老年重症心力衰竭急诊内科治疗的临床效果研究

Clinical effect of elderly patients with severe heart failure in emergency medicine

目的探讨老年重症心力衰竭患者急诊内科治疗方案及临床效果。方法选取本院急诊科2012年1月至2013年6月收治的老年重症心力衰竭患者90例为研究对象,按就诊顺序编号分为观察组和对照组,每组各45例。对照组患者仅接受急诊内科常规治疗,观察组患者在对照组基础上口服厄贝沙坦氢氯噻嗪和美托洛尔,两组患者均随访1年。比较两组患者临床疗效、治疗前后左室射血分数(LVEF)和B型脑钠肽(BNP)的变化情况、不良反应发生情况、复发率及死亡率。结果观察组患者治疗总有效率为95.56%(43/45),对照组为77.78%(35/45),两组比较差异具有显著性(P<0.05)。两组患者治疗前LVEF和BNP比较差异无显著性(P>0.05),治疗后观察组患者LVEF明显升高,两组BNP均明显降低,观察组LVEF和BNP变化幅度均明显大于对照组(P<0.05)。两组均未见明显不良反应;观察组患者心力衰竭复发率为4.44%,死亡率为2.22%;对照组患者心力衰竭复发率为26.67%,死亡率为22.22%,两组比较差异均有显著性(P<0.05)。结论老年重症心力衰竭患者在接受急诊内科常规治疗基础上口服贝沙坦氢氯噻嗪和美托洛尔,疗效显著,可有效改善患者心功能,安全性较高,心力衰竭复发率和死亡率较低,值得临床推广应用。

Objective To explore the diagnosis and treatment of elderly patients with severe heart failure in the emergency medical and analyze the clinical effect. Method 90 elderly patients with severe heart failure treated in our hospital from January 2012 to June 2013 were selected as the research objects, according to the treatment order number divided into observation group and control group, 45 cases in each group. Control group received only routine medical emergency treatment, observation group were treated with irbesartan hydrochlorothiazide and metoprolol based on control group, all of the patients were followed up for 1 year. The clinical efficacy, the changes of left ventricular ejection fraction（LVEF） and B-type natriuretic peptide（BNP） before and after treatment, adverse reactions, disease recurrence and mortality were compared between the two groups. Result The total effective rate in control group was 95.56%（43/45）, observation group was 77.78%（35/45）, the difference was statistically significant（P〈0.05）. Before treatment, there were no significant differences of LVEF and BNP levels between the two groups（P〉0.05）. After treatment, the level of LVEF was increased significantly in observation group, the two groups of BNP were significantly reduced, LVEF and BNP changes were significantly greater in observation group than control group（P〈0.05）. There were no obvious adverse reactions in two groups, heart failure recurrence rate of observation group was 4.44%, mortality rate was 2.22%, heart failure recurrence rate of control group was 26.67%, mortality rate was 22.22%, the differences were statistically significant（P〈0.05）. Conclusion Elderly patients with severe heart failure in an emergency department on the basis of conventional treatment of oral irbesartan hydrochlorothiazide and metoprolol, has obvious curative effect, can effectively improve the heart function of patients, high safety, heart failure recurrence rate and mortality rate are low, worthy of clinical application.