曲美他嗪对老年慢性心力衰竭易损期患者的干预作用

Effect of trimetazidine in elderly heart failure patients at vulnerable stage

目的探讨标准治疗基础上加用曲美他嗪对老年慢性心力衰竭易损期患者的临床疗效。方法选择我院治疗出院的老年心力衰竭易损期患者160例,随机分为对照组和观察组,每组80例。对照组行常规心力衰竭治疗,观察组在对照组基础上加用曲美他嗪治疗3个月。观察2组临床疗效及治疗前、后心功能指标和炎性因子等变化情况,随访3个月。结果观察组治疗后总有效率明显优于对照组(88.8%vs 76.3%,P<0.05)。与治疗前比较,治疗后2组心率、血压、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、N末端B型钠尿肽前体(NT-proBNP)、白细胞介素6(IL-6)、TNF-α及C反应蛋白(CRP)水平均较治疗前显著降低,LVEF和6min步行距离(6MWD)显著升高(P<0.01)。治疗后,观察组LVEDD、LVESD、NT-proBNP、IL-6、TNF-α及CRP水平明显低于对照组,LVEF和6MWD显著高于对照组(P<0.05,P<0.01)。随访3个月,观察组心力衰竭恶化再住院率明显低于对照组(7.5%vs 18.8%,P<0.05)。结论曲美他嗪对心力衰竭易损期的临床治疗效果良好,可以有效改善患者心功能,降低炎性反应及心力衰竭再住院率,对老年心力衰竭易损期患者安全有效。

Objective To study the clinical effect of trimetazidine in elderly heart failure(HF)patients at vulnerable stage.Methods One hundred and sixty elderly HF patients at vulnerable stage admitted to our hospital were randomly divided into control group(n=80)and observation group(n=80).The patients in control group received routine treatment and those in observation group received routine treatment combined with trimetazidine for 3 months.The clinical effect of trimetazidine was recorded,the inflammatory mediators were detected before and after treatment.The patients were followed up for 3 months.Results The total effective rate of trimetazidine was significantly higher in observation group than in control group(88.8%vs 76.3%,P<0.05).The HR and blood pressure were significantly higher,the LVEDD and LVESD were significantly shorter,the serum levels of NT-proBNP,IL-6,TNF-αand CRP were significantly lower while the LVEF was significantly higher and the 6 MWD was significantly longer in two groups after treatment than before treatment(P<0.01).The LVEDD and LVESD were significantly shorter and the serum levels of NT-proBNP,IL-6,TNF-αand CRP were significantly lower while the LVEF was significantly higher and the 6 MWD was significantly longer in observation group than in control group(P<0.05,P<0.01).The 3-month follow-up showed that the readmission rate due to deteriorative HR was significantly lower in observation group than in control group(7.5% vs18.8%,P<0.05).Conclusion The clinical effect of trimetazidine is good in elderly HF patients at vulnerable stage.Trimetazidine can effectively improve their cardiac function,reduce their inflammatory reaction and readmission rate due to HF.