参麦注射液联合地高辛对老年急性左心衰竭患者心功能的影响

摘要

目的：探讨参麦注射液联合地高辛对老年急性左心衰竭心功能的影响。方法选取自2013年1月至2014年1月遂宁市第一人民医院收治的老年急性左心衰竭患者80例，按照随机数字表法将患者分为地高辛组和联合组，每组40例。两组患者均给予镇静、吸氧、强心、利尿、扩血管等常规治疗，在此基础上地高辛组患者给予地高辛、联合组患者给予参麦注射液联合地高辛治疗。观察比较两组患者治疗后的疗效、心功能指标、心功能分级及洋地黄中毒情况。结果联合组患者治疗后的总有效率显著高于地高辛组[92.5％（37／40）比67.5％（27／40），P＜0.01]，且联合组的疗效显著优于地高辛组（Z＝5.548，P＝0.024）；治疗前，两组患者心功能指标及分级比较差异无统计学意义（ P＞0.05）；治疗后，两组患者的心率、左心室舒张末期容积、左心室收缩末期容积较治疗前明显降低，且联合组低于地高辛组，差异均有统计学意义[（81.8±10.3）次／min 比（74.8±8.5）次／min，（133.8±20.6） mL比（120.4±27.5） mL、（86.4±18.6） mL比（65.9±22.2） mL，P＜0.01]；心排血量、心排指数、左心室射血分数较治疗前明显升高，联合组患者高于地高辛组，差异均有统计学意义[（4.4±0.9） L／min 比（5.5±0.8） L／min、（2.5±0.5） L／（min· m2）比（3.0±0.5） L／（min· m2）、（48.3±9.2）％比（60.8±8.7）％，P＜0.01]；两组患者的心功能分级均较治疗前明显改善，且联合组患者改善较地高辛组更为明显，差异均有统计学意义（ P＜0.05）。治疗后联合组、地高辛组患者洋地黄中毒发生率比较差异无统计学意义[0％（0／40）比12.5％（5／40）]（P ＞0.05）。结果参麦注射液联合地高辛治疗老年急性左心衰竭患者的疗效较地高辛单独应用更为显著，心功能改善明显，值得在临床上推广应用。%Objective To investigate the effect of Shenmai injection combined with digoxin on treating acute left ventricular failure of elderly patients.Methods Total of 80 elderly patients with acute left ventric-ular failure Suining First People′s Hospital from Jan.2013 to Jan.2014 were included in the study,according to random number table,the patients were divided into a combined group and a digoxin group,40 cases each. All the patients were given sedation, oxygen, cardiotonic, diuresis, vasodilator and other conventional treat-ment,and the digoxin group was added digoxin,the combined group was added with Shenmai injection on the basis of digoxin group′s regimen.The curative effect,heart function,cardiac functional grading and digitalism of the two groups were compared.Results The total effective rate of the combined group was higher than the digoxin group [92.5%(37/40) vs 67.5%(27/40),P <0.05],and the evident effect of the combined group was significantly better than the digoxin group(Z=5.548,P=0.024).Before treatment,there were no differences in functional parameters and grade (P >0.05).After treatment,the heart rate,left ventricular end diastolic volume,left ventricular end-systolic volume were significantly lower than before,and the com-bined group was lower than the digoxin group[(81.8 ±10.3) times/min vs (74.8 ±8.5) times/min, (133.8 ±20.6) mL vs (120.4 ±27.5) mL,(86.4 ±18.6) mL vs (65.9 ±22.2) mL,P<0.05],left ventricular ejection fraction,cardiac output and cardiac index were significantly higher than before,and the combined group was higher than the digoxin group [ ( 48.3 ±9.2 )% vs ( 60.8 ±8.7 )%, ( 4.4 ± 0.9) L/min vs (5.5 ±0.8) L/min,(2.5 ±0.5) L/(min· m2) vs (3.0 ±0.5) L/(min· m2),P <0.05];the cardiac function grading of both groups after treatment was significantly better than before treat-ment,and the combined group more significantly than the digoxin group(P<0.05).There was no digitalism case in the combined group,and 5 cases(12.5%,5/40) in digoxin group,the difference between the two groups had not statistically significant ( P >0.05 ) .Conclusion The effect of Shenmai injection combined with digoxin treatment on acute left ventricular failure in the elderly patients is better than digoxin alone , which can improve the heart function significantly,thus is worthy of the clinical application.