强化降压方案对风湿性心脏病合并中度二尖瓣狭窄患者心功能 实验室指标及不良反应的影响

Effect of intensive antihypertensive protocol on cardiac function, laboratory parameters and adverse reactions in patients with rheumatic heart disease and moderate mitral stenosis

目的研究强化降压方案对风心病合并中度二尖瓣狭窄患者心功能、实验室指标及不良反应的影响。方法选取2015年6月至2017年6月我院收治的风心病合并中度二尖瓣狭窄患者128例为研究对象,用随机数表法分为对照组和试验组,每组各64例。对照组患者采用利尿剂、洋地黄等常规药物治疗,试验组患者应用硝苯地平联合美托洛尔,2组患者均治疗8周。观察比较2组患者的心功能指标、其他实验室指标、临床治疗效果以及不良反应发生情况。结果 2组患者在年龄、性别、体质量、病程和NYHA心功能分级等差异无统计学意义(P>0.05)。2组患者的有效率分别为81.25%及93.75%,差异有统计学意义(P<0.05),且2组患者在显效、有效、无效的构成比比较差异有统计学意义(P<0.05)。2组患者治疗后左室射血分数(LVEF)、左室射血时间(LVET)、二尖瓣流速(MFV)均较治疗前有所升高,观察组在LVEF、MFV均高于对照组(P<0.05);2组患者治疗后在静息时心率(HR)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)方面较治疗前降低,观察组在LVESV、LVEDV均低于对照组(P<0.05)。2组患者的平均二尖瓣压力差(mMPG)、肺动脉平均压(mPAP)、左房平均压(mLAP)治疗后均较治疗前有所降低,且观察组mPAP、mMPG治疗后低于对照组,mLAP高于对照组(P<0.05);2组患者治疗后六分钟步行实验(6MWT)均有所上升,且观察组6MWT明显高于对照组(P<0.05)。2组不良反应发生率差异无统计学意义(P>0.05)。结论强化降压方案可以提高风心病合并中度二尖瓣狭窄患者的临床疗效,降低心功能分级,改善患者心功能相关指标和血流动力学指标,并未出现明显的不良反应差异。

Objective To investigate the effect of intensive antihypertensive protocol on cardiac function,laboratory parameters and adverse reactions in the patients with rheumatic heart disease and moderate mitral stenosis.Methods A total of 128 patients with rheumatic heart disease and moderate mitral stenosis admitted to our hospital between June 2015 and June 2017 were included as the subjects in the study.All patients were randomly divided into the control group and study group(n=64 each).The control group was treated with conventional drugs such as Diuretics and Digitalis.The study group was treated with Nifedipine and Metoprolol.Both groups were treated for 8 weeks.Thecardiac function,laboratory parameters,clinical effect and incidence of adverse reactions were compared between the two groups.Results There were no statistically significant differences in the age,gender,weight,course of disease,and NYHA cardiac function classification between the two groups(P>0.05).The effective rate in the two groups was 81.25%and 93.75%,respectively,with statistically significant difference(P<0.05).There were significant differences in the constituent ratiosof marked effectiveness,effectiveness and ineffectiveness between the two groups(P<0.05).The left ventricular ejection fraction(LVEF),left ventricular ejection time(LVET),and mitral flow velocity(MFV)in the two groups increased after the treatment compared with baseline,and the LVEF and MFV in the study group were higher than those in the control group(P<0.05).The resting heart rate(HR),left ventricular end systolic volume(LVESV),and left ventricular end diastolic volume(LVEDV)in the two groups decreased after the treatment compared with the baseline,and the LVESV and LVEDV in the study group were both lower than those in the control group(P<0.05).The mean mitral valve pressure gradient(mMPG),mean pulmonary arterial pressure(mPAP),and mean left atrial pressure(mLAP)in the two groups decreased after the treatment compared with baseline,and the mPAP and mMPG in the study group were lower than those in the control group,whereas the mLAP in the study group was higher than that in the control group(P<0.05).The score of six-minute walk test(6MWT)in the two groups increased after the treatment,and the 6MWT score in the study group was significantly higher than the that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The intensive antihypertensive protocol may improve the clinical effect in the treatment of rheumatic heart disease and moderate mitral stenosis,reduce cardiac function grading,improve cardiac function related parameters and hemodynamic parameters,with no significant difference in adverse reactions.