尼可地尔联合氯沙坦钾治疗老年缺血性心肌病并心力衰竭患者的临床疗效及安全性

Effect and safety of nicorandil combined with losartan potassium tablets on elderly ischemic cardiomyopathy patients complicated with heart failure

目的观察尼可地尔联合氯沙坦钾治疗老年缺血性心肌病并心力衰竭患者的临床疗效及安全性。方法选取2019—2020年新余市人民医院收治的老年缺血性心肌病并心力衰竭患者70例,按随机数字表法分为观察组(35例)和对照组(35例)。对照组患者采用盐酸曲美他嗪缓释片治疗,观察组患者采用尼可地尔联合氯沙坦钾片治疗,2组均持续治疗3个月。比较2组的临床疗效、临床症状(气促、胸闷、水肿)改善率及治疗前后心功能指标[每搏输出量(SV)、左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)]、心肌损伤标志物[N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)]、生活质量评分、治疗满意度评分及不良反应发生率。结果观察组总有效率为91.14%,高于对照组的74.29%(χ^(2)=7.715,P=0.005)。观察组气促、胸闷、水肿改善率高于对照组(P<0.05)。治疗后,2组SV、LVEF高于治疗前,LVESV低于治疗前,且观察组SV、LVEF高于对照组,LVESV低于对照组(P<0.01);2组NT-proBNP、cTnI、hs-CRP水平低于治疗前,且观察组低于对照组(P<0.01);2组躯体、情感、社会、意识评分高于治疗前,且观察组高于对照组(P<0.01)。观察组治疗满意度评分高于对照组(P<0.01)。观察组胃肠道不良反应发生率为2.86%,与对照组的11.43%比较,差异无统计学意义(P>0.05)。结论尼可地尔联合氯沙坦钾治疗老年缺血性心肌病并心力衰竭患者的临床疗效确切,可有效改善患者心功能,减轻炎症反应及心肌损伤,提高生活质量,且安全性较高。

Objective To explore the effect and safety of nicorandil combined with losartan potassium tablets on elderly ischemic cardiomyopathy patients complicated with heart failure.Methods A total of 70 elderly ischemic cardiomyopathy patients complicated with heart failure who were treated in Xinyu People′s Hospital from 2019 to 2020 were selected,and randomly divided into observation group(35 cases)and control group(35 cases).Patients in the control group were treated with trimetazidine hydrochloride sustained-release tablets,and patients in the observation group were treated with nicorandil combined with losartan potassium tablets,all groups were treated with three months.Clinical effect,improvement of clinical symptoms(including shortness of breath,chest tightness,and edema),and cardiac function indexes(SV,LVEF,LVESV),myocardial injury markers(NT-proBNP,cTnI,hs-CRP),score of quality of life before and after treatment,treatment satisfaction score and incidence of adverse reactions were compared between the two groups.Results Compared with that of the control group,the observation group has a higher effective rate(P<0.05).Improvement of shortness of breath,chest tightness,and edema in the observation group were significantly higher than those of the control group(P<0.05).After treatment,SV,LVEF and scores of body,emotion,society and consciousness of the two groups were higher than those before treatment,LVESV and levels of NT-proBNP,cTnI,hs-CRP were lower than those before treatment,respectively;compared with those of the control group,the observation group had higher SV,LVEF and scores of body,emotion,society and consciousness,lower LVESV and levels of NT-proBNP、cTnI、hs-CRP after treatment(P<0.05).Treatment satisfaction score in the observation group was higher than that of the control group(P<0.05).The incidence of gastrointestinal adverse reactions in observation group was 2.86%,which was not statistically significant compared with 11.43%in control group(P>0.05).Conclusion Nicorandil combined with Losartan potassium is effective in treating elderly ischemic cardiomyopathy patients complicated with heart failure,which can significantly improve cardiac function,reduce inflammatory reaction and myocardial injury,promote quality of life,and with higher safety.