Application effect of exercise rehabilitation therapy in elderly patients with chronic heart failure

Objective:To investigate the effects of rehabilitation exercise therapy on 6-minute walking distance (6 minute walk distance, 6MWD), brain natriuretic titanium (Brain natriuretic peptide, BNP) and (Minnesota heart failure quality of life scale, MLHFQ score in elderly patients with chronic heart failure (CHF).Methods: Choose xi'an medical college affiliated hospital heart treated with 96 cases of elderly patients with chronic heart failure (from January 2016 to January 2018), according to random number table method, divide the patients as control group and observation group 48 cases/group, control group to implement regular heart failure treatment, the observation group in the control group, the implementation of rehabilitation exercise therapy on the basis of comparing the clinical curative effect of two groups of indicators, heart colour to exceed, 6 MWDS, BNP levels, plate movement, MLHFQ score. Results: (1) compared with the control group, the total effective rate of the observation group was higher than that of the control group (P<0.05). (2). After treatment, the left ventricular end-diastolic diameter (Left ventricular end diastolic diameter, LVEDD) and the left ventricular end-systolic diameter (Left ventricular end systolic diameter, LVESD), BNP) in the observation group were higher than those in the control group. All the MLHFQ scores were lower than those in the control group (P<0.05). The left ventricular ejection fraction (Left ventricular ejection fraction, LVEF), stroke output (Stroke volume, SV) and treadmill metabolic equivalent (Metabolic equivalent, METs) were higher than those in the control group (P<0.05). The treadmill exercise time was longer than that in the control group (P<0.05), and its 6MWD was higher than that in the control group (P<0.05).Conclusion: Rehabilitation exercise therapy in elderly patients with chronic heart failure can effectively improve the cardiac function, enhance their exercise endurance and energy metabolism level, and improve the clinical efficacy and quality of life.

Echocardiographic Evaluation of Qiangxin Decoction Combined with Cardiac Resynchronization Therapy for Patients with Chronic Heart Failure

OBJECTIVE: To explore the echocardiographic evaluation of patients with chronic heart failure (CHF) after Qiangxin Decoction combined with cardiac resynchronization therapy. METHODS: A total of 140 CHF patients admitted to our hospital were randomly divided into combined group (Qiangxin Decoction and cardiac resynchronization, n = 70) and routine group (cardiac resynchronization, n = 70), and they were treated for 2 courses (16 weeks), with 8 weeks as a course. The improvement of heart function classification (HYHA) was observed before and after treatment, and the therapeutic effects were evaluated according to the improvement of heart function classification (markedly effective, effective, invalid, and worsening). The traditional Chinese medicine (TCM) diagnostic criteria was the main symptoms (0 to 6 points), secondary symptoms (0 to 3 points), tongue picture (0 to 1 point) and pulse condition (0 to 1 point), and the higher the score was, the more obvious the symptoms were. The left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF) and cardiac output (CO) were observed and recorded according to the heart color ultrasound before and after treatment. And the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to evaluate the life quality before and after treatment, and the highest score of the scale was 105 points. The higher the score was, the obvious the symptoms were, and the worse the life quality was. And the adverse reactions were recorded in the 2 groups. RESULTS: After the treatment, the total effective rate in the routine group was significantly lower than that in the combined group (75.71% vs . 94.30%), and there was statistically significant difference (P < 0.05). After the treatment, the TCM syndrome score in the routine group was higher than that in the combined group ((14.37±3.59) points vs.(10.53±3.11) points), and there was statistically significant difference (P < 0.05). After the treatment, the levels of LVEDD and LVESD in the routine group were higher than those in the combined group, and there were statistically significant differences (P < 0.05). The levels of LVEF and CO in the routine group were lower than those in the combined group, and there were statistically significant differences (P < 0.05). After the treatment, the score of MLHFQ scale in the routine group was higher than that in the combined group ((57.38±8.53) points vs.(46.39±7.14) points), and there was statistically significant difference (P < 0.05). CONCLUSION: Qiangxin Decoction combined with cardiac resynchronization therapy has good echocardiographic evaluation in patients with chronic heart failure.

