摘要
目的分析加用尼可地尔对难治性高血压患者的治疗效果及对早期肾功能的影响,探讨难治性高血压的优化药物及靶器官的保护方案。方法选取2018-12-1-2019-12-30开封市中心医院收治的128例难治性高血压患者为研究对象,按照组间基线资料均衡可比的原则分为观察组(尼可地尔+螺内酯组,68例)和对照组(螺内酯组,60例)。观察组在原有标准治疗方案不变的基础上给予尼可地尔片和螺内酯片治疗,对照组仅给予螺内酯片治疗。2组患者均连续用药12周,不随意更换药物,常规复诊;动态记录患者4、8和12周血压下降情况并计算血压控制有效率,测定治疗前后血糖、低密度脂蛋白胆固醇、血钾、肌酐、校正肾小球滤过率(eGFR)、尿白蛋白、尿肌酐及尿白蛋白肌酐比值(UACR)等指标,同时应用超声心动图测量左室射血分数(LVEF)、二尖瓣口血流频谱测量参数(E/A,E峰是指早期充盈峰值流速;A峰是指舒张晚期最大流速)、左心室舒张末期内径(LVEDD)和左心房舒张末期内径(LAD)变化。结果对照组口服螺内酯治疗4周后,降压治疗显效率为13.33%,治疗第8和12周总有效率分别为58.3%及78.3%,降压效果持续上升;观察组治疗4、8和12周降压有效率持续平稳上升,分别为60.3%、70.6%和92.6%,第8周(χ^(2)=4.091,P=0.043)和12周(χ^(2)=33.92,P=0.001)均高于同期对照组。2组降压治疗效果对比,观察组治疗8周(t=1.965,P=0.042)和12周(t=2.315,P=0.022)降压效果均高于同期对照组。治疗12周后观察组UACR、LVEF及E/A值与对照组比较差异有统计学意义,均P<0.05。2组均未出现严重临床不良反应。结论尼可地尔在标准规范降压的基础上有进一步安全降压及保护肾功能的作用,可作为难治性高血压的辅助降压药物。
Objective To analyze the therapeutic effect of adding nicorandil on patients with refractory hypertension and its influence on early renal function,and explore the optimal drugs for refractory hypertension and the protection of target organs.Methods Totally 128 patients with refractory hypertension admitted to Kaifeng Central Hospital from December 1,2018 to December 30,2019 were selected as the research objects,and divided them into the observation group according to the principle of balanced and comparable baseline data between the groups(nicorandil+spironolactone group,68 cases)and control group(spironolactone group,60 cases).The observation group was given nicorandil tablets and spironolactone tablets on the basis of the original standard treatment plan unchanged,and the control group was given only spironolactone tablets.The two groups of patients were taking medication for 12 weeks without changing the medication at will,and routine follow-up visits.The patient’s blood pressure drop at 4,8 and 12 weeks was dynamically recorded and the effective rate of blood pressure control was calculated,and blood glucose,low-density lipoprotein cholesterol,blood potassium,creatinine,corrected glomerular filtration rate(eGFR),urinary albumin,urinary creatinine and urinary albumin-creatinine ratio(UACR)and other indicators,while using echocardiography to measure left ventricular ejection fraction(LVEF),mitral valve orifice blood flow spectrum measurement parameters(E/A,E peak refers to the early filling peak flow velocity.A peak refers to the maximum late diastolic flow velocity),left ventricular end diastolic diameter(LVEDD)and left atrium end diastolic diameter(LAD)changes.Results After 4 weeks of oral spironolactone treatment in the control group,the effective rate of antihypertensive treatment was 13.33%,and the total effective rates were 58.3%and 78.3%at the 8 th and12 th week of treatment,respectively.The antihypertensive effect continued to rise.The observation group was treated for4 weeks and 8 weeks.The effectiv
作者
李慧娟
杨文
刘洁云
秦雷
LI Hui-juan;YANG Wen;LIU Jie-yun;QIN Lei(Department of Cardiology,Kaifeng Central Hospital,Kaifeng 475000,China)
出处
《社区医学杂志》
CAS
2021年第16期979-983,共5页
Journal Of Community Medicine
基金
开封市科技发展计划(1803050)。
关键词
尼可地尔
螺内酯
难治性高血压
早期肾损伤
nicorandil
spironolacton
refractory hypertension
early renal damage
