螺内酯治疗老年冠心病并慢性心力衰竭患者的疗效及对脑钠肽、心功能的影响

摘要

目的:探讨螺内酯在老年冠心病并慢性充血性心力衰竭患者的疗效及对脑钠肽(BNP) 、心功能的影响.方法:选择我院收治的老年冠心病并慢性充血性心力衰竭患者96例作为研究对象,随机分为常规治疗组(48例)与螺内酯组(48例) .治疗3个月后,观察两组的疗效及治疗前后血浆BNP水平和心功能的变化情况.结果:治疗3个月后,螺内酯组临床总有效率显著高于常规治疗组(95-8% 比72-9%, P＝0-002) ;两组血浆BNP水平均显著下降,左室射血分数(LVEF)均显著提高,左室舒张末内径(LVEDd)均显著减小( P均＜0-01) ;与常规治疗组比较,螺内酯组血浆BNP [(440-11 ± 76-90) ng／L比(359-21 ± 51-21) ng／L]水平显著下降, LVEF [(43-23 ± 5-80)% 比(49-46 ± 5-98)%]显著提高, LVEDd [ (62-91 ± 3-90) mm比(59-12 ± 2-38) mm]显著减小(P均＝0-001) .螺内酯组并发症发生率显著低于常规治疗组(8-3% 比22-9%, P＝0-049) .结论:螺内酯治疗老年冠心病并慢性充血性心力衰竭患者疗效显著,可显著降低血浆脑钠肽水平,改善心功能,值得推广.%Objective :To explore therapeutic effect of spironolactone on aged patients with coronary heart disease (CHD) complicated chronic congestive heart failure (CHF ) and its influence on level of brain natriuretic peptide (BNP) and cardiac function .Methods : A total of 96 aged CHD + CHF patients treated in our hospital were ran-domly and equally divided into routine treatment group and spironolactone group ,both groups were treated for three months.Therapeutic effect ,plasma BNP level and cardiac function before and after treatment were observed and compared between two groups .Results : After three-month treatment ,total effective rate of spironolactone group was significantly higher than that of routine treatment group (95-8% vs.72-9%,P＝0-002).Compare with before treatment , there were significant reductions in plasma BNP level and left ventricular end-diastolic dimension (LVEDd) ,and significant rise in left ventricular ejection fraction (LVEF) in two groups after three-month treat-ment , P＜ 0-01 all ;compared with routine treatment group after treatment ,there were significant reductions in plasma BNP level [ (440-11 ± 76-90) ng／L vs.(359-21 ± 51-21 ) ng／L ] and LVEDd [ (62-91 ± 3-90 ) mm vs. (59-12 ± 2-38) mm] ,and significant rise in LVEF [ (43-23 ± 5-80)% vs.(49-46 ± 5-98)%] in spironolactone group , P＝0-001 all .Incidence rate of complications in spironolactone group was significantly lower than that of routine treatment group (8-3% vs.22-9%, P＝0-049).Conclusion : Spironolactone possesses significant therapeu-tic effect on aged CHD + CHF patients .It can significantly reduce plasma BNP level and improve cardiac function , which is worth extending .