小剂量螺内酯联合氢氯噻嗪、培哚普利及非洛地平治疗难治性高血压的效果

Effects of Low-Dose Spironolactone Combined with Hydrochlorothiazide,Perindopril and Felodipine in the Treatment of Refractory Hypertension

目的分析小剂量螺内酯联合氢氯噻嗪、培哚普利及非洛地平治疗难治性高血压患者的效果。方法选取2017年9月至2019年12月义马煤业集团股份有限公司总医院收治的86例难治性高血压患者,依照随机数表法分为螺内酯组、常规组。常规组(43例)接受氢氯噻嗪、培哚普利及非洛地平治疗,螺内酯组(43例)接受小剂量螺内酯联合氢氯噻嗪、培哚普利及非洛地平治疗,比较两组治疗效果、治疗前后血压水平(收缩压、舒张压)、超声心动图指标水平[左心室内径(LVD)、左心房内径(LAD)、室间隔厚度(IVST)]、内分泌指标水平(血清肌酐、尿素氮)。结果螺内酯组总有效率较常规组高(P<0.05);治疗后,与常规组比较,螺内酯组收缩压、舒张压均较低(P<0.05);治疗后,螺内酯组LAD较常规组小(P<0.05),两组LVD、IVST对比差异无统计学意义(P>0.05);治疗后,两组血清肌酐、尿素氮对比,差异无统计学意义(P>0.05)。结论小剂量螺内酯联合氢氯噻嗪、培哚普利及非洛地平治疗难治性高血压效果较好,能有效降低血压水平,改善心功能,且对内分泌系统影响小。

Objective To analyze the efficacy of low-dose spironolactone combined with hydrochlorothiazide,perindopril and felodipine in the treatment of refractory hypertension.Methods A total of 86 patients with refractory hypertension in General Hospital of Yima Coal Industry Group Co.,Ltd.from September 2017 to December 2019 were selected and divided into spironolactone group and routine group according to random number table method.Routine group(43 cases)received hydrochlorothiazide,perindopril and felodipine,while spironolactone group(43 cases)received low-dose spironolactone combined with hydrochlorothiazide,perindopril and felodipine.The therapeutic effect,blood pressure(systolic and diastolic),ECG indexes[left ventricular diameter(LVD),left atrial diameter(LAD),ventricular septal thickness(IVST)],endocrine indexes(serum creatinine and urea nitrogen)before and after treatment were compared between the two groups.Results The total effective rate of spironolactone group was higher than that of routine group(P<0.05).After treatment,the systolic blood pressure and diastolic blood pressure in spironolactone group were lower than those in routine group(P<0.05).After treatment,the LAD in spironolactone group was smaller than that in the routine group(P<0.05),but there were no significant differences in LVD and IVST between the two groups(P>0.05).After treatment,there were no significant differences in serum creatinine and urea nitrogen between the two groups(P>0.05).Conclusion Low-dose spironolactone combined with hydrochlorothiazide,perindopril and felodipine can effectively reduce blood pressure and improve cardiac function in patients with refractory hypertension,with little effect on endocrine level.