不同剂量参附注射液联合左卡尼汀治疗老年慢性心力衰竭临床疗效的对比研究

摘要

目的：比较不同剂量参附注射液联合左卡尼汀治疗老年慢性心力衰竭（CHF）的临床疗效。方法选取2014年3月—2016年1月在鄂东医疗集团黄石市中心医院心内科、心内科重症监护室住院治疗的老年 CHF 患者142例，按照随机数字表法分为对照组（n =47）、观察1组（n =47）和观察2组（n =48）。3组患者均给予常规抗心力衰竭治疗，对照组患者给予左卡尼汀治疗，观察1组患者在对照组治疗基础上给予小剂量（50 ml）参附注射液进行治疗，观察2组患者在对照组治疗基础上给予大剂量（100 ml）参附注射液进行治疗，14 d 为1个疗程。比较3组患者心功能指标〔美国纽约心脏病协会（NYHA）心功能分级、Lee 氏心衰积分、左心室射血分数（LVEF）、心肌做功指数（MPI）、N 末端脑钠肽前体（NT-proBNP）及6分钟步行距离（6MWD）〕及生活质量评分基线值及变化值，比较3组患者 Lee 氏心衰积分疗效及治疗期间不良反应发生情况。结果3组患者 NYHA 心功能分级、Lee 氏心衰积分、LVEF、MPI、NT-proBNP、生活质量评分及6MWD 基线值比较，差异均无统计学意义（P ﹥0.05）。观察2组和观察1组患者 NYHA 心功能分级、Lee 氏心衰积分、MPI 及生活质量评分变化值小于对照组，6MWD 和 LVEF 变化值大于对照组，治疗后NT-proBNP下降30%者所占比例高于对照组（P ﹤0.05）；观察2组患者 NYHA 心功能分级、Lee 氏心衰积分、MPI、生活质量评分变化值小于观察1组，6MWD 和 LVEF 变化值大于观察1组，治疗后NT-proBNP下降30%者所占比例高于观察1组（P ﹤0.05）。观察2组患者 Lee 氏心衰积分疗效优于观察1组和对照组（P ﹤0.05）；观察1组和对照组患者 Lee 氏心衰积分疗效比较，差异无统计学意义（P ﹥0.05）。3组患者治疗期间均未出现明显不良反应。结论大剂量参附注射液（100 ml）联合左卡尼汀治疗老年 CHF 的临床疗效优于小剂量参附注射液（50 ml）联合左卡尼汀，能更有效地改善患者心功能，提高患者生活质量，且安全性较高。%Objective To compare the clinical effect in treating elderly patients with chronic heart failure in different doses of shenfu injection based on levocarnitine. Methods From March 2014 to January 2016,a total of 142 elderly patients with chronic heart failure were selected in the Department of Cardiology and the Coronary Care Unit,Huangshi Central Hospital of Edong Medical Treatment Corp,and they were randomly into A group(n = 47),B group(n = 47) and C group( n = 48) according to random number table. Based on conventional treatment for heart failure,patients of A group received levocarnitine, patients of B group received small - dose shenfu injection(50 ml) combined with levocarnitine,while patients of C group received large - dose shenfu injection(100 ml) combined with levocarnitine,14 days as a course. Baseline value and change value of index of cardiac function( including NYHA cardiac functional grades,Lee' s heart failure scores,LVEF,MPI, NT-proBNP and 6 - minute walk distance)and life quality score were compared among the three groups,clinical effect based on Lee's heart failure scores and incidence of adverse reactions during treatment were compared,too. Results No statistically significant differences of baseline value of NYHA cardiac functional grades, Lee' s heart failure scores, LVEF, MPI, NT-proBNP,6 - minute walk distance or life quality score was found among the three groups(P ﹥ 0. 05). The change value of NYHA cardiac functional grades,Lee's heart failure scores,MPI and life quality score of B group and C group were statistically significantly smaller than those of A group,the change value of 6 - minute walk distance and LVEF of B group and C group were statistically significantly larger than those of A group,the proportion of patients with NT-proBNP decreased for 30% of B group and C group was statistically significantly higher than that of A group,respectively( P ﹤ 0. 05);the change value of NYHA cardiac functional grades,Lee's heart failure scores,MPI and life quality score of C group were statistically significantly smaller than those of B group,the change value of 6 - minute walk distance and LVEF of C group were statistically significantly larger than those of B group,the proportion of patients with NT-proBNP decreased for 30% of C group was statistically significantly higher than that of B group( P ﹤ 0. 05). The clinical effect based on Lee's heart failure scores of C group was statistically significantly better than that of A group and B group,respectively(P ﹤ 0. 05);while no statistically significant differences of clinical effect based on Lee's heart failure scores was found between A group and B group( P ﹥ 0. 05). No one of the three groups occurred any obvious adverse reactions during the treatment. Conclusion Based on levocarnitine,large - dose shenfu injection(100 ml)has better clinical effect in treating elder patients with chronic heart failure than small - dose shenfu injection (50 ml),can more effectively improve the cardiac function and quality of life,and is safe.