Effects of Digoxin and Tongxinluo capsule combination treatment on oxidative stress, cytokines and vascular endothelial function in patients with chronic heart failure

Objective:To explore the effect of digoxin and Tongxin capsule combined therapy on oxidative stress, cytokines and vascular endothelial function in patients with chronic heart failure, and provide help for clinical treatment of patients with chronic heart failure.Methods:95 cases of chronic heart failure in our hospital were randomly divided into observation group (47 cases) and control group (48 cases). Control group patients were given basic treatment, and observation group received combination therapy of digoxin and Tongxinluo capsule, to detect and to investigate the changes of oxidative stress, cytokines and vascular endothelial function in two groups of patients before and after treatment.Results:There was no significant difference in oxidative stress, cytokines and vascular endothelial function between the two groups of chronic heart failure patients before treatment (P>0.05). Compared with before treatment, the malondialdehyde (MDA) and cytokines [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6) and brain natriuretic peptide (BNP)] in two groups of patients with chronic heart failure after treatment decreased significantly (P<0.05), while indexes related to endothelial function [hyperemic brachial artery diameter after reactive hyperemia, brachial artery diameter change rate, brachial artery endothelial dependent diastolic function (FMD), and brachial artery endothelium dependent diastolic function (NMD)] and related indexes of oxidative stress [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT)] were significantly increased (P<0.05). The related indexes and oxidative stress indexes (GSH-Px, CAT and SOD) of observation group after the combined treatment in patients with endothelial function were significantly higher than the control group after treatment (P<0.05). After treatment, cytokines and MDA levels were significantly lower than the control group (P<0.05).Conclusions:Tongxinluo capsule combined with digoxin treatment significantly improved the oxidative stress, cytokines and vascular endothelial function levels in patients with chronic heart failure, and has important clinical significance for the treatment of patients with chronic heart failure.

Treatment of Chronic Heart Failure Complicated with Anxiety and Depression Using Traditional Chinese and Western Medicine

Chronic heart failure(CHF)is the terminal stage of various heart diseases,and is the main cause of death from cardiovascular disease.In recent years,the prevalence of CHF combined with anxiety and depressive state has shown an upward trend,and this paper was aimed to provide a reference for the diagnosis and treatment of CHF combined with anxiety and depression using Traditional Chinese medicine(TCM)and Western medicine.

Effect of thermal therapy using hot water bottles on brain natriuretic peptide in chronic hemodialysis patients

Introduction: The use of repeated thermal therapy for improving the symptoms of chronic heart failure (CHF) has been recently demonstrated. Usually, thermal therapy requires an infrared dry sauna. However, it is difficult for small clinics to acquire such an expensive and extensive system. The author assessed the efficacy of its substitution with hot water bottles. Moreover, there are no prior studies demonstrating the efficacy of thermal therapy in hemodialysis patients with chronic heart failure. Methods: The author evaluated plasma brain natriuretic peptide (BNP) levels in 98 hemodialysis patients in a clinic. A total of nine patients whose BNP levels were more than 500 pg/mL agreed to be enrolled in this study and received thermal therapy using hot water bottles. Results: Plasma BNP levels, a potential marker for CHF, tended to decrease (891 ± 448 pg/mL to 680 ± 339 pg/mL), but the difference was not significant (P = 0.0845). The oral temperature changed from 36.44℃± 0.45℃ to 37.04℃ ± 0.48℃ (+0.597℃, P < 0.0001). No side effects were experienced during the therapy. Moreover, most patients had an improvement in their symptoms and the ability to perform activities of daily living. Conclusion: Thermal therapy using hot water bottles is very safe and tends to reduce plasma BNP levels in hemodialysis patients with CHF.

