老年慢性心力衰竭综合治疗干预效果评价

Effect of angiotensin converting enzyme inhibitor combined with comprehensive intervention on treatment outcome and living quality in old patients with chronic heart failure

目的通过运用血管紧张素转换酶抑制剂(ACEI)联合综合干预治疗老年慢性心力衰竭(CHF)患者,分析其治疗效果以及对生活质量影响。方法将2009年1月—2012年1月诊断为老年CHF的328例患者随机分为干预组和对照组,对照组接受ACEI常规治疗,干预组接受ACEI联合综合干预治疗,干预6个月后,观察2组患者心功能,生活质量以及不良心血管事件的再发生率的变化,并进行统计学分析。结果最终285例老年CHF患者完成本次研究;干预6个月后,干预组患者纽约心脏病协会(NYHA)心功能分级分别为Ⅰ级15例、Ⅱ级82例、Ⅲ级42例、Ⅳ级17例,左心射血分数(LVEF)、N端脑利钠钛前体(NT-proBNP)和6 min步行试验(6 MWT)分别为(46.4±7.9)%、(1 510±530)ng/mL、(430.8±84.5)m,与干预前比较差异均有统计学意义(P=0.000 1),对照组患者治疗6个月后NYHA分级分别Ⅰ级5例、Ⅱ级54例、Ⅲ级43例、Ⅳ级27例,LVEF、NT-proBNP和6 MWT分别为(41.2±7.0)%、(1 830±590)ng/mL、(348.4±71.2)m,与治疗前比较,仅NT-proBNP差异均有统计学意义(t=12.47,P=0.000 1);与干预前比较,干预组老年CHF患者身体情况、感官与语言交流功能、排泄功能、智能与情绪适应情况均有所改善,差异有统计学意义(P<0.01),对照组患者身体情况比6个月前有改善,差异均有统计学意义(t=2.25,P=0.026);干预组患者心血管不良事件再发生比例(26.8%)低于对照组(52.4%),差异有统计学意义(χ2=22.48,P=0.000 1)。结论 ACEI联合综合干预能明显改善老年CHF患者心功能,提高患者的生活质量。

Objective To analyze the effect of angiotensin converting enzyme inhibitor combined with comprehensive intervention treatment on treatment outcome and living quality in elder patients with chronic heart failure.Methods A total of 328 elder patients with chronic heart failure were randomly divided into intervention group and control group.Control group accepted routine treatment of angiotensin converting enzyme inhibitor and the intervention group accepted angiotensin converting enzyme inhibitor combined with comprehensive intervention for six months.The change of cardiac function,living quality and adverse cardiovascular events in the two groups were observed.Results Totally 285 elder patients with chronic heart failure completed the study eventually（156 in intervention group and 129 in control group）.No difference in cardiac function between the two groups was observed before intervention（P＆gt;0.05）.According to the classification of New York Heart Association,in the intervention group there were 15 cases with heat function at I level,82 cases at Ⅱ level,42 cases at Ⅲ level,17 cases at Ⅳ level,and left ventricular ejection function（LVEF）,N-terminal pro-B-type natriuretic peptide（N-proBNP）,and six-minutes walk test（6MWT）were 46.4±7.9%,1 510±530 ng/mL,and 430.8±84.5 m after six months’ intervention,with significant differences compared with those before the intervention（P＆lt;0.05 for all）;while for the control group,5 cases at I level,54 cases at Ⅱ level,43 cases at Ⅲ level,27 cases at Ⅳ level,and the value of LVEF,NT-proBNP,and 6 MWT were 41.2±7.0%,1830±590 ng/mL,and 348.4±71.2 m,with statistical difference compared with that before treatment only for NT-proBNP（P＆lt;0.05）.Physical condition sensory and language exchange function,drainage function,intelligence,and emotions of the patients were all improved in the intervention group compared with those before the intervention（P＆lt;0.05 for all）;while for the control group,only physical condition was improved after the intervention（P＆lt;0.05）.The second incidence rate of cardiovascular adverse events in the intervention group（26.8%）was lower than that in the control group（52.4%,P＆lt;0.05）.Conclusion The treatment of angiotensin converting enzyme inhibitor combined with comprehensive intervention can significantly improve cardiac function and living quality of the elderly patients with chronic heart failure.