曲美他嗪联合硝酸异山梨酯口服治疗老年冠心病合并心力衰竭疗效观察

Effect of trimetazidine combined with isosorbide nitrate on elderly coronary heart disease and heart failure

目的 观察曲美他嗪及硝酸异山梨酯联合应用对冠心病合并心力衰竭的老年患者的疗效。方法 收集2019年12月—2021年9月入住南通市第三人民医院老年医学科的68例老年冠心病合并心力衰竭患者,根据治疗方法不同分为观察组30例及对照组38例。两组均给予基础抗心力衰竭药物(袢利尿剂、螺内酯、β受体阻滞剂、血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂等)治疗,观察组在此基础上,口服曲美他嗪(初始剂量20 mg,每日3次)及硝酸异山梨酯(初始剂量5 mg,每日3次)。对比两组治疗前后临床疗效、静息心率、血清肌钙蛋白I水平,并观察平均住院日、再入院情况及不良反应。结果 两组治疗后临床症状均有所改善,观察组心功能分级、肌钙蛋白I水平改善优于对照组(P均<0.05)。两组治疗后静息心率均有所改善(P均<0.05)。与对照组相比,观察组平均住院日缩短,3个月内再入院率低(P均<0.05)。两组治疗过程中均未出现明显不良反应。结论 基础抗心力衰竭药物联合应用曲美他嗪及硝酸异山梨酯治疗老年冠心病合并心力衰竭短期内能够改善临床症状,减慢静息心率,改善心肌缺血,并缩短平均住院日,减少患者再入院风险。

Objective To research the efficacy of trimetazidine combined with isosorbide nitrate in elderly patients with coronary heart disease and heart failure.Methods A total of 68 elderly patients with coronary heart diseaseand heart failure admitted to the Geriatrics Department of The Third People’s Hospital of Nantong from December 2019 to September 2021 were collected.They were divided into the observation group(n=30)and the control group(n=38)ac-cording to the treatments.Both groups were given basic anti heart failure drugs(including loop diuretics,spironolactonebeta receptor blockers and ace inhibitors/angiotensin receptor inhibitors).The observation group was treated with trimetazi-dine and isosorbide nitrate tablets on the basis of the control group.The initial dose was 20 mg trimetazidine three times aday,and 5 mg isosorbide nitrate three times a day.The clinical efficacy,resting heart rate,serum troponin I level werecompared between the two groups before and after the treatment.The adverse reactions,the average hospital stay and thereadmission were compared between the two groups.Results The clinical symptoms of the two groups were improved af-ter treatment.The improvement of cardiac function grade and troponin I in the observation group was significantly betterthan that in the control group(P<0.05).The resting heart rate was improved in both groups after treatment(P<0.05).The average hospital stay in the observation group was shorter,and the readmission rate within three months was lower thanwhich in the control group(both P<0.05).There were no obvious adverse reactions in both groups.Conclusion The results suggest that trimetazidine combined with isosorbide nitrate on the basis of general anti heart failure drugs in elderly pa-tients with coronary heart disease and heart failure can improve clinical symptoms,slow down the resting heart rate,im-prove myocardial is chemia,shorten the average hospital stay and reduce the risk of readmission.