【摘要】 目的观察在常规慢性充血性心力衰竭(CHF)治疗基础上联合应用前列地尔对患者心功能改善情况,进一步探讨影响慢性充血性心力衰竭(心衰)患者预后的危险因素。方法选择2013年5月~2014年6月在烟台市莱阳中心医院心内科住院的CHF患者130例,其中男性45例,女性85例,年龄53~79岁(68.5±7.8)岁。随机分为2组:对照组(n=65)和治疗组(n=65),对照组行常规心衰药物治疗,治疗组在此基础上联合应用前列地尔制剂10μg,1/日,连用7 d。比较2组治疗前后6 min步行试验距离(6MWD)、血浆氨基末端脑钠肽前体(NT-pro BNP)水平、住院时间、左室射血分数(LVEF)、左室短轴缩短率(FS)、左室舒张末期内径(LVEDD)及左室收缩末期内径(LVESD)的变化。受试者随访120 d,记录2组因心衰进展再入院治疗患者例数及时间。结果与对照组比较,治疗组治疗后6MWD距离增加,NT-pro BNP水平下降,[(359.9±144.4)m vs.(414.9±145.1)m]、[(3120.0±1811.6)ng/L vs.(2350.1±1731.1)ng/L],差异有统计学意义(P均<0.05)。并且治疗组第一次住院时间短于对照组[(11.2±2.6)d vs.(12.3.±3.5)d],差异有统计学意义(P<0.05)。与对照组治疗后比较,治疗组LVEF、FS提高,LVEDD缩小,[(42.6±7.9)%vs.(45.7±7.7)%]、[(33.3±4.1)%vs.(35.1±4.3)%]、[(52.3±5.8)mm vs.(49.9±6.0)mm],差异有统计学意义(P<0.05)。随访120 d,共有26例患者因心衰进展恶化再次住院治疗,其中对照组15例,治疗组11例,治疗组心衰进展恶化再入院间隔时间长于对照组,[(101.6±19.0)d vs.(69.5±16.0)d],差异有统计学意义(P<0.01)。NT-pro BNP水平(RR=7.395,95%CI:1.881~29.073)及合并COPD(RR=7.120,95%CI:2.762~18.349)是心衰患者病情进展的危险因素,常规治疗基础上应用前列地尔可能会改善心衰患者的预后(RR=0.253,95%CI:0.096~0.666)。结论 CHF患者常规药物治疗基础上联合应用前列地尔制剂可进一步改善心功能及预后。更多还原

【Abstract】 Objective To observe the improvement effect of alprostadil based on routine therapy for chronic congestive heart failure(CHF), and investigate further the risk factors influencing the prognosis in patients with CHF. Methods CHF patients(n=130, male 45, female 85, aged from 53 to 79, and average age=68.5±7.8) were chosen from May 2013 to Jun. 2014, and then randomly divided into control group and treatment group(each n=65). The control group was treated with routine anti-CHF drugs and treatment group was additionally treated with alprostadil(10 μg) once a day for 7 d. The changes of 6-minute walk test(6MWT), plasma N-terminal pro brain natriuretic peptide(NT-pro BNP), hospitalization duration, left ventricular ejection fraction(LVEF), left ventricular fraction shortening(LVFS), left ventricular end-diastolic inner diameter(LVEDd) and left ventricular end-systolic diameter(LVESd) were compared in 2 groups before and after treatment. All patients were followed up for 120 d, and numbers of re-hospitalized cases due to progressive CHF and hospitalization duration were recorded. Results Compared with control group, 6MWD increased [(359.9±144.4) m vs.(414.9±145.1) m] and NT-pro BNP decreased [(3120.0±1811.6) ng/L vs.(2350.1±1731.1) ng/L] in treatment group(all P<0.05). The first time hospitalization duration was shorter in treatment group than that in control group [(11.2±2.6) vs.(12.3.±3.5), P<0.05]. After treatment, LVEF [(42.6±7.9)% vs.(45.7±7.7)%] and LVFS [(33.3±4.1)% vs.(35.1±4.3)%] increased and LVEDd decreased [(52.3±5.8) mm vs.(49.9±6.0) mm] in treatment group compared with control group(P<0.05). After followed up for 120 d, there were 26 cases re-hospitalized, and 15 in control group and 11 in treatment group. The interval between discharge and re-hospitalization was longer in treatment group than that in control group [(101.6±19.0) vs.(69.5±16.0), P<0.01]. The level of NT-pro BNP(RR=7.395, 95%CI: 1.881~29.073) and COPD(RR=7.120, 95%CI: 2.762~18.349) were risk factors of progressive CHF. Theadministration of alprostadil based on routine therapy might improve the prognosis in CHF patients(RR=0.253, 95%CI: 0.096~0.666). Conclusion The administration of alprostadil based on routine therapy can further improve heart function and prognosis in CHF patients.更多还原