不同剂量甲状腺素联合厄贝沙坦氢氯噻嗪治疗老年重症心力衰竭的效果及心功能分析

Effect analysis of different doses of thyroxine combined with irbesartan hydrochlorothiazide in the treatment of elderly patients with severe heart failure and analysis of cardiac function

目的研究探讨不同剂量甲状腺素联合厄贝沙坦氢氯噻嗪治疗老年重症心力衰竭的效果及对患者心功能的影响。方法选择于本院住院治疗的100例老年重症心力衰竭患者(2017年1月至2018年10月)进行前瞻性研究,随机分为两组,各50例。对照组给予常规剂量甲状腺素联合厄贝沙坦氢氯噻嗪片治疗,观察组给予小剂量甲状腺素联合厄贝沙坦氢氯噻嗪片治疗,比较两组的临床疗效、症状及体征改善情况、心功能指标、不良反应发生率。结果对照组与观察组临床总有效率分别为92%、96%,组间比较差异无统计学意义;观察组与对照组在全身水肿、呼吸困难、肺啰音等缓解时间方面比较,差异无统计学意义;两组治疗后的6min步行距离、LVEF均较治疗前增大(P<0.05),两组治疗后的NT-proBNP水平均较治疗前降低(P<0.05),而治疗后组间比较差异无统计学意义;对照组不良反应总发生率为14%,观察组为2%,观察组明显低于对照组(P<0.05)。结论在厄贝沙坦氢氯噻嗪常规治疗的基础上,应用小剂量甲状腺素治疗老年重症心力衰竭可达到与常规剂量相当的临床疗效,可有效缓解症状,改善心功能,还具有减少用药不良反应的优势。

Objective To study the effect of different doses of thyroxine combined with irbesartan hydrochlorothiazide on severe heart failure and cardiac function in elderly patients. Methods 100 cases of elderly patients with severe heart failure (January 2017 to October 2018) were selected for prospective study. They were randomly divided into two groups, 50 cases in each group. The control group was treated with routine dose of thyroxine combined with irbesartan hydrochlorothiazide tablets, while the observation group was treated with low dose of thyroxine combined with irbesartan hydrochlorothiazide tablets. The clinical efficacy, improvement of symptoms and signs, cardiac function index and incidence of adverse reactions were compared between the two groups. Results The total clinical effective rates of the control group and the observation group were 92% and 96%, respectively, there was no significant difference between the two groups. There was no significant difference between the observation group and the control group in the relief time of systemic edema, dyspnea and lung rale. The 6-minute walking distance and LVEF of the two groups increased after treatment (P<0.05), and the level of NT-proBNP of the two groups decreased after treatment (P<0.05), but there was no significant difference between the two groups after treatment. The total incidence of adverse reactions was 14% in the control group and 2% in the observation group, which was significantly lower than that in the control group (P<0.05). Conclusion On the basis of routine treatment of irbesartan and hydrochlorothiazide, low dose thyroxine can achieve the same clinical effect as routine dose thyroxine in the treatment of elderly patients with severe heart failure, it can effectively alleviate symptoms, improve cardiac function and reduce adverse reactions of drugs.