托拉塞米联合左卡尼汀治疗慢性心力衰竭急性加重期的临床研究

Clinical study on torsemide combined with levocarnitine in treatment of acute exacerbation of chronic heart failure

目的探讨托拉塞米联合左卡尼汀治疗慢性心力衰竭急性加重期的临床疗效。方法选取2015年3月—2017年1月在濮阳市安阳地区医院住院治疗的慢性心力衰竭急性加重患者96例,随机分为对照组和治疗组,每组各48例。对照组静脉滴注左卡尼汀注射液,2.0 g/次加至生理盐水或5%葡萄糖注射液配成100 mL溶液,2次/d。治疗组在对照组治疗基础上静脉滴注托拉塞米注射液,20 mg/次。两组均连续治疗1周。观察两组的临床疗效,比较两组治疗前后血浆B型利钠肽原(NT-proBNP)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)及心室肥厚程度。结果治疗后,对照组和治疗组的总有效率分别为72.9%、91.7%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者血浆NT-proBNP、PRA、AngⅡ、ALD、舒张末期左心室内径(LVEDD)、舒张末期左心室后壁厚度(LVPWT)、室间隔舒张末期厚度(IVST)、明尼苏达心衰生活质量量表(MLWHF)评分均显著下降,6 min步行距离显著升高,同组治疗前后差异具有统计学意义(P<0.05);治疗后,治疗组NT-proBNP、PRA、AngⅡ、ALD、LVEDD、LVPWT、IVST、MLWHF水平显著低于对照组,6 min步行距离高于对照组,两组比较差异具有统计学意义(P<0.05)。结论托拉塞米联合左卡尼汀治疗慢性心力衰竭临床疗效确切,可明显降低血浆NT-proBNP、PRA、AngⅡ、ALD水平,改善心室重塑,提高患者活动能力和生活质量,具有一定的临床推广应用价值。

Objective To investigate the therapeutic effect of torsemide combined with levocarnitine in treatment of acute exacerbation of chronic heart failure. Meathods Patients（96 cases） with acute exacerbation of chronic heart failure in Puyang Anyang District Hospital from March 2015 to January 2017 were randomly divided into control（48 cases） and treatment（48 cases） groups. Patients in the control group were iv administered with Levocarnitine Injection, 2.0 g/time added into normal saline or 5% glucose injection 100 mL, twice daily. Patients in the treatment group were iv administered with Torsemide Injection on the basis of the control group, 20 mg/time. Patients in two groups were treated for 1 week. After treatment, the clinical efficacy was evaluated, and the changes of NT-proBNP, PRA, AngⅡ, ALD, and ventricular hypertrophy degree in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 72.9% and 91.7%, respectively, and there was difference between two groups（P〈0.05）. After treatment, NT-proBNP, PRA, AngⅡ, ALD, LVEDD, LVPWT, IVST, MLWHF score in two groups were decreased, but 6 min walking distance in two groups were increased, and the difference was statistically significant in the same group（P〈0.05）. After treatment, NT-proBNP, PRA, AngⅡ, ALD, LVEDD, LVPWT, IVST, MLWHF score in treatment group were lower than those in the control group, but 6 min walking distance was higher than that in the treatment group, and there was difference between two groups（P〈0.05）. Conclusion Torsemide combined with levocarnitine has clinical efficacy in treatment of acute exacerbation of chronic heart failure, and can obviously decrease the plasma NT-proBNP, PRA, Ang Ⅱ, ALD levels, also can improve the ventricular remodeling, and improve the activity and life quality, which has a certain clinical application value.