不同剂量左旋肉毒碱治疗维持性血液透析合并心力衰竭的临床疗效评价

Clinical Evaluation of Different Doses of L-carnitine in the Treatment of Maintenance Hemodialysis with Heart Failure

目的 探析不同剂量(大剂量与常规剂量)左旋肉毒碱(LC)治疗维持性血液透析(MHD)合并心力衰竭(HF)的临床疗效,为临床医师选择合理治疗方案提供参考。方法 选择2017年3月至2019年12月期间中一东北国际医院收治的228例慢性肾衰MHD合并HF患者为研究对象,依据随机数字表法,随机将研究对象分成两组:A组和B组,每组病例数为114例。A组采用大剂量LC治疗,B组应用常规剂量LC治疗,给药30 d后,结合临床症状及体征,评估LC的临床治疗效果,并分析患者心脏超声检查指标及心肌脂肪酸代谢指标。结果 治疗前,两组患者的心功能各项指标差异无统计学意义,P> 0.05;治疗后,A组患者的心脏超声检查及BMIPP、BNP、CTR均有所改善,B组的左心室射血分数及BMIPP、BNP、CTR均有所改善,收缩期及舒张期左心室内径及左心室质量分数未见明显改善。结论 大剂量LC辅助治疗MHD合并HF的临床疗效显著,可更好地改善心肌脂肪酸代谢异常和心功能异常。

Objective To explore the clinical effect of different doses(large dose and conventional dose)of L-carnitine(LC)in the treatment of maintenance hemodialysis(MHD)combined with heart failure(HF),and to provide reference for clinicians to choose a reasonable treatment regimen.Methods A total of 228 patients with chronic renal failure complicated with HF who were admitted to our hospital during from March 2017 to December 2019 were randomly divided into two groups:group A and group B(114 cases in each group)according to the method of random number table.Group A was treated with high-dose LC and group B was treated with conventional dose LC.After 30 days of administration,combined with clinical symptoms and signs,the clinical therapeutic effect of LC was evaluated,and the indexes of echocardiography and myocardial fatty acid metabolism were analyzed.Results Before treatment,there was no significant difference in the indexes of heart function between the two groups(P>0.05);after treatment,echocardiography,BMIPP,BNP and CTR were improved in group A,left ventricular ejection fraction,BMIPP,BNP and CTR were improved in group B,systolic and diastolic left ventricular diameter and left ventricular mass fraction were not significantly improved.Conclusion The clinical effect of high-dose LC in the treatment of MHD with HF is significant,which can better improve the myocardial fatty acid metabolism and cardiac function.