坎地沙坦酯联合氢氯噻嗪治疗老年退行性心瓣膜病心力衰竭的临床疗效及对预后的影响

Clinical Eefficacy of Candesartan Cilexetil Combined with Hydrochlorothiazide in the Treatment of Elderly Patients with Heart Failure Due to Degenerative Heart valvular Disease and Its Impact on Prognosis

目的 :探讨坎地沙坦酯联合氢氯噻嗪治疗老年退行性心瓣膜病心力衰竭的临床疗效及对预后的影响。方法:选择2014年2月-2017年3月在我院接受治疗的老年退行性心瓣膜病患者146例为研究对象。依照入院顺序分为观察组和对照组,各73例。对照组在常规基础上加用氢氯噻嗪(25 mg,qd)治疗,观察组在对照组基础上再辅以坎地沙坦酯(4 mg,qd)治疗。比较两组治疗前后血浆脑利钠肽(BNP)、左心室射血分数(LVEF)以及左心室舒张末内径(LVEDD)的变化,临床疗效与不良反应发生情况,并随访统计出院后两组症状复发率和存活率。结果 :治疗后,观察组的总有效率为98.63%,对照组总有效率为75.34%,两组比较差异有统计学意义(P<0.05);观察组BNP、LVEDD明显低于对照组,LVEF水平高于对照组,两组比较均有统计学意义(P<0.05);观察组不良反应发生率为19.18%,明显低于对照组的46.58%(P<0.05)。经半年的随访统计,观察组复发率为1.37%,显著低于对照组的9.58%(P<0.05);观察组半年存活率为97.26%(71/73),显著高于对照组的89.04%(65/73)(P<0.05)。结论 :坎地沙坦酯联合氢氯噻嗪治疗老年退行性心瓣膜病心力衰竭的临床疗效显著,不良反应少,安全性高,并能改善预后,具有显著的临床价值。

Objective:To observe the clinical efficacy of candesartan cilexetil combined with hydrochlorothiazide in the treatment of elderly patients with heart failure due to degenerative heart valvular disease and its impact on prognosis. Methods:146 cases of elderly patients with heart failure due to degenerative valvular heart disease were selected from February 2014 to March 2017 in our hospital. The patients were randomly divided into the observation group and the control group according to the order of hospitalization, 73 cases in each group. The control group was treated with hydrochlorothiazide(25 mg, qd), while the observation group was treated with candesartan cilexetil(4 mg, qd) combined with hydrochlorothiazide(25 mg, qd). The levels of brain natriuretic peptide(BNP), left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDD) were compared between the two groups before and after treatment. The clinical efficacy and adverse reactions of the two groups were compared, and the recurrence rate and survival rate of the two groups after hospital discharge were followed up. Results:After treatment, total effective rate of observation group was 98.63% which was significantly higher than 75.34% of the control group, the difference between the two groups was statistically significant(P<0.05). The BNP and LVEDD of the observation group were significantly lower than those of the control group, and the level of LVEF of the observation was higher than that of the control group, the difference between the two groups was statistically significant(P<0.05); the incidence of adverse reactions in the observation group was 19.18% which was significantly lower than 46.58% of the control group(P<0.05). After six months of follow-up, the recurrence rate of the observation group was 1.37% which was significantly lower than 9.58% of the control group(P<0.05); the survival rate of the observation group was 97.26%(71/73) which was significantly higher than 89.04%(65/73) of the control group(P<0.05). Conclusion:Candesartan cilexetil combined with hydrochlorothiazide in the treatment of elderly patients with heart failure due to degenerative heart valvular disease has significant clinical efficacy, less adverse reactions, high safety, and can improve the prognosis, and has significant clinical value.