托拉塞米联合美托洛尔治疗老年退行性心脏瓣膜病心力衰竭的临床研究

Clinical study on torasemide combined with metoprolol in treatment of heart failure of senile degenerative valvular heart disease

目的探讨托拉塞米注射液联合酒石酸美托洛尔注射液治疗老年退行性心脏瓣膜病心力衰竭的临床疗效。方法选取2015年1月—2017年1月在聊城市第二人民医院心胸外科接受治疗的老年退行性心脏瓣膜病心力衰竭患者86例,入选患者采用随机数字表法分为对照组和治疗组,每组各43例。对照组静脉滴注酒石酸美托洛尔注射液,15 mL加入到0.9%氯化钠注射液500 mL中,1次/d。治疗组在对照组基础上静脉滴注托拉塞米注射液,初始剂量10 mg/d,加入到0.9氯化钠注射液250 mL,若疗效不如意可增加至20 mg/d,最大剂量为40 mg/d。两组患者均治疗1周。观察两组的临床疗效,比较两组的心功能指标和血清细胞因子情况。结果治疗后,对照组和治疗组的总有效率分别为81.39%、97.67%,两组比较差异有统计学意义(P<0.05)。治疗后,两组左室射血分数(LVEF)显著上升,左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)明显下降,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和N末端脑钠肽原(NT-pro BNP)水平均显著下降,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论托拉塞米注射液联合酒石酸美托洛尔注射液治疗老年退行性心脏瓣膜病心力衰竭具有较好的临床疗效,可有效改善心脏功能,调节血清细胞因子水平,改善炎症反应,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Torsemide Injection combined with Metoprolol Tartrate Injection in treatment of heart failure of senile degenerative valvular heart disease. Methods Patients（86 cases） with heart failure of senile degenerative valvular heart disease in Department of Cardiothoracic Surgery of Liaocheng Second People＇s Hospital from January 2015 to January 2017 were randomly divided into control and treatment groups, and each group had 43 cases. Patients in the control group were iv administered with Metoprolol Tartrate Injection, 15 mL added into normal saline 500 mL, once daily. Patients in the treatment group were iv administered with Torsemide Injection on the basis of the control group, starting dosage 10 mg/d added into normal saline 250 mL, once daily, if the effect was not satisfactory, it could be increased to 20 mg/d, and the maximum dose was 40 mg/d. Patients in two groups were treated for 1 weeks. After treatment, the clinical efficacies were evaluated, and cardiac function index and serum cytokines in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 81.39% and 97.67%, respectively, and there was difference between two groups（P〈0.05）. After treatment, the LVEF in two groups were significantly increased, but the LVEDD and LVESD in two groups were significantly decreased, and the difference was statistically significant in the same group（P〈0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups（P〈0.05）. After treatment, the levels of TNF-α, IL-1β, IL-6, and NT-pro BNP in two groups were significantly decreased, and the difference was statistically significant in the same group（P〈0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P〈0.05）. Conclusion Torasemide combined with metoprolol has clinical curative effect in treatment of heart failure of senile degenerative valvular heart disease, can improve heart function, regulate serum cytokine level, and improve inflammatory reaction, which has a certain clinical application value.