有氧八段锦联合踏车运动训练对慢性阻塞性肺疾病合并慢性心力衰竭的干预效果

目的:观察有氧八段锦联合踏车运动训练对慢性阻塞性肺疾病(COPD)合并慢性心力衰竭(CHF)的干预效果。方法:纳入2019年1月至2021年6月间绵阳市中心医院收治的COPD合并CHF患者180例,根据随机数字表法均分为对照组(基础治疗及干预)和试验组(在对照组基础上给予有氧八段锦联合踏车运动训练),两组均干预12周。比较两组干预前、4周、8周和12周后的慢阻肺评估测试量表(CAT)评分、左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)和左心室舒张末期容积(LVEDV)、改良呼吸困难指数(mMRC)和明尼苏达心力衰竭生活质量问卷(MLHFQ)评分。结果:干预12周期间,两组CAT评分、LVESV、LVEDV、mMRC及MLHFQ评分呈逐渐降低趋势,LVEF呈逐渐升高趋势(P<0.05或<0.01)。与对照组相比,干预12周后试验组CAT评分[(17.47±3.96)分比(13.36±3.42)分]、LVEDV[(139.44±7.12)ml比(131.74±6.47)ml]、LVESV[(81.84±8.54)ml比(74.29±9.18)ml]、mMRC评分[(1.67±0.47)分比(1.42±0.50)分]和MLHFQ各维度分及总分[(40.07±6.86)分比(32.54±6.61)分]均显著降低,LVEF[(41.29±4.76)%比(44.56±4.42)%]显著升高,P均<0.001。结论:在基础治疗上增加有氧八段锦联合踏车运动训练,可显著改善COPD合并CHF患者的心肺功能,缓解呼吸困难并提高生活质量,值得推广。

益气活血法对慢性心力衰竭大鼠心肌能量代谢及炎性因子的影响

目的:基于益气活血法探讨全真一气汤合补阳还五汤对慢性心力衰竭(CHF)大鼠心肌能量代谢及炎性因子的影响。方法:将30只健康雄性SD大鼠随机分为对照组、模型组和中药组,每组10只。采用腹腔注射阿霉素制备CHF模型,中药组给予全真一气汤合补阳还五汤干预。采用酶联免疫吸附法(ELISA)检测三磷酸腺苷(ATP)、二磷酸腺苷(ADP)、一磷酸腺苷(AMP)、白细胞介素6(IL-6)、N末端脑钠肽前体(NT-proBNP)水平;采用逆转录定量聚合酶链式反应(qRT-PCR)检测miR-21水平。结果:与对照组比较,模型组ATP、ADP、AMP降低(P<0.05),IL-6、NT-proBNP、miR-21表达均升高(P<0.05);与模型组比较,中药组ATP、ADP、AMP均升高(P<0.05),IL-6、NT-proBNP、miR-21表达均降低(P<0.05)。结论:益气活血法治疗可提高CHF大鼠心肌能量供应,减轻炎症反应,改善心功能。

个性化的容量管理联合运动疗法对慢性心力衰竭病人预后的影响

目的:探讨个性化的容量管理联合运动疗法对慢性心力衰竭(CHF)病人预后的影响。方法:选择医院2020年5月—2023年2月收治的80例慢性心力衰竭病人作为研究对象,使用随机数字表法将其分为研究组与对照组,每组40例,对照组采取CHF常规治疗方案以及临床管理干预,研究组在其基础上采取个性化的容量管理联合运动疗法干预,两组均干预2个月,比较两组干预前后心功能指标、心功能级别、6 min步行距离、生活质量,随访至出院后12周,比较两组随访期间再入院和病死率情况。结果:干预后两组左心室射血分数(LVEF)均明显升高(P<0.05),LVEDD和NT-proBNP均明显降低(P<0.05),研究组各指标变化均较对照组更加明显(P<0.05);干预后两组心功能级别均明显降低,6 min步行距离均明显升高(P<0.05),研究组变化较对照组更加明显(P<0.05);干预后研究组MLHFQ评分明显降低(P<0.05),且低于对照组(P<0.05);研究组再入院率明显低于对照组(P<0.05),两组病死率无显著差异(P>0.05)。结论:个性化的容量管理联合运动疗法能显著改善了慢性心力衰竭病人的心功能、预后和生活质量。

