摘要
目的探讨新活素联合左西孟旦治疗对急性心肌梗死(AMI)合并心源性休克(CS)患者的临床疗效,以及心泵功能,脉搏指数连续心排量监测技术(PICCO)血流动力学指标,心肌功能,血清血管加压素(AVP)、血管紧张素Ⅱ(AngⅡ)水平的影响。方法选取2017年1月—2020年1月开封市某医院收治的AMI合并CS患者177例为研究对象,按照不同治疗方案分为对照组、研究组和综合组,各59例。对照组患者采用新活素治疗,研究组患者采用左西孟旦治疗,综合组患者采用新活素联合左西孟旦治疗,3组患者均持续治疗7 d。比较3组患者的治疗效果,比较3组患者治疗前、治疗3 d时及治疗7 d时的心泵功能[心搏量(SV)、左室射血分数(LVEF)、心脏指数(CI)],PICCO血流动力学指标[中心静脉压(CVP)、体循环阻力指数(SVRI)、肺毛细血管楔嵌压(PCWP)],心肌功能[血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、室壁运动计分指数(WMSI)、纵向收缩期峰值应变率(SRs)]及血清AVP、AngⅡ水平,比较3组患者随访6个月时的不良心脏事件(MACE)发生情况。结果综合组患者的治疗总有效率为93.22%,高于对照组的79.66%和研究组的76.27%,差异均有统计学意义(P<0.05)。治疗前,3组患者SV、LVEF、CI及WMSI、SRs水平比较,差异均无统计学意义(P>0.05);治疗3 d及治疗7 d时,3组患者SV、LVEF、CI及SRs水平均高于治疗前且综合组高于对照组和研究组,WMSI水平均低于治疗前且综合组低于对照组和研究组,差异均有统计学意义(P<0.05)。治疗前,3组患者CVP、SVRI及PCWP比较,差异均无统计学意义(P>0.05);治疗3 d及治疗7 d时,3组患者CVP、SVRI及PCWP均低于治疗前,且综合组低于对照组和研究组,差异均有统计学意义(P<0.05)。治疗前,3组患者血清cTnI、CK-MB水平比较,差异均无统计学意义(P>0.05);治疗3 d及治疗7 d时,3组患者血清cTnI、CK-MB水平均低于治疗前,且综合组低于对照组和研究组,
Objective To investigate the clinical effects of rh BNP combined with levosimendan on patients with acute myocardial infarction(AMI) combined with cardiogenic shock(CS), and the effects on the patients’ cardiac pump function, pulse-indicated continuous cardiac output(PICCO) hemodynamic indexes, myocardial function, and serum arginine-vasopressin(AVP) and angiotensin Ⅱ(AngⅡ) levels. Methods One hundred and seventyseven patients with AMI combined with CS admitted to a hospital in Kaifeng from January 2017 to January 2020 were selected for the study and divided into a control group, a study group and a combined group according to different treatment protocols, 59 cases each. Patients in the control group were treated with rh BNP, patients in the study group were treated with levosimendan, and patients in the combined group were treated with rh BNP combined with levosimendan, all for 7 d. The treatment effects of the three groups were compared, and patients in the three groups were compared in terms of cardiac pumping function [stroke volume(SV), left ventricular ejection fraction(LVEF), cardiac index(CI)], PICCO hemodynamic parameters [central venous pressure(CVP), systemic vascular resistance index(SVRI), pulmonary capillary wedge pressure(PCWP)], myocardial function [serum cardiac troponin I(cTnI), creatine kinase myocardial band(CK-MB), wall motion score index(WMSI), longitudinal peak systolic strain rates(SRs)] and serum AVP and AngⅡ levels before treatment, at 3 d and at 7 d. The occurrence of major adverse cardiac events(MACE) in the three groups were compared at 6 months of follow-up. Results The total treatment efficacy of patients in the combined group was 93.22%, which was higher than that of the control group(79.66%) and the study group(76.27%), and the differences were statistically significant(P<0.05). Before treatment, there were no statistically significant differences in SV, LVEF, CI,WMSI and SRs among the 3 groups(P>0.05);at 3 d and 7 d of treatment, SV, LVEF, CI,WMSI and SRs of the 3 groups
作者
周宏伟
罗秀英
Zhou Hongwei;Luo Xiuying(Department of Pharmacy,Kaifeng People′s Hospital,Kaifeng Henan 475000,China)
出处
《保健医学研究与实践》
2022年第2期9-14,共6页
Health Medicine Research and Practice
