比索洛尔联合曲美他嗪对射血分数保留心力衰竭老年病人的影响

Effect of bisoprolol combined with trimetazidine in the treatment of heart failure with retention of ejection fraction in the elderly patients

目的评价比索洛尔联合曲美他嗪对射血分数保留心力衰竭(心衰)老年病人心脏舒张功能、B型利钠肽(BNP)及C反应蛋白(CRP)的影响。方法选择来我院就诊的射血分数保留老年心衰病人118例,按住院单双号法随机分为试验组和对照组,每组各59例。2组病人采用相同的基础治疗,对照组联合口服曲美他嗪,试验组在对照组的基础上联合口服比索洛尔。观察2组病人的治疗效果,比较治疗前后2组病人BNP、CRP、心功能指标[左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室舒张末期内径(LVEDD)、舒张早期血流峰速率(E)及舒张晚期血流峰速率(A)]的变化及不良反应发生情况。结果治疗后,试验组总有效率为96.61%,对照组为73.91%,2组比较差异有统计学意义(χ2=3.9324,P=0.0473)。治疗后,2组病人的BNP及CRP水平均显著降低,且试验组均低于对照组,差异有统计学意义(P<0.05)。治疗后,2组病人的LVEF、LVEDV、E及E/A均显著升高,LVESV、LVEDD和A均显著降低,且试验组病人的各项心功能指标均明显优于对照组病人,差异有统计学意义(P<0.05)。2组病人治疗期间均未出现严重并发症。结论比索洛尔联合曲美他嗪治疗射血分数保留心衰老年病人的临床疗效显著,可以明显降低BNP和CRP水平,同时还可以有效改善心功能,抑制心室重构,病人预后较好。

Objective To analyze the effect of bisoprolol combined with trimetazidine in the treatment of heart failure with retention of ejection fraction in the elderly patients and to investigate its influence on cardiac diastolic function,brain natriuretic peptide（BNP） and C-reactive protein（CRP）.Methods 118 elderly cases of heart failure with retention of ejection fraction were selected in our hospital from March 2014 to March 2017,and were divided into trial group（n=59） and control group（n=59）.All the patients received the same basic therapy,and the control group was treated with trimetazidine,while the trial group was treated with trimetazidine combined with bisoprolol.The therapeutic effects of the two groups were observed.The levels of BNP and CRP and the results of cardiac function such as left ventricular ejection fraction（LVEF）,left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume（LVESV）,left ventricular end-diastolic diameter（LVEDD）,E,A and E/A were also observed before and after treatment.Results The effective rate in the trial group was 96.61%,compared with 73.91% in the control group（χ^2=3.9324,P=0.0473）.The levels of BNP and CRP were significantly decreased after treatment,especially in the trial group（P〈0.05）.After treatment,the levels of LVEF,LVEDV,E and E/A were significantly increased,and the levels of LVESV,LVEDD and A were significantly decreased in two groups,especially in the trial group（P〈0.05）.There were no serious complications during the treatment in the two groups.Conclusions The effect of bisoprolol combined with trimetazidine in the treatment of heart failure with retention of ejection fraction is significant.Which not only significantly reduces the levels of BNP and CRP,but also effectively improves cardiac function.