基于双心理论的强心康颗粒+耳穴贴压联合西药治疗慢性心衰合并中重度焦虑临床观察

目的观察强心康颗粒+耳穴贴压联合氟哌噻吨美利曲辛片对慢性心力衰竭(以下简称“心衰”)合并中重度焦虑的疗效。方法纳入合并中重度焦虑[广泛性焦虑量表(GAD-7)测评≥10分]的慢性心衰患者72例,纽约心脏病协会(NYHA)心功能分级Ⅱ~Ⅲ级,分为观察组与对照组,各36例;两组均给予血管紧张素转化酶抑制剂(ACEI)、β受体阻滞剂等心衰基础治疗,观察组给予强心康颗粒+耳穴贴压联合氟哌噻吨美利曲辛片,对照组给予强心康颗粒。观察两组的心功能分级、6 min步行试验、N末端B型脑钠肽原(NT-proBNP)、中医证候评分、GAD-7评分。结果治疗后,两组患者的心功能分级疗效、6 min步行试验、NT-proBNP、中医证候评分、GAD-7评分等指标均较治疗前明显改善,且观察组优于对照组(P<0.05)。结论强心康颗粒+耳穴贴压联合氟哌噻吨美利曲辛片可明显提高慢性心衰合并中重度焦虑患者的临床疗效。

严氏苍山太阳炷燎穴位敷贴治疗阳虚血瘀型慢性心力衰竭的临床研究

目的观察严氏苍山太阳炷燎穴位敷贴治疗阳虚血瘀型慢性心力衰竭的临床疗效。方法将145例阳虚血瘀型慢性心力衰竭患者随机分为对照组73例、治疗组72例,两组均给予标准化西药治疗,对照组加用空白自发热贴膏,治疗组加用“严氏苍山太阳炷燎穴位敷贴”药物自发热贴膏,两组疗程均为90 d。观察临床疗效,比较中医证候积分、中医主次症与兼症分层、明尼苏达心力衰竭生活质量量表(MLHFQ)评分、纽约心脏病协会(NYHA)心功能分级、6 min步行试验(6MWT)距离以及B型钠尿肽(BNP)水平等指标的变化情况。结果①试验过程中,对照组脱落8例、治疗组脱落7例,最终完成试验者130例,其中治疗组65例、对照组65例。②治疗前后组内比较,两组中医证候积分均降低(P<0.05);组间治疗后比较,治疗组积分下降更为明显(P<0.05)。③治疗后,治疗组中医主次症与兼症分层得到改善(P<0.05),且治疗组的改善情况优于对照组(P<0.05)。④治疗前后组内比较,两组MLHFQ评分均降低(P<0.05);组间治疗后比较,治疗组MLHFQ评分较对照组显著降低(P<0.05)。⑤治疗后,两组NYHA心功能分级均得到改善(P<0.05),且治疗组的改善情况优于对照组(P<0.05)。⑥治疗前后组内比较,两组6MWT距离均较治疗前增加(P<0.05);组间治疗后比较,治疗组6MWT距离增加较对照组更明显(P<0.05)。⑦治疗前后组内比较,两组BNP水平均降低(P<0.05);组间治疗后比较,治疗组BNP水平显著低于对照组(P<0.05)。⑧两组各项安全性指标均未见明显异常。结论严氏苍山太阳炷燎穴位敷贴对阳虚血瘀型慢性心力衰竭患者临床症状与BNP的改善、运动耐量的提升及生活质量的提高都具有积极促进作用,且安全性好。

中医药益气温阳、活血利水法治疗慢性心力衰竭作用机制的研究进展

综述中医药益气温阳、活血利水法治疗慢性心力衰竭作用机制的研究进展。慢性心力衰竭可依据阳气虚弱、心血瘀阻、水饮内停的病机,采用中医药益气温阳、活血利水法治疗。研究显示,该法治疗慢性心力衰竭的临床疗效显著,其机制主要与改善心肌纤维化及心室重构、调节氧化应激反应、改善血流动力学障碍与心肌能量代谢、干预相关信号通路、缓解利尿剂抵抗等有关。

