磷酸肌酸钠治疗老年人缺血性心肌病并发顽固性心力衰竭的疗效观察

The effects of creatine phosphate sodium on heart function and NT-proBNP in older patients combination with ischemic cardiomyopathy and intractable heart failure

目的：观察磷酸肌酸钠治疗老年人缺血性心肌病并发顽固性心力衰竭的疗效及对氨基末端前脑钠尿肽（NT－proBNP）水平、心功能的影响。方法选择老年（年龄＞60岁）缺血性心肌病顽固性心力衰竭患者70例，随机（应用随机数字表）分为对照组（n＝33）以及治疗组（n＝37），对照组给予常规抗心衰药物：洋地黄制剂、利尿剂、血管扩张剂、ACEI等治疗10 d。治疗组在此基础上给予磷酸肌酸钠1 g溶于5％葡萄糖溶液100 mL，2次／d，持续应用10 d。观察两组患者治疗前后心衰症状、体征，评估NYHA分级，应用超声心动图检测患者左心室收缩末直径（ LVESD ），左心室舒张末直径（ LVEDD ）及左室射血分数（ LVEF ）；实验室检测NT－proBNP水平。结果治疗后，治疗组LVESD、LVEDD（47．16±4．30、57．92±4．30）（mm）与对照组比较[（50．63±4．67）mm、（61．30±4．58）mm]均明显下降（t＝5．73、4．96，均P＜0．01），LVEF明显增加[（40．57±4．51）％、（37．63±4．53）％]（t＝5．53，P＜0．01）。两组NT－proBNP[（1659．±248．18）pg／mL、（1899．3± 205．45）pg／mL]均较治疗前[（2043．46±217．04）pg／mL、（2105．46±239．09）pg／mL]降低（t＝3．23、3．64，均P＜0．05），治疗组与对照组比较下降更显著（t＝4．11，P＜0．05）。结论磷酸肌酸钠可以明显改善老年缺血性心肌病顽固性心衰患者的心功能，提高射血分数，改善患者临床症状。

Objective To observe the effects of creatine phosphate sodium on heart function and B -type natriuretic peptide in patients combination with ischemic cardiomyopathy and intractable heart failure .Methods 70 cases of coronary heart disease combined with ischemic cardiomyopathy and intractable heart failure were randomly （ with the random number table ） divided into the control group （ n=33） and the creatine phosphate sodium treatment group （n=37）.The control group treated with conventional therapy （digitalis,diuretics,vasodilator,ACEI,et al） ten days;the treatment group with creatine phosphate sodium treatment on the basis of conventional therapy .The symp-tom,sign of the heart failure patients of the two groups before and after treatment were observed .NYHA cardiac func-tional grading were estimated.Echocardiography was used to detect left ventricular end -systolic diameter（LVESD）, left ventricular end diastolic diameter （ LVEDD ） and left ventricular ejection fraction （ LVEF ）; amino terminal pro brain natriuretic peptide （NT-proBNP） tested by laboratory of the two groups.Drug treatment for 10 days,the chan-ges of the indicators before and after treatment were observed .Results After treatment , compared with the control group[（50.63 ±4.67） mm,（61.30 ±4.58） mm].LVESD,LVEDD of the creatine phosphate sodium treatment [（47.16 ±4.30）mm,（57.92 ±4.30）mm]significantly decreased（t=5.73,4.96,all P〈0.01）,LVEF[（40.57 ± 4.51）%,（37.63 ±4.53）%]increased significantly（t =5.53,P〈0.01）.After ten days of treatment levels of NT-proBNP decreased in both two groups [（1 659.±248.18） pg/mL,1 899.3 ±205.45] than before treatment [2 043.46 ±217.04,（2 105.46 ±239.09）pg/mL]（t=3.23,3.64,all P＆lt;0.05）,and the decrease degree of the creatine phosphate sodium treatment group was more obvious than those of the control group （t=4.11,P〈0.05）. Conclusion Creatine phosphate sodium can improve the cardiac function and left ventricular ejection fraction of ischemic cardiomyopathy and intractable heart failurepatients ,enhance the clinical symptoms of patients .