P ﹤ 0. 05);the 6 min walking distance before treatment and after 3-month treatment had no statistical difference between the two groups,but the 6 min walking distance after 6-month treatment in the study group was significantly higher than that in the control group and after 3-month treatment in the study group( P ﹤ 0. 05);the total effective rate in the study group was 91. 67%,which was significantly higher than 75. 00% in the control group( P ﹤ 0. 05). The cardiac function indexes of SV,CO,LVEF,E/A,etc. after treatment in the two group were significantly improved compared with before treatment( P ﹤ 0. 05),but the improvement in the study group was more obvious than that in the control group and the differences were statistically significant( P ﹤ 0. 05). Conclusion Spironolactone has the diuretic effect by the above mecha-nism,alleviates the cardiac preload,effectively prevents myocardial fibrosis and ventricular remodeling in the patients with CHD com-plicating heart failure,can effectively improve the heart function without adverse reactions,which is worthy of clinical promotion.%目的：探讨小剂量螺内酯治疗冠状动脉粥样硬化性心脏病(简称冠心病)慢性心力衰竭的临床疗效。方法选择2013年医院住院治疗的冠心病合并心力衰竭患者72例，按随机数字表法将其分为研究组和对照组，各36例。对照组患者在常规治疗基础上口服卡托普利和倍他乐克，研究组患者在对照组基础上联合应用小剂量螺内酯治疗，比较两组患者的临床疗效及不良反应发生情况。结果研究组患者在治疗3，6个月后的6 min步行距离均较治疗前明显延长（ P﹤0.05）；治疗前、治疗3个月后6 min步行距离组间比较无明显差异，但在治疗6个月后研究组的6 min步行距离明显高于对照组，而且较本组治疗3个月明显延长（ P﹤0.05）；研究组患者的临床总有效率为91.67%，明显高于对照组的75.00%（ P﹤0.05）；两组患者治疗后每博输出量( SV )、心输出量( CO )、左室射血分数( LVEF )、E峰/A峰比值( E/A )等心功能指标均较治疗前明显改善（ P﹤0.05），且研究组改善更显著（ P﹤0.05）。结论螺内酯可通过利尿减轻心脏前负荷，有效阻止冠心病合并心力衰竭患者心肌纤维化和心室重构，可有效改善患者的心功能，无不良反应，值得临床推广。