经导管心房分流装置治疗慢性心力衰竭:一项系统评价分析

目的 经导管心房分流装置作为慢性心力衰竭的新方法,其可行性和有效性仍存疑,本研究通过系统评价和Meta分析,综合分析随机对照试验和非随机对照试验的数据,以全面评估该治疗方法的效果。方法 全面检索PudMed、Cochrane Library、EMBase、中国知网、万方、维普、CBM等从建库至2022年10月发表的经导管心房分流装置治疗慢性心力衰竭的对照试验,并按选择标准纳入相关文献。经由两名研究者独立筛选、数据提取和偏倚风险评估,采取RevMan5.4进行Meta分析。结果 共纳入7篇文献,其中包括2篇随机对照试验(670例),和5篇非随机对照试验(178例),共509例患者成功植入了心房分流设备。Meta分析结果显示:经导管心房分流装置能够显著增加6 min步行距离(MD=24.01,95%CI:-2.74~50.76,P=0.08),降低N末端脑钠肽前体(NT-proBNP)水平(MD=-7.63,95%CI:-306.91~291.66,P=0.96),降低肺毛细血管契压(PCWP)(MD=-2.88,95%CI:-3.93~-1.83,P=0.50)以及降低平均肺动脉压(mPAP),(MD=-1.32,95%CI:-3.31~0.67,P=0.88)。此外,左室射血分数(LVEF)明显增加(MD=3.16,95%CI:0.80~5.52,P=0.89),左心房容积指数(LAVI)明显减少(MD=-3.15,95%CI:-7.92~1.61,P=0.19),而TAPSE在随访期间保持稳定。堪萨斯城心肌病问卷(KCCQ)评分和明尼苏达心功能不全生命质量量表评分(MLFHQ)均有所改善KCCQ:(MD=-11.52,95%CI:-45.68~22.64,P<0.01);MLFHQ:(MD=-20.21,95%CI:-32.8~-7.56,P=0.04),然而,与治疗相关的严重不良事件的风险偏高(RR=5.58,95%CI:2.97~10.50,P<0.01),全因死亡风险也有所增加早期全因死亡的风险(RR=5.00,95%CI:0.61~41.05,P=0.13),全因死亡率:(RR=10.20,95%CI:2.84~36.64,P=0.0004)。结论 研究表明经导管心房分流装置在治疗射血分数保留型慢性心力衰竭患者方面具有显著的疗效。

基于“元气”探讨心力衰竭的神经内分泌机制及治疗

慢性心力衰竭(chronic heart failure,CHF)是各种心血管疾病发展的终末期表现,神经内分泌是此病发生的重要机制之一,通过细致梳理近年来中医学对于CHF神经内分泌机制的研究进展,基于中医“元气”理论,从中、西医两个维度阐述此病的病因病机,探讨从“元气”角度干预其神经内分泌机制及应用中药治疗,丰富了中医学对CHF的认识,以期为临床中西医结合治疗慢性心力衰竭提供新的思路。

益气温阳活血利水方治疗慢性心力衰竭阳气亏虚、血瘀兼痰饮证的疗效及对心室重构和肾素-血管紧张素-醛固酮系统的影响

目的观察益气温阳活血利水方治疗慢性心力衰竭(CHF)阳气亏虚、血瘀兼痰饮证的疗效及对心室重构(VR)和肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法将60例CHF阳气亏虚、血瘀兼痰饮证患者按照随机数字表法分为2组,对照组30例予常规西药治疗,治疗组30例在对照组治疗基础上应用益气温阳活血利水方治疗,2组均治疗4周。比较2组疗效;比较2组治疗前后中医证候评分、VR参数、心力衰竭标志物水平、RAAS相关指标变化;观察2组不良反应发生情况。结果治疗组总有效率93.33%(28/30),对照组总有效率73.33%(22/30),治疗组疗效优于对照组(P<0.05)。2组治疗后主症、次症评分及总评分均较本组治疗前降低(P<0.05),治疗后治疗组主症、次症评分及总评分均低于对照组(P<0.05)。2组治疗后左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVSd)、左心室质量指数(LVMI)均较本组治疗前降低(P<0.05),右心室内径(RVD)、左心室射血分数(LVEF)均较本组治疗前升高(P<0.05);治疗后治疗组LVEDD、LVESD、IVSd、LVMI均低于对照组(P<0.05),RVD、LVEF均高于对照组(P<0.05)。2组治疗后心肌钙蛋白I(cTnI)、N末端脑利钠肽前体(NT-proBNP)水平均较本组治疗前降低(P<0.05),治疗后治疗组cTnI、NT-proBNP水平均低于对照组(P<0.05)。2组治疗后肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平均较本组治疗前降低(P<0.05),治疗后治疗组PRA、AngⅡ、ALD水平均低于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论益气温阳活血利水方治疗CHF阳气亏虚、血瘀兼痰饮证,能抑制RAAS过度激活,减轻心肌损伤,改善VR,临床效果显著,安全性高。

