Effect observation of bisoprolol combined with enalapril and spironolactone for patients with heart failure induced by rheumatic heart disease
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摘要: 目的 探讨比索洛尔联合依那普利及螺内酯对风湿性心脏病所致心力衰竭患者心功能及预后的影响。 方法 将210例风湿性心脏病所致心力衰竭患者随机分为单一组与联合组,每组105例。单一组予以依那普利及螺内酯治疗,联合组在单一组基础上加用比索洛尔治疗。比较2组美国纽约心脏病学会(NYHA)心功能分级、心功能指标、血浆脑利钛钠(BNP)及N端B型脑钠肽前体(NT-proBNP)水平、6 min步行距离、累积生存率、不良反应发生情况。 结果 治疗后,联合组NYHA心功能分级显著优于单一组(P<0.05)。2组治疗后左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)较治疗前显著降低(P<0.05), 左室射血分数(LVEF)较治疗前显著升高(P<0.05), 且联合组变化幅度显著大于单一组(P<0.05)。2组BNP、NT-proBNP水平较治疗前显著降低(P<0.05), 联合组下降幅度显著大于单一组(P<0.05)。2组6 min步行距离较治疗前显著增加(P<0.05), 联合组增加幅度显著大于单一组(P<0.05)。联合组出院后3、6、12个月生存率显著高于单一组(P<0.05)。2组不良反应发生率无显著差异(P>0.05)。 结论 比索洛尔联合依那普利及螺内酯治疗风湿性心脏病所致慢性心力衰竭患者安全、有效,可明显改善患者心功能状况,降低BNP、NT-proBNP水平,增加6 min步行距离,提高累积生存率。Abstract: Objective To explore the effect of bisoprolol combined with enalapril and spironolactone on cardiac function and prognosis of patients with heart failure induced by rheumatic heart disease. Methods A total of 210 patients with heart failure induced by rheumatic heart disease were randomly divided into single group and combined group, with 105 cases in each group. Single group was treated with enalapril and spironolactone, and combined group was additional treated with bisoprolol on the basis of the single group. The cardiac function grading of New York Heart Association(NYHA), cardiac function indexes, levels of plasma brain natriuretic peptide(BNP)and N-terminal pro-brain natriuretic peptide(NT-proBNP), 6 min walking distance, cumulative survival rate and the incidence of adverse reactions were compared between the two groups. Results After treatment, the cardiac function grading of NYHA in combined group was significantly better than that in single group(P<0.05). The left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)in both groups were significantly lower than those before treatment(P<0.05), while the left ventricular ejection fraction(LVEF)was significantly higher than that before treatment - (P<0.05), and the changes in combined group were significantly greater than those in single group (P<0.05). The levels of BNP and NT-proBNP in both groups were significantly lower than those before treatment(P<0.05), and the reductions in combined group were significantly greater than those in single group(P<0.05). The 6 min walking distance in both groups was significantly increased when compared with that before treatment(P<0.05), and the combined group was significantly better than that in single group(P<0.05). The survival rates at 3, 6 and 12 months after hospital discharge in combined group were significantly higher than those in single group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Bisoprolol combined with enalapril and spironolactone is effective and safe in the treatment of patients with heart failure induced by rheumatic heart disease, which can significantly improve cardiac function status, reduce levels of BNP and NT-proBNP, increase 6 min walking distance, and improve cumulative survival rate.
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Keywords:
- bisoprolol /
- enalapril /
- spironolactone /
- rheumatic heart disease /
- heart failure /
- cardiac function /
- prognosis
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