地尔硫艹卓在高血压合并快速心房颤动致急性左心衰竭治疗中的临床效果分析

Analysis of the clinical effects of diltiazem in patients with acute left heart failure caused by hypertension and rapid atrial fibrillation

目的控讨地尔硫革在高血压合并快速心房颤动致急性左心衰竭治疗中的临床价值。方法将99例高血压合并快速心房颤动致急性左心衰竭患者按入院顺序随机分为观察组（61例）和对照组（38例）。对照组给予休息，吸氧，使用强心、利尿及扩血管类药物，烦躁者加用镇静剂，必要时使用哌替啶等药物止痛。观察组在对照组治疗的基础上加用地尔硫革，首次剂量为0．125mg／kg，推注时间不少于5min，然后根据血压及心率情况调整剂量，直至停用。观察两组患者治疗前后血压、心率及呼吸情况的变化。结果治疗后30min、1h，观察组收缩压和舒张压均显著低于对照组，差异有统计学意义（P〈0．01）。治疗后30min，观察组呼吸困难消失、心率下降至100次／min以下、肺部哕音明显减少或消失和安静、大汗终止的比率[分别为44．3％（27／61）、42．6％（26／61）、44．3％（27161）、41．0％（25161）]显著高于对照组[分别为18．4％（7／38）、15．8％（6／38）、18．4％（7／38）、15．8％（6／38）]，治疗后1h，观察组上述指标的比率仍显著高于对照组，差异有统计学意义（P〈0．01）。结论地尔硫革在高血压合并快速心房颤动致急性左心衰竭治疗中效果确切，值得在临床中推广。

Objective To explore the clinical value of diltiazem in patients with acute left heart failure caused by hypertension and rapid atrial fibrillation . Methods Ninety-nlne hospitalized patients with acute left heart failure caused by hypertension and rapid atrial fibrillation were randomly divided into observation group （61 cases） and control group （38 cases）. Conventional therapy was given in the two groups and diltiazem was added in observation group. Blood pressure, heart rate and respiration rate was compared. Results After treatment for 30 min and 1 h, the levels of SBP and DBP were significantly lower in observation group than those in control group （P 〈 0.01 ）. After treatment for 30 min, the rate of dyspnea disappearing, heart rate decreasing below 100 times/min, rale in lung decreasing or disappearing, quiet and sweat disappearing [44.3% （27/61） ,42.6% （26/61） ,44.3% （27/61） ,41.0% （25161） ] were significantly higher than those in control group [ 18.4%（7/38）, 15.8%（6/38）, 18.4%（7/38）, 15.8%（6/38） ] （p 〈 0.01 ）. After treatment for 1 h, the levels of above mentioned index were significantly higher than those in control group （P 〈 0.01 ）. Conclusion Diltiazem has exact effect in the treatment of acute left heart failure caused by hypertension and rapid atrial fibrillation, and is valuable in clinic.