小剂量地高辛联合美托洛尔对应用低分子肝素的老年慢性心力衰竭伴心房颤动患者凝血功能的影响

Effect of low dose digoxin combined with metoprolol on coagulation function in elderly patients with chronic heart failure and atrial fibrillation treated with low molecular weight heparin

目的探讨小剂量地高辛联合美托洛尔对应用低分子肝素的老年慢性心力衰竭(CHF)伴心房颤动患者凝血功能、心功能和心肌酶谱的影响。方法选取河北省保定市第二中心医院2017年1月至2019年1月收治的老年CHF伴心房颤动患者130例。应用随机数字表法分为对照组和观察组,各65例。对照组在常规治疗基础上口服美托洛尔缓释片治疗,观察组在对照组治疗基础上联合地高辛治疗,比较2组患者治疗30 d后的临床疗效,治疗前后活化部分凝血活酶时间、凝血酶原时间、凝血酶时间、左心室舒张末期内径、左心室收缩末期内径、左心室射血分数和血清乳酸脱氢酶、肌酸激酶及肌酸激酶同工酶水平。结果治疗30 d后,观察组总有效率高于对照组[95.4%(62/65)比78.5%(51/65)](P<0.05)。治疗前后,2组患者的活化部分凝血活酶时间、凝血酶原时间、凝血酶时间水平比较差异均无统计学意义(均P>0.05)。治疗前,2组患者的心功能和心肌酶谱指标水平比较差异均无统计学意义(均P>0.05)。治疗后2组患者的左心室舒张末期内径、左心室收缩末期内径和血清乳酸脱氢酶、肌酸激酶及肌酸激酶同工酶水平均小于/低于治疗前,且观察组低于对照组[(50±6)mm比(55±7)mm、(39±4)mm比(41±3)mm、(160±21)U/L比(205±18)U/L、(160±17)U/L比(176±15)U/L、(19±5)U/L比(33±4)U/L],左心室射血分数均高于治疗前,且观察组高于对照组[(49±5)%比(46±4)%](均P<0.05)。结论小剂量地高辛联合美托洛尔治疗应用低分子肝素的老年CHF伴心房颤动患者临床疗效显著,心功能和心肌酶谱指标改善明显,且不影响凝血功能。

Objective To investigate the effect of low dose digoxin combined with metoprolol on coagulation function,cardiac function and myocardial enzyme spectrum in elderly patients with chronic heart failure( CHF) and atrial fibrillation treated with low molecular weight heparin. Methods From January 2017 to January 2019,130 elderly CHF patients with atrial fibrillation admitted to the Baoding Second Central Hospital,Hebei Province were randomly divided into control group and observation group,with 65 cases in each group. The control group were given metoprolol sustained-release tablets on the basis of routine treatment and the observation group were given metoprolol plus digoxin on the basis of contrd group. Clinical efficacy was observed 8 weeks after treatment.Thrombin time,prothrombin time,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular ejection fraction,serum lactate dehydrogenase,creatine kinase and creatine kinase isoenzyme were analyzed. Results Total effective rate in observation group was significantly higher than that in control group[95. 4%( 62/65) vs 78. 5%( 51/65),P < 0. 05]. There were no significant differences in prothrombin time between groups before and after treatment( P > 0. 05). Cardiac function and myocardial enzyme spectrum showed no statistical differences between groups before treatment( P > 0. 05). After treatment,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,levels of serum lactate dehydrogenase,creatine kinase and creatine kinase isoenzyme were significantly reduced and the indexes in observation group were less/lower than those in control group[( 50 ± 6) mm vs( 55 ± 7) mm,( 39 ± 4) mm vs( 41 ± 3) mm,( 160 ± 21) U/L vs( 205 ±18) U/L,( 160 ± 17) U/L vs( 176 ± 15) U/L,( 19 ± 5) U/L vs( 33 ± 4) U/L];left ventricular ejection fraction increased after treatment and it was higher in observation group than control group[( 49 ± 5) % vs( 46 ± 4) %]( all P < 0. 05). Conclusion Low dose digoxin combined with metoprolol is effective in treatment of CHF with atrial fibrillation in elderly patients. Cardiac function and myocardial enzyme indexes can be improved and no adverse reactionfrom coagulation is observed.