益气活血法治疗慢性心力衰竭的数据挖掘与临床疗效

目的:通过数据挖掘,探索益气活血法治疗慢性心力衰竭(CHF)的用药规律和“药物-指标”关联关系,并回顾分析益气活血法的临床疗效。方法:选取2021年9月至2023年8月在安徽中医药大学第一附属医院心内科治疗CHF的患者病例资料,根据是否使用中药大于7 d,分为中药组和对照组,录入中药处方、检验和检查数据,使用聚类分析、关联分析、网络可视化等探索用药规律和“药物-指标”关联关系,运用倾向评分法、Kaplan-Meier法回顾中药治疗CHF的疗效。结果:共采集956例CHF患者的资料,其中785例中药组,对照组171例。对785首处方中出现频率前15名的药物进行聚类分析,发现治疗CHF的2组常用中药。第一组中药功在益气温阳,活血利水。第二组中药侧重于益气健脾,淡渗利湿。关联分析得到高频中药组合6对,进一步将“药物-疗效”进行关联分析发现,中药配伍与CHF相关指标的改善有较强的相关性。进行1∶1倾向性匹配,匹配出155对病例样本,统计结果显示,与西药常规治疗比较,使用中药明显降低肌酸激酶、B型脑钠肽、低密度脂蛋白胆固醇、C反应性蛋白、空腹血糖、收缩压和舒张压,显著升高高密度脂蛋白胆固醇水平、左室射血分数、24 h尿量。结论:中药益气活血法可提高CHF患者心功能,改善临床症状,提高生命质量。

补肾启枢强心颗粒治疗慢性心力衰竭临床观察

目的观察补肾启枢强心颗粒对慢性心力衰竭的临床疗效。方法选取120例江西中医药大学附属医院心血管科2019年1月—2020年12月收治的住院患者,采用随机数字表分为治疗组和对照组,各60例,对照组常规西药治疗,治疗组在常规西药治疗基础上加用补肾启枢强心颗粒,疗程8周。观察比较2组患者中医证候积分、左室射血分数、左室舒张末期内径、左室收缩末期内径、心功能分级变化、脑钠肽水平、6 min步行距离、明尼苏达生活质量量表调查积分等的改善情况。结果治疗组疗效明显优于对照组,差异有统计学意义(P<0.05)。结论补肾启枢强心颗粒治疗慢性心力衰竭临床效果显著,值得推广应用。

“新四联”背景下伊伐布雷定治疗CHF的药物经济学评价

目的从卫生体系角度出发,评价伊伐布雷定在“新四联”背景下治疗慢性心力衰竭(CHF)的经济性。方法基于真实世界队列研究数据,根据CHF疾病自然发展进程构建Markov模型,循环周期设为3个月,研究时限为20年,贴现率为5%;以质量调整生命年(QALY)和增量成本-效果比(ICER)为产出指标,采用成本-效用分析法评价伊伐布雷定联合“新四联”方案相较于“新四联”方案治疗CHF的经济性,并通过单因素敏感性分析、概率敏感性分析验证基础分析结果的稳健性。结果基础分析结果显示,伊伐布雷定联合“新四联”方案相较于“新四联”方案的ICER为165065.54元/QALY,低于以3倍我国2022年人均国内生产总值(GDP)作为的意愿支付(WTP)阈值(257094元/QALY)。单因素敏感性分析结果显示,贴现率对模型的稳健性影响最大。概率敏感性分析结果显示,在本研究的WTP阈值下,伊伐布雷定联合“新四联”方案具有经济性的概率为59.50%。结论当采用3倍我国2022年人均GDP(257094元/QALY)作为WTP阈值时,伊伐布雷定联合“新四联”方案治疗CHF具有经济性。

