强化降压治疗RHD伴中度二尖瓣狭窄的效果

Efficacy of enhanced antihypertensive treatment of moderate mitral stenosis in rheumatic heart disease

目的观察风湿性心脏病(RHD)中度二尖瓣狭窄(MS)患者应用强化降压方案后的临床效果以及神经内分泌因子和血流动力学变化。方法选取我科2019年2月至2021年2月期间87例风湿性心脏病中度二尖瓣狭窄患者作为研究对象,用计算机随机抽样法将其分为对照组43例,观察组44例,对照组给予利尿剂、洋地黄等常规药物治疗,观察组硝苯地平联合美托洛尔强化降压方案治疗,对比两组的治疗效果、心功能指标、血流动力学指标、神经内分泌因子水平和不良反应。结果治疗后两组患者LVEF、LVET和E/A均升高,HR、LVESV、LVEDV、mMPG、mPAP、mLAP、BNP和hs-CRP水平均降低,观察组患者各项指标变化更大,观察组、对照组总有效率为90.91%和74.42%,观察组疗效好(p<0.05);观察组、对照组患者在治疗过程中不良反应总发生率6.82%和9.30%,两组不良反应发生率无统计学差异(p>0.05)。结论风湿性心脏病伴发中度二尖瓣狭窄患者应用强化降压方案的临床效果佳,血流动力学、心肌损伤指标以及心功能等均得到了改善。

Objective To observe the clinical effect and changes of neuroendocrine factors and hemodynamics of patients with rheumatic heart disease(RHD)with moderate mitral stenosis(MS)after the application of intensive antihypertensive regimen.Methods A total of 87 patients with moderate mitral stenosis of rheumatic heart disease in our department from February 2019 to February 2021 were selected as the research objects,and they were divided into control group(n=43)and observation group(n=44)by computer random sampling method.The control group(n=43)received diuretics,digitoxin and other conventional drugs.Observation group 44 cases of nifedipine combined with metoprolol enhanced antihypertensive regimen,the treatment effect,cardiac function indicators,hemodynamic indicators,neuroendocrine factor levels and adverse reactions of the two groups were compared.Results After treatment,LVEF,LVET and E/A were increased in 2 groups,while HR,LVESV,LVEDV,mMPG,mPAP,mLAP,BNP and Hs-CRP levels were decreased in the observation group.The changes of various indicators were greater in the observation group.The total effective rate of observation group and control group was 90.91%and 74.42%.The observation group had good curative effect(p<0.05).The total incidence of adverse reactions in the observation group and the control group was 6.82%and 9.30%,and there was no significant difference in the incidence of adverse reactions between the two groups(p>0.05).Conclusions In patients with rheumatic heart disease with moderate mitral stenosis,the clinical effect of intensive antihypertensive program is good,and the hemodynamics,myocardial injury index and cardiac function are improved.