某院老年慢性心力衰竭住院患者用药现状分析

目的分析老年慢性心力衰竭(CHF)住院患者用药现状。方法选取医院2018年6月至2023年6月收治的老年(≥65岁)CHF患者417例,统计患者入院时和出院时的用药种数,分析多药(≥5种)治疗情况,并将全部用药分为CHF相关药物、非CHF心血管系统药物和非心血管系统药物,计算三者的占比。统计患者住院期间用药种类,以及入院时和出院时常用药物类型及具体种类。结果入院时患者多药治疗率为50.84%,所用药物中CHF相关药物、非CHF心血管系统药物和非心血管系统药物分别占28.56%,21.42%,50.02%,出院时分别为54.92%及32.73%,19.45%,47.82%;患者入院时和出院时用药种类均以5~9种最多(26.62%,31.65%)。患者住院期间较常使用的3类药物为β受体拮抗剂、血管紧张素转化酶抑制剂(ACEI)、抗血小板聚集药(阿司匹林)。入院时和出院时,CHF相关药物使用率较高的均为β受体拮抗剂、袢利尿剂,非CHF心血管系统药物均为抗血小板聚集药(阿司匹林)、他汀类,非心血管系统药物均为质子泵抑制剂、电解质补充剂、复合维生素;且患者出院时前述药物使用率均较入院时有一定升高。结论该院老年CHF患者入院时和出院时多药治疗率均较高,且其中非心血管系统药物占比较大,临床应高度关注相关用药的合理性与安全性,且有必要制订相关策略加以监督。

心脏康复治疗在慢性心力衰竭患者中的应用效果

目的针对慢性心力衰竭患者,分析心脏康复治疗的具体措施和效果。方法选取2021年11月至2023年6月武威市凉州医院收治的80例慢性心力衰竭患者作为研究对象,按照随机数字表法分为参照组(n=40)和研究组(n=40)。参照组采用常规治疗,研究组在参照组的基础上加用心脏康复治疗。比较两组患者的心肺功能变化以及治疗满意度。结果两组患者治疗后的左心室射血分数(LVEF)水平高于本组治疗前,6 min步行距离(6MWT)长于本组治疗前,左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)水平低于本组治疗前,差异有统计学意义(P<0.05)。治疗后,研究组LVEF水平高于参照组,6MWT长于参照组,LVEDD、LVESD水平低于参照组,差异有统计学意义(P<0.05)。两组患者治疗后的第1秒用力呼吸容积(FEV_(1))、深吸气量(IC)、用力肺活量(FVC)、FEV_(1)/FVC等各项肺功能指标水平高于本组治疗前,研究组FEV_(1)、IC、FVC、FEV_(1)/FVC等各项肺功能指标水平高于参照组,差异有统计学意义(P<0.05)。研究组治疗总满意率高于参照组,差异有统计学意义(P<0.05)。结论心脏康复治疗用于慢性心力衰竭患者,可改善其心肺功能,提升治疗满意度,有积极的临床价值。

中药联合艾灸序贯疗法治疗慢性心力衰竭临床观察

目的观察木防己汤合真武汤-艾灸序贯疗法对心力衰竭(阳虚水泛型)患者的治疗效果。方法选取2020年1月—2022年6月滑县中医院收治的120例慢性心衰患者为研究对象,将研究对象随机分为试验组(60例)与对照组(60例)。对照组给予西药治疗,试验组在对照组基础上给予木防己汤合真武汤加味,下午给予艾灸气海、关元、水道治疗,治疗4周后比较2组患者的效果,观察指标为NAHY心功能分级、Lee氏心衰积分、中医证候积分、左室射血分数、BNP疗效指标、安全性分析。结果试验组和对照组治疗4周后的上述指标明显改善,差异有统计学意义(P<0.05)。结论对此类患者采用木防己汤合真武汤-艾灸序贯疗法治疗,能明显改善慢性心衰患者心功能指标及临床症状,可以在临床上